I don’t understand why my blood sugar only high in the morning. Before the bedtime it’s ok, but in the morning isn’t. What can be the possible cause of this sugar increasing?
Does anyone know? Thank you in advance.
There are few reasons why your blood glucose might be higher in the morning than it was at bedtime. There is growth hormone release that means that the levels of growth hormone may begin to rise in the early morning hours and this hormone stimulates the liver to release glucose into the bloodstream. It is called the “Dawn Phenomenon”. Another possible reason is that your bedtime insulin needs adjusting. For example if you take NPH or Lente at bedtime and the dose is too low, then by 6:00 a.m. the insulin will be past its peak effect and you may experience a rise in blood glucose. Your doctor may increase you the bedtime dose. Then there is Rebound Hyperglycemia.
This happens when your blood sugar falls rapidly during the night then your liver may be triggered into releasing glucose into the bloodstream. When this happens, too much glucose is released, and the result is called “Rebound Hyperglycemia.”
For people taking insulin, blood sugars are often elevated in the morning. This is likely due to inadequate amounts of NPH/Lente insulin before dinner or at bedtime. High morning insulin is referred to as either the dawn phenomenon or the Somogyi effect.
• Dawn phenomenon. The dawn phenomenon is the end result of a combination of natural body changes that occur during the sleep cycle and can be explained as follows. Between 3:00 a.m. and 8:00 a.m., your body starts to increase the amounts of counterregulatory hormones (Growth hormone, cortisol and catecholamines). These hormones work against insulin's action to drop blood sugars. The increased release of these counterregulatory hormones, at a time when bedtime insulin is wearing out, results in an increase in blood sugars. These combined events cause your body's blood sugar levels to rise in the morning (at "dawn").
• Somogyi effect. Named after the doctor who first wrote about it, this condition is also called "rebound hyperglycemia." Although the cascade of events and end result -- high blood sugar levels in the morning -- is the same as in the dawn phenomenon, the cause is more "man-made" (a result of poor diabetes management) in the Somogyi effect. The term refers to pattern of high morning sugars preceded by an episode of asymptomatic (without symptoms) hypoglycemia. Your blood sugar may drop too low in the middle of the night, so your body counters by releasing 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.
How Do You Determine Which of the Two Conditions Is Causing the High Blood Sugar Levels?
Your doctor will likely ask you to check your blood sugar levels between 2:00 a.m. and 3:00 a.m. for several nights in a row. If your blood sugar is consistently low during this time, the Somogyi effect is suspected (too much nighttime insulin or too small of a bedtime snack for the insulin given). If the blood sugar is normal or high during this time period, the dawn phenomenon (increases in counterregulatory hormone) is more likely to be the cause.
How Can This Situation Be Corrected?
Once you and your doctor determine how your blood sugar levels are behaving during the nighttime hours, he or she can advise you about the changes you need to make to better control them. Options that your doctor may discuss include:
• Changing the time you take the long-acting insulin in the evening so that its peak action occurs when your blood sugars start rising.
• Changing the type of insulin you take in the evening
• Taking extra insulin overnight if you find that overnight your blood sugars are progressively elevated. Here, the additional insulin would help lower high morning blood sugars.
• Switching to an insulin pump, which can be programmed to release additional insulin in the morning
Why is my blood sugar so high in the morning, when I do not eat during the night?
It may surprise you to know that sugar continues to enter your bloodstream throughout the night. No, you are not sleepwalking to your kitchen for secret snacks. Rather, your body has stored up sugar (mostly inside your liver) during the day and lets this sugar flow into your bloodstream when you stop eating. Your liver also can manufacture sugar out of the raw ingredients it has collected from other foods (such as fats).
Another reason that the blood sugar can rise through the night is that your body is less able to move glucose from your blood to your body cells at night. Hormones such as cortisol build up in higher levels as a normal part of your nightly sleep cycle. These hormones interfere with the work of insulin, making insulin less efficient. Overnight, when you are not active, your muscles and other tissues use up less sugar.
