Avoid Morning Glucose Spikes

You manage your diabetes carefully, making certain your diet is balanced and your insulin is taken at the correct times. So, why are you waking up each morning with blood sugar much higher than you went to bed with?

There are three major reasons why your blood sugar spikes in the morning, and there is one way to figure out which of the three is the problem so that you know how to treat it.

The Dawn Phenomenon

After many hours without food, our bodies need to “gear up” for the day. During the night, after several hours of sleep, the body naturally begins to release the hormones it will need upon wakening: cortisol, glucagon and epinephrine, among others. By the middle of the night – between about 2am and 5am – these levels are coursing through the bodies of all of us, diabetic and non-diabetic alike.

For those who are not diabetic, insulin levels also rise, to counter the increased blood glucose. For those with diabetes, however, the body doesn’t respond this way. When the person with diabetes awakes, the consequence is a high blood glucose reading.

The Somogyi Effect

Sometimes the cause of high blood glucose readings in the morning is overcompensation. While sleeping, sugar levels may drop too low. The body’s response to this is to release these same hormones – cortisol, glucagon and epinephrine. The glucagon causes the liver to produce glucose, flooding the bloodstream. Sugar levels may become very high, but you are sleeping through it.

When you wake, you may feel a pounding headache and be lying in sweat-soaked sheets. Your sugar is still high. These could be indicators that your sugar levels have rebounded, a condition known as the Somogyi effect (named after researcher Michael Somogyi PhD, who first described it in 1938.)

Waning Insulin

Maybe the problem is even simpler. Perhaps the insulin you took at bedtime was just not strong enough to do the job of maintaining a normal sugar level for the entire night. Maybe your dinner had more carbs than usual, or you took a walk in the evening. Your evening dose of insulin managed your glucose levels for a while, but it wasn’t enough to sustain you for the night.

How to Figure it Out

There is a way to find out which of these reasons is causing your morning sugar spikes. Over a period of several nights, consistently check your blood sugar at bedtime, at 3 am and upon waking.

  • If your blood sugar is about the same at bedtime and 3 am, but sharply higher when you wake up, you are probably experiencing the dawn phenomenon.
  • If your blood sugar is low at 3 am, and higher at both bedtime and upon waking, then it is likely you are experiencing the Somogyi effect.
  • If your glucose levels are higher than bedtime at 3 am, and higher still at waking, then your insulin levels are probably waning.
  • Treatment

    Bring the results of your test to your physician and discuss the approach he or she recommends to counter the problem. Don’t attempt to materially change your dosing or diet yourself, without the guidance of your physician.

    Sources: Diabetes Forecast, Today’s Dietician and Diabetes Self Management

    Photo image courtesy NIH

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