Correcting Morning Blood Sugar Highs — Know The Causes Of These Spikes And Ways To Treat Them
Today’s Dietitian Vol. 14 No. 11 P. 18 Jill is frustrated. Her type 1 diabetes seems out of control, and she comes to your office at her wits’ end. She says she’s doing everything right: counting carbs, taking her insulin as prescribed, monitoring her blood glucose levels four times per day. A look at Jill’s testing logs and most recent blood work confirms there’s a problem. She has a hemoglobin A1c of 9.2, and her blood glucose levels are all over the map. Her numbers generally are fine before she goes to bed but incredibly high in the morning. Recently, her physician increased her nighttime basal insulin dose to counteract the morning highs, but things seem worse now than ever. Her breakfast bolus doesn’t seem to be effective, and her high blood glucose levels persist into the afternoon. “Fluctuating blood sugars can be very frustrating,” says Eileen M. Sturner, RD, LDN, CDE, BC-ADM. “RDs can play an important role in helping patients get to the bottom of problems such as morning highs. Working with patients to gather the appropriate data and facilitating the sharing of those data with the healthcare provider that’s managing their diabetes can have life-changing results.” Hyperglycemia In type 1 diabetes, the pancreas can no longer provide either the steady drip of basal insulin that keeps blood sugar levels stable between meals or the bolus release of insulin that directs the uptake of glucose after eating. Patients must take basal insulin to keep their fasting blood sugar levels steady and bolus insulin to match their carbohydrate intake and correct highs. The primary cause of hyperglycemia in type 1 diabetes is carbohydrate intake that isn’t matched with bolus insulin dosing. Perhaps Jill is underreporting her carbohydrate intake, administer Continue reading >>
Why Blood Sugar Levels Rise Overnight
get the scoop When you go to bed, your blood sugar reading is 110, but when you wake up in the morning, it has shot up to 150. Why does this happen? To understand how blood sugar levels can rise overnight without your eating anything, we have to look at where glucose comes from — and where it goes — while we sleep. During the day, the carbohydrates we eat are digested into glucose and absorbed into the bloodstream. Some of this glucose goes to the liver, where it is stored for later use. At night, while we are asleep, the liver releases glucose into the bloodstream. The liver acts as our glucose warehouse and keeps us supplied until we eat breakfast. The amount of glucose being used is matched by the amount of glucose being released by the liver, so blood sugar levels should remain constant. what is the dawn phenomenon? A rise in blood sugar level between approximately 3 A.M. and the time you wake up is called the “dawn phenomenon.” The liver is supposed to release just enough glucose to replace what is being used, and insulin works as the messenger to tell the liver how much is enough. But if there's not enough insulin (as with type 1 diabetes), or if there's enough insulin but it cannot communicate its message to the liver (as with type 2 diabetes), the liver starts to release glucose much too quickly. In addition, levels of hormones such as cortisol begin to increase in the early morning hours, which can contribute to altered insulin sensitivity. The result? Blood sugar levels rise. This is why blood sugar levels can go up between the time you go to bed and the time you wake up. what can you do about it? You might be able to make changes in the timing of your meals, medications, or insulin injections to help prevent dawn phenomenon. First, keep a detailed rec Continue reading >>
Why Do I Have Low Blood Sugar In The Morning?