Waking Up With High Blood Glucose Levels:
Author: Nina Nazor, Dietitian and Diabetes Educator
Source: About Diabetes
Waking Up With High Blood Glucose Levels
The Dawn Phenomenon and the Somogyi Effect
Morning readings can be so frustrating! Do you go to bed with a blood glucose of 120 mg/dL (6.6 mmol/L) and wake up with a blood glucose of 170 (9.4 mmol/L) or more? Is this happening in spite of following your diet, exercise and taking your medications as your doctor prescribed?
Well, don't worry; all this may be happening due to the Dawn Phenomenon or the Somogyi Effect (also called rebound hyperglycemia). Let's see what this is all about.
What is the Dawn Phenomenon?
Every human being experiences the Dawn Phenomenon. While we sleep, usually around 3-8 AM, glucose is released in response of the stimulus of some hormones in order to repair and maintain our body.
These hormones are growth hormone, cortisol, glucagon, and epinephrine (also called adrenalin), which are also known as counterregulatory hormones, since they have the opposite effect of insulin: they cause glucose levels to rise.
So, the release of these hormones to repair and maintain your body causes an increase in blood glucose levels during the first hours of the morning.
That is why it is called the Dawn Phenomenon.
What is the Somogyi Effect?
The Somogyi Effect happens when your blood glucose levels are high in the morning due to hypoglycemia (low blood glucose levels) overnight.
This is also called rebound hyperglycemia, since your body reacts to low blood glucose levels by increasing the release of glucose from muscles, liver and fat, therefore causing hyperglycemia.
What can I do to prevent or correct this high blood glucose in the morning?
If you wake up high because your blood glucose levels are high overnight (Dawn Phenomenon) try the following:
• Limit your carbs at night and eat a small snack of fat and protein before bed, like a tablespoon of peanut butter, or some cheese and/or meat. No carbs, just protein and fat in that snack.
• Try to exercise in the evening for at least 45 minutes at moderate pace, like walking or bicycling. This type of exercise has a longer hypoglycemic effect that will help your blood glucose levels keep down during the night.
• Talk with your doctor about an adjustment of your medications in the evening. If you take pills you might need another dose or an increase of the dose before bed. If you use insulin, you might need a little bit more of long acting before bed and/or some more for breakfast. If you use a pump, then it is easier and you just need to adjust your basal rate to prevent the blood sugar from rising during the night.
• You should also eat breakfast. The increase in blood glucose after you eat your breakfast will often turn off the release of glucose from liver or muscles, since your body senses the fuel is coming through food. If you don't eat your breakfast because you are afraid your blood glucose is high, your blood sugar might continue to rise until noon or until you eat again.
• Do not skip taking your medication in the morning. You must always eat breakfast and take your medication, so your body does not feel that it is in a state of emergency.
If you have lows overnight and wake up with high (Somogyi Effect) you can try the following:
• Go to bed with a blood glucose level a little bit higher than usual, which might prevent you from having hypoglycemia over night.
• Also, you might need to add some carbs and fat to your dinner or bedtime snack, in order to have a slower digestion and available carbs during the night, for example yogurt with nuts or a slice of whole wheat bread with peanut butter.
In both cases, you should try to wake up around 2-3 AM and check your blood glucose levels. If you are high and wake up high, it might be the Dawn Phenomenon; if you are low and wake up high, then it could be the Somogyi Effect.
Finally, record all your readings and talk with your health care team so they make adjustments in your treatment to help you achieve better glucose control.
Friend of mine has very typical problem, his blood sugar is normal early morning but after excercise it goes up without any food. for examle in the morning around 5.30AM it is 110 but after excercise say swiming for 30 minutes and walking for 30 minuets it goes up to 250 or some time more than this. What could be reason, he takes lantus in the night but if increses 2 units then it is hypo at 2 to 3 AM?? Any suggesitions???
I am off insulin and all other diabetic medications. The only time my sugars are high is when I wake up in the morning. I am Canadian so we use a different system for our blood sugar range but my A1C is good at 5.9. I think the only reason it is even that high is because of my morning highs. I don't know what to do to get rid of them. I do not normally eat before bed but I have tried that in the past and nothing seems to get rid of my morning highs. My sugars were 5.4 when I went to bed and 6.7 when I woke up. I just don't know what to try. Even when I was taking insulin and having lows all the time my sugars were still high in the morning. Anyone have any suggestions? -A