Sometimes diabetes just doesn’t make sense. Not that it always makes sense but it really does a number in the morning. I’m talking about morning highs. Since you’re sound asleep and not eating at all while at it, it seems logical to assume that your BG level should be lower in the morning. Yet sometimes this isn’t happening and you get a BG spike in the morning. I know I do although my spikes are not too high but still.
There are 3 reasons for the BG being higher in the morning: the dawn phenomenon, the Somogyi effect, and the waning insulin.
THE DAWN PHENOMENON
All people have it, whether they have diabetes or not. Those with diabetes however, don’t have normal insulin responses to adjust to it, hence the fasting BG spike.
Between midnight and 3 am when you’re sleeping most soundly, your body has little need for glucose or insulin. Then in the early morning hours, usually between 4 and 5 am, hormonal changes will occur in preparation for the upcoming day. Your pancreas starts making less insulin and more glucagon, a hormone that increases BG.
The pattern continues; the less insulin is made by the pancreas, the more glucagon is made as a result. Glucagon in turn signals the liver to break glycogen down into glucose. This is why high fasting BG is more common in T2D.
In those who don’t have diabetes, the BG rise is being offset by secreting more insulin. However this can present a problem in people with diabetes. You can think about insulin as a key that opens the door (of the cells) and lets glucose in. If not enough insulin is produced or if there’s an insulin resistance, the door won’t open. BG then stays in the bloodstream, hence the resulting spike. The effects of dawn phenomenon vary and your BG may be higher on some mornings than on the others.
Treatment of the Dawn Phenomenon depends on how you treat your diabetes. Unlike mealtime BG spikes which can be somewhat controlled by diet and exercise, high fasting BG might need to be treated with medication.
WHAT MIGHT HELP
- eat dinner earlier in the evening
- do something active after dinner, such as going for a walk
If that doesn’t help and your morning BG continues to be high, you might want to discuss this with your doctor. If you’re on insulin, you might want to try to adjust the dosage so that peak action occurs closer to the morning BG rise. In T2D diabetes pills can be an option. Such as Metformin to reduce the liver’s glucose production.
THE SOMOGYI EFFECT or rebound hyperglycemia
Named for Michael Somogyi, the researcher who first described it, this is your body response to a low while sleeping. To counter the low, your body releases stress hormones that cause rise in BG levels.
There are two potential causes for this. In one scenario, your blood sugar may drop too low in the middle of the night and then your body releases hormones to raise the sugar levels. This could happen if you took too much insulin earlier or if you did not have enough of a bedtime snack. The other scenario is when your dose of long-acting insulin at bedtime is not enough and you wake up with a high morning blood sugar.
Treatment of the Somogyi Effect is in the opposite way of how you would treat the dawn phenomenon. You could have a snack before going to sleep OR reduce your insulin infusion at night. You can also use the type of insulin that won’t dip you down at 3 am.
This happens when your insulin runs out of wears off. The treatment is to adjust your insulin.
WHICH ONE IS IT?
To figure this out, you need to know where your BG level is at bedtime, at 3 am, and in the morning. As inconvenient as it may sound, you need to check your BG levels at these times, and do so consistently for a few nights in a row. The results will differ depending on the cause.
- If your BG levels are even between bedtime and 3 am and then rise in the morning, this means that you’re experiencing a Dawn Phenomenon
- If your BG level is low at 3 am, this means most likely Somogyi effect
- If your BG level is higher at 3 am than at bedtime and higher still in the morning, your insulin is probably waning.
This is something for me to start working on, since I do experience morning fasting high BG; not too high but it can be better. I usually have my dinner late and consequently, ditto for the bedtime snack. Then I’m up for the most part of the night, mostly because I used to work nights so my body clock continues in the night owl pattern (I think). Up to now, I didn’t see anything wrong with staying up for the good part of the night, actually I like it.
Unfortunately this has to change, starting tonight. I really want to know why I’m having morning spikes and see if I can change that without taking more medications. Currently I am not on any diabetes medications and don’t want to start now. So will have to do what I have to do.