Your body uses blood sugar, called glucose, as a source of energy for cells and organs. Low blood sugar, also called hypoglycemia, happens when your body doesn’t have enough glucose to use for energy. People with diabetes mellitus may have low blood sugar in the morning due to too much long-acting insulin, also called background insulin and basal insulin. Insulin helps to manage blood sugar by allowing glucose to enter your cells, where it can be turned into energy. Too much insulin of any kind can cause low blood sugar. Some noninsulin medications to treat type 2 diabetes mellitus can cause hypoglycemia also. People without diabetes can also have low blood sugar, known as non-diabetic hypoglycemia. This is usually caused by lifestyle factors, such as diet and exercise habits. Low blood sugar is usually defined as a glucose reading below 70 milligrams per deciliter (mg/dL). Readings below 54 mg/dL are more significant and signal that you may need immediate medical treatment. If you have low blood sugar in the morning, you may wake up with some of these symptoms: headache sweating dry mouth nausea lightheadedness dizziness shaking hunger anxiety blurred vision pounding heart beat If your blood sugar dips below 54 mg/dL, you might have more severe symptoms, including: fainting seizures coma If you have any of these severe symptoms, get medical help as soon as possible. Extremely low blood sugar can be life-threatening. The causes of low blood sugar in the morning vary. If you have diabetes, you likely need to adjust your background insulin levels. Make sure you’re aware of how any other medications you take can affect your blood sugar. Your doctor can help you make sure that your insulin dosage and any other medications you take are a good fit with your diet and exerc Continue reading >>
Why Your “normal” Blood Sugar Isn’t Normal (part 2)
Hi, I just found this site and would like to participate. I will give my numbers, etc. First, my last A1c was 6.1, the doc said it was Pre-diabetes in January of 2014, OK, I get it that part, but what confuses me is that at home, on my glucometer, all my fastings were “Normal” however, back then, I had not checked after meals, so maybe they were the culprits. Now, I am checking all the time and driving myself crazy. In the morning sometimes fasting is 95 and other times 85, it varies day to day. Usually, after a low carb meal, it drops to the 80’s the first hour and lower the second. On some days, when I am naughty and eat wrong, my b/s sugar is still low, and on other days, I can eat the same thing, and it goes sky high, again, not consistent. Normally, however, since February, my fbs is 90, 1 hour after, 120, 2nd hour, back to 90, but, that changes as well. In February, of 2014, on the 5th, it was horrible. I think I had eaten Lasagne, well, before, my sugars did not change much, but that night, WHAM-O I started at 80 before the meal, I forgot to take it at the one and two hour mark, but did at the 3 hour mark, it was 175, then at four hours, down to 160, then at 5 hours, back to 175. I went to bed, because by that time, it was 2 AM, but when I woke up at 8:00 and took it, it was back to 89!!!! This horrible ordeal has only happened once, but, I have gone up to 178 since, but come down to normal in 2 hours. I don’t know if I was extra stressed that day or what, I am under tons of it, my marriage is not good, my dear dad died 2 years ago and my very best friend died 7 months ago, I live in a strange country, I am from America, but moved to New Zealand last year, and I am soooo unhappy. Anyway, what does confuse me is why the daily differences, even though I may Continue reading >>
Decoding The Dawn Phenomenon (high Morning Blood Sugar)
Are your fasting blood sugar levels often higher than when you went to bed? Is high fasting blood sugar with normal PP figures something to worry about? If you are worried about your glucose numbers swinging during sleep or pre-dawn hours, you could be experiencing the Dawn Phenomena. What Is The Dawn Phenomena? When we are asleep, our bodies are tasked with repair, maintenance and growth jobs. Since we are not eating anything during sleep, the body uses glucose from the liver to maintain metabolic functions. In addition to that, there is a surge in growth hormones in the early hours of the dawn between 4 am to 5 am, which makes the liver produce more glucose. Fact is; this is a natural occurrence and happens to all of us. In simpler words, everyone has the dawn phenomenon. The body produces hormones, including cortisol, glucagon, and epinephrine, to help maintain and restore cells within our bodies, and also give us the energy we need to start our day and make it until breakfast. In people who don’t have diabetes, the insulin produced by the body keeps these higher glucose levels in check. However, in diabetics who suffer from insulin resistance or have impaired insulin function, this leads to higher fasting blood sugar levels which normalize only post breakfast. For pregnant women, the dawn phenomenon is even more exaggerated due to additional hormones released in the night. The body has mechanisms to maintain normal basal glucose levels during sleep, so we don’t get hypoglycemia or low blood sugar at night. In patients displaying impaired glucose tolerance, their body is unable to handle the glucose surge at night combined with the insulin suppression. People who do strenuous exercise early in the morning (e.g. weight training) are also more likely to experience Continue reading >>
Sugar Highs Explained
You're taking your medications as prescribed and you're keeping an eye on your carbohydrates, yet there still may be times when your blood sugar is too high. There are many reasons for blood sugar surges--I'd like to zero in on two common issues: high morning sugar and sugar that's high after exercising. Waking up to high sugar You'd think that your blood sugar should be lower after a night's sleep. After all, you haven't eaten anything for many hours. But the body needs glucose 24 hours a day, and if you're not getting it from food, your body will turn to stored glucose in the liver. Your pancreas needs to make insulin to deal with this glucose, just as it does for glucose derived from the food you eat. Unfortunately, in many people with diabetes, insulin production during periods of fasting is as meager as (or worse than) during eating. Therefore, the sugar may rise overnight because glucose being produced by the liver is not matched by adequate insulin from the pancreas. Also, certain medications, including glyburide (brand name Micronase or DiaBeta), glipizide (brand name Glipizide) and glimepiride (brand name Amaryl), improve meal-related insulin production more than fasting insulin production. As a result, many people who take these medicines have higher glucose levels in the morning than before bed at night. Sometimes a bedtime snack will actually help lower morning blood glucose, because the sugar (from the carbohydrates in your snack) that hits your bloodstream causes the body to release more insulin than the sugar your liver releases during the night while you're fasting. Ideally, your snack should contain protein, some healthy fat and a slowly absorbed carbohydrate, such as two teaspoons of peanut butter on a half-slice of stone-ground whole-wheat bread. If t Continue reading >>
What Should Your Blood Sugar Level Be In The Morning?
