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 type of dinner at a particular time, and then doing multiple testing throughout the night over two to three nights. We watch what the blood sugar does throughout the night and adjust the medications until the blood sugar stays in normal range throughout the night, waking up with 70 - 90mg/dL as the ideal goal. It takes working with a knowledgeable provider, plus time and patience to get this set right.
If we know medications and/or the long-acting/basal insulin is set right and you’re still waking up high, then it is likely one of the next three scenarios:
2.) DINNER took longer to digest than expected.
Just because you go to bed with a great blood sugar level does not mean it's going to stay that way. Depending on what you had for dinner, especially if it was large, and/or contained a mix of high carb and fat and/or protein, digestion can take 4-8 or even more hours. (This is especially true for those with gastroparesis, which can occur from years of high blood sugars damaging the nerves to the digestive system.)
So when you go to bed, if your dinner hasn't completely digested, your blood sugar level will continue to go up for many more hours...even beyond the time your fast-acting insulin finishes working.
I help my patients try different dinners, until we dial in waking up with a good glucose level. Sometimes we find the answer, but sometimes we don’t. If so, you’ve got to keep looking…
3.) Your HORMONES spiked in the early morning hours, making your liver dump glucose into your blood.
Even if you don't eat, your body can raise blood sugar on it's own. One of those ways is via the natural cycle of hormones that tend to peak in the morning.
The hormone cortisol peaks around 8am and has the effect of raising blood sugar.
Furthermore, this can be accompanied by what is called the 'Dawn Phenomenon,' which refers to the daily morning activity of the liver clearing out insulin from the blood, having the effect of raising blood sugar levels.
This can be frustrating to say the least! I understand. I can help you figure out if this is what is going on via setting you up on a plan that includes testing at specific times throughout the night.
4.) You’re REBOUNDING from a low.
Your body doesn't like to go low, so after an intense low, the body can actually rebound and make you go high afterwards.
The only way to see if this is happening is to monitor your sugar level every few hours through the night.
Understanding these four scenarios is essential for waking up with a good glucose level. Consistently starting your morning in the normal range IS possible. Trust me, it CAN be done.
The tips I just gave you I'd have paid thousands of dollars for when I was young because it would've saved me years of frustration with trying to figure all of this out on my own!
Do you have questions? I’d love to help. Let's chat. I make time in my schedule, when I can, to connect with others because talking one diabetic to another can be life changing. My specialty is Type 1 but I help Type 2’s as well.
If you need help with how to wake up with a perfect blood glucose level, or have other diabetes related questions for that matter, schedule a complimentary phone consult with me here: www.consultwithdrjody.com/type1
You CAN be healthy and happy while living with diabetes. To your health!