October 3, 2008
What’s going on in the morning with my blood sugar? My first blood sugar check of the day is consistently high.
First, we have to eliminate the obvious question of, “did I take enough insulin for breakfast?” If the answer to that is yes, then we go to the next question: Do you drink coffee in the am? There is what I call the “coffee phenomenon” where blood glucose may rise after drinking even black coffee. In this instance, I have suggested that my patients take a small bolus for the coffee, maybe just .5 units for each cup or two, but that really depends on how much the blood glucose is going up. So that brings up another question. Does the caffeine make my blood sugar go up? Remember ladies, in diabetes there are few black and white answers. The answer to that is maybe for some people coffee does affect you but for others it may not. I can drink a 20 Oz diet Mt Dew and see no rise in my blood sugar but for my coffee, I need a small amount of insulin. What’s up with the coffee?…hence the coffee phenomenon. Also with coffee drinks, you have to consider what else is in them. For example a small latte has about 1 cup of milk which equals 12 grams of carbohydrate. The other various drinks that are out there like mochas have varying amounts of carbohydrate.The other issue with morning rises in blood sugar may be due to what I call “delayed dawn phenomenon” The typical dawn phenomenon is seen first thing in the morning where the blood glucose level is high after normal blood glucose the night before. The liver makes glucose to help us get up in the morning so without adequate insulin, we see higher morning numbers. This usually starts about 2-4 am. To combat this, often people have higher basal rates between 2 and 4 am and or take their long acting insulin at bedtime. The “delayed” dawn phenomenon may start at around 7am-8am though10 am.It just means that you may need more basal insulin at that time of day. So how do you make sense of this morning thing? One thing that you can do to figure out what’s going on in the mornings are the dreaded “basal rate testing.” To do this you test first thing in the morning when you wake up. If your fasting blood glucose is between 80-130, delay or skip breakfast and coffee and test every hour to 11/2 hours. If the blood glucose stays in that same range, you probably don’t have the delayed dawn phenomenon. Next you would need to do the same test again, but this time add your coffee and see what happens to the blood sugar pre and post coffee. If the blood sugar raises post coffee, then you may need to take a bolus for the coffee. This may sound like a royal pain… but the neat thing is that you can figure it out and know what your body needs for what and when!There is never a dull moment when it comes to managing your diabetes!! Good luck!