Fasting blood sugar readings can set the tone for your entire day. When your morning blood glucose is high or low, you have to adjust your number before you can get your day started. Understand what your morning target should be and the other factors that may contribute to problem readings. Tight control starts with managing your overnight and morning readings. Video of the Day The American Diabetes Association recommends a fasting blood sugar between 70 and 130 for diabetics. A morning blood sugar reading below 70 indicates a hypoglycemic reaction, or low blood sugar condition. Blood sugar readings over 130 are considered high readings and should be treated according to your care team's recommendations. Gestational Diabetes Gestational diabetes occurs when a woman who has never been diagnosed with diabetes develops high blood sugar during pregnancy. High blood sugar levels during pregnancy can cause your baby to be larger than average at birth, have low blood sugar problems after delivery and possibly have respiratory problems. Keeping your blood glucose levels within the target range will protect you and your baby. The National Institute of Diabetes and Digestive and Kidney Diseases recommends that women with gestational diabetes keep morning glucose numbers below 95. Your doctor or diabetic educator may have a different recommendation based on your pregnancy and medical history. Testing your blood sugar within 10 to 15 minutes of waking up will help ensure that you receive an accurate reading. Wash your hands before you test to eliminate any contaminants that can cause errors or inaccuracies. Do not eat or drink anything before you test. Caffeine may cause increases in blood sugar, so avoid coffee before testing. If you suffer with high morning blood sugar numbers wi Continue reading >>
Why Blood Sugar Can Be High In The Morning
You wouldn’t expect hours of sleep and fasting to leave you with high blood sugar. But elevated morning glucose may be more common than you think. Although it’s not a major problem when it occurs from time to time, consistently high morning levels need your doctor’s attention. Causes of Morning Hyperglycemia High blood glucose in the morning typically occurs due to one of three distinct causes: Dawn Phenomenon The “dawn phenomenon” describes high morning glucose that occurs due to a natural rise in hormone levels. During the early morning hours between about 4 and 8 a.m., your body releases hormones like cortisol and growth hormones to get ready for the day. For reasons experts don’t completely understand, your liver produces extra glucose in response to these hormones. People without diabetes secrete more insulin to handle the extra glucose. But for people with diabetes, blood glucose levels can rise too high. Increased blood sugar due to the dawn phenomenon is usually treated with diabetes medication. If you are on insulin, your insulin levels may need to be changed. The Somogyi Effect It’s possible to experience low blood sugar, or hypoglycemia, while sleeping and not even know it. The potentially dangerous problem can occur for a number of different reasons—from not eating enough or taking too much insulin, to drinking too much alcohol. In some people, the body compensates for the hypoglycemia by producing a lot of hormones. This, in turn, causes blood sugar levels to rise. Not everyone wakes in reaction to low blood glucose levels. But being sweaty or having a headache in the morning can be a sign. If you suffer from the Somogyi effect (named after the scientist who first described the condition), your doctor may recommend that you eat a snack befor Continue reading >>
Why Is My Blood Glucose So High In The Morning?
I am puzzled by my blood sugar pattern. I am not on any medications. My morning fasting blood sugar is always the highest of the day—between 120 and 140 mg/dl. The rest of the day it is in the normal range. Why does this occur? Continue reading >>
Why Is My Blood Sugar High In The Morning?
That early morning jump in your blood sugar? It's called the dawn phenomenon or the dawn effect. It usually happens between 2 and 8 a.m. But why? Generally, the normal hormonal changes your body makes in the morning will boost your blood sugar, whether you have diabetes or not. If you don't, your body just makes more insulin to balance everything out. You don't even notice that it's happening. But if you have diabetes, it's different. Since your body doesn't respond to insulin the same as most, your fasting blood sugar reading can go up, even if you follow a strict diet. The boost in sugar is your body's way of making sure you have enough energy to get up and start the day. If you have diabetes, your body may not have enough insulin to counteract these hormones. That disrupts the delicate balance that you work so hard to keep, and your sugar readings can be too high by morning. The effects of the dawn phenomenon can vary from person to person, even from day to day. Some researchers believe the natural overnight release of what are called counter-regulatory hormones -- like growth hormones, cortisol, glucagon and epinephrine -- makes your insulin resistance stronger. This will make your blood sugar go up. You may also have high blood sugar in the morning because: You didn't have enough insulin the night before. You took too much or too little medicine. You ate the wrong snack before bedtime. If the dawn phenomenon affects you, try to: Eat dinner earlier in the evening. Do something active after dinner, like going for a walk. Check with your health care provider about the medicine you’re taking. Eat breakfast. It helps bring your blood sugar back to normal, which tells your body that it's time to rein in the anti-insulin hormones. Eat a snack with some carbohydrates and Continue reading >>
Managing Morning Blood Sugar Highs: How To Treat The Top 3 Causes
A high blood sugar reading first thing in the morning can throw off your whole day — and signal a chronic problem. Despite their best efforts to control their blood sugar levels, some people simply wake up with elevated blood sugar. Starting your day this way isn't just alarming: If it becomes a pattern, high morning readings can make it difficult to achieve your long-term diabetes management goals. Whether you have type 1 or type 2 diabetes, a morning blood sugar high can be due to several causes. But with a little detective work and the help of your diabetes care team, you can isolate the cause and take steps to correct it. Here are three common scenarios: 1. The Dawn Phenomenon This occurs during the night while you're asleep and the body releases stress hormones. This phenomenon usually occurs between 3 a.m. and 8 a.m. and involves growth hormone, cortisol, and adrenaline, which trigger the production and release of glucose from your liver. The end result of this chemical cascade is an increase in blood sugar. “These hormones are designed to get us up and moving in the morning,” says endocrinologist Renee Amori, MD, assistant professor of medicine in the division of endocrinology at the Drexel University College of Medicine in Philadelphia. While everybody experiences these natural changes in hormone levels, in people with diabetes the body may not adjust appropriately. This can lead to higher-than-normal blood sugar at the start of the day. Testing for these elevated first morning blood sugars is one way to diagnose people with type 2 diabetes. 2. The Somogyi Effect High morning readings can also be caused by the Somogyi effect, a rebound response that occurs when the body overcompensates for a low blood sugar reaction at night. If you take blood sugar–lowe Continue reading >>
Proven Tips & Strategies To Bring High Blood Sugar Down (quickly)
Untreated, high blood sugar can cause many problems and future complications. Recognizing signs of high blood sugar levels and knowing how to lower them can help you prevent these complications and increase the quality and length of your life. Topics covered (click to jump to specific section) High blood sugar level symptoms and signs Symptoms of high blood sugar include: Increased thirst Tired all the time Irritability Increased hunger Urinating a lot Dry mouth Blurred vision Severe high blood sugar can lead to nausea and fruity smelling breath The signs and symptoms for high blood sugar are the same for both type 1 and type 2. Signs usually show up quicker in those who have type 1 because of the nature of their diabetes. Type 1 is an autoimmune disease that causes the body to stop making insulin altogether. Type 2 is caused by lifestyle factors when the body eventually stops responding to insulin, which causes the sugar to increase slowly. People with type 2 can live longer without any symptoms creeping because their body is still making enough insulin to help control it a little bit. What causes the blood sugar levels go to high? Our bodies need sugar to make energy for the cells. Without it, we cannot do basic functions. When we eat foods with glucose, insulin pairs with it to allow it to enter into the cell wall. If the insulin is not there, then the glucose molecule can’t get through the wall and cannot be used. The extra glucose hangs out in the bloodstream which is literally high blood sugar. The lack of insulin can be caused by two different things. First, you can have decreased insulin resistance which means that your insulin doesn’t react the way that it is supposed to. It doesn’t partner with glucose to be used as fuel. Secondly, you can have no insuli Continue reading >>
Why Do I Have High Blood Sugar Levels In The Morning?
Some people experience very high blood sugar levels in the morning. But what implications does this have for a person's health? There are two main causes of high blood sugar in the morning, the dawn phenomenon and the Somogyi effect This article explores these two causes of high blood sugar levels in the morning. It also discusses what risk factors may cause people to experience them and gives practical advice around how to better manage blood sugar levels. Contents of this article: The dawn phenomenon The dawn phenomenon has to do with natural body changes that occur during the sleep cycle: Midnight - 3 a.m. While most people are sleeping, their body has little need for insulin. During this period, however, any insulin that may have been taken during the evening causes the blood sugar levels to drop off drastically. Between 3 - 8 a.m. The body automatically begins to dish out stored sugar (glucose) in preparation for the upcoming day. In addition, hormones that actively reduce the body's sensitivity to insulin are also being released. During this time period, counter-regulatory hormones are being released. This can interfere with insulin, which may lead to a rise in blood sugar. These include growth hormones, such as: cortisol glucagon epinephrine These events are all happening simultaneously as bedtime levels of insulin are beginning to taper off. Each of these events ultimately plays a part in causing blood sugar levels to rise at "dawn" or in the morning. Who the dawn phenomenon affects Although people with diabetes are generally more aware of the dawn phenomenon, it actually happens to everyone. However, it affects people with or without diabetes differently. Typically, people who do not have diabetes tend not to notice these high blood sugar levels in the morning. Continue reading >>
Why Is Blood Sugar Highest In The Morning?
Many people with diabetes find that their fasting blood sugar first thing in the morning is the hardest blood sugar to control. In addition, they find that if they eat the same food for breakfast as they do for lunch or dinner they will see a much higher blood sugar number when testing after breakfast than they see at the other meals. The reason for this is a normal alteration in hormones experienced by many people not just people with diabetes. It is called "Dawn Phenomenon." What Causes Dawn Phenomenon? The body prepares for waking up by secreting several different hormones. First, between 4:00 and 6:30 a.m. it secretes cortisol, epinephrine, and norepinephrine. You may recognize these as the hormones involved in the "fight or flight response." In this case, their job is more benign, to give you the energy to get up and moving so you can find the food your body needs for energy. To help you do this, these hormones also raise your blood sugar. After a long night's sleep, the fuel your body turns to to get you going is the glucose stored in the liver. So after these stress hormones are secreted, around 5:30 a.m., plasma glucose rises. In a person with normal blood sugar, insulin will also start to rise at this time but many people with diabetes won't experience the corresponding rise in insulin. So instead of giving their cells a dose of morning energy, all they get is a rise in blood sugar. Not Everyone Experiences Dawn Phenomenon Researchers who have infused different hormones into experimental subjects have found that the trigger for dawn phenomenon is a nocturnal surge in growth hormone. If they block the growth hormone, blood sugars stay flat. This may explain why some people, particularly older people, do not experience a rise in blood sugar first thing in the mor Continue reading >>
Four Reasons For Morning High Blood Sugar Levels
Q: Dr. Stanislaw, why do I go to bed with a good blood sugar reading, but then wake up and it’s too high? A: There are 4 reasons for unexplained high morning blood sugar levels. Having a thorough knowledge of why blood sugar levels do what they do is an essential, yet often lacking, piece to good diabetes care. Morning blood sugars can be especially hard to understand. You go to bed and your blood sugar level is perfect....Ahhh. Then you wake up and it's awful?! What happened?? I’ve had type 1 since I was seven years old. When I was diagnosed in 1980, blood glucose testing didn’t even exist. I had to pee in a cup twice a day and test how much sugar was in it, which only told me if I had been high over the past few hours. There was no way to ever know what my glucose level was in the moment…we’ve come a long way! Being able to know what your glucose level is at any time is a fabulous advancement that allows you to have better care. But more information can lead to new frustrations. Back then, if I woke up and didn’t feel low, all was good. Today, we can know exactly where our level is at anytime and if it’s in good range we’re happy and smiling! But if it’s not, we’re likely frowning and not feeling so hot. So let’s take a look at four reasons why blood sugar can be high in the morning: 1.) Your BACKGROUND MEDICATION is set too low. A perfectly set regimen of oral blood sugar management medications and/or basal/long-acting insulin dose should keep your blood sugar normal throughout the night and allow you to wake up with a normal blood sugar level. However many people with diabetes are not on adequate oral meds and/or do not have a properly set basal insulin dose to allow this to happen. I help my patients figure this out via planning a specific typ Continue reading >>