Managing morning blood sugar highs requires playing detective to find the reason and then taking steps to prevent it in the future.
It’s not that they’re all that unusual, but it’s something to be aware of, as it can represent complications. Keeping track will help you and your physician to choose the right treatment.
Although it’s not anyone’s favorite thing to do, setting your alarm to wake you up for blood sugar testing in the middle of the night can help you solve the mystery because 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, however.
- If it becomes a pattern, high morning readings can make it difficult to meet 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:
The Dawn Phenomenon
This usually happens between 3 a.m. and 8 a.m. and involves the release of the growth hormones cortisol, and adrenaline by your body, which triggers the production and release of glucose from your liver.
Adrenaline increases your heart rate, elevates your blood pressure and boosts energy supplies.
Cortisol, the primary stress hormone, increases sugars (glucose) in the bloodstream, enhances your brain’s use of glucose and increases the availability of substances that repair tissues.
➡ Cortisol also suppresses some functions that would not be essential and might even be harmful in a fight-or-flight situation.
➡ It alters your immune system responses, the digestive system, the reproductive system, and your growth processes.
➡ This “natural alarm system” also communicates with the areas of your brain that control your moods, motivation, and fear.
The result of this chemical cascade is an increase in blood sugar.
These hormones are designed to get us up and moving in the morning, but 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 higher first-morning blood sugars is one of the ways physicians diagnose people with type 2 diabetes.
The Somogyi Effect
High morning readings can also be caused by the Somogyi effect. This is a rebound response that occurs when the body overcompensates for a low blood sugar reaction at night.
➡ If you take blood sugar–lowering medication — such as insulin — in the evening, this may cause you to have a hypoglycemic reaction while you’re asleep, and your body will then release these stress hormones, causing you to have high blood sugar in the morning.
➡ If this is contributing to your high morning blood sugar, you may experience symptoms of hypoglycemia that can wake you from sleep in the middle of the night, including a headache and excessive sweating.
➡ You may also experience difficulty waking up in the morning. If your physician is increasing your evening diabetes medication to lower your morning blood sugar but your blood sugar keeps going up, you may be experiencing the Somogyi effect.
Declining Levels Of Insulin
The third common cause of high morning blood sugar levels is lower levels of insulin which are no longer keeping your blood sugar stable. As a result, you wake up to an elevated reading.
Finding The Cause Of Your Morning Blood Sugar High
Though the three most likely causes of high morning blood sugar can all be treated, you first have to know which one is the source of your condition.
If you’re not sure, you might have to deal with the inconvenience of waking up to check your blood sugar levels in the middle of your sleep (such as at 3 a.m. if you go to bed at 11 p.m.).
- Consistent blood sugar from bedtime until about 3 a.m. and then an elevated reading suggests The Dawn Phenomenon.
- Low blood sugar at 3 a.m. suggests the Somogyi Effect.
- Blood sugar that increases from bedtime to 3 a.m. and then is even higher when you wake is probably due to declining levels of insulin.
Using a continuous glucose monitor allows you to get the information you need, without having to wake up for it. These monitors potentially help find patterns and severity of high and low blood sugars.
Treating High Morning Blood Sugar
A blood sugar high in the morning can be tough to treat, but with the help of your medical team, you can try different approaches. Talk to your doctor about these strategies:
➡ If you’re using an insulin pump, adjusting it will help. If you’re testing high regularly you might be able to program it to help manage those high morning readings.
➡ Check your blood sugar before bed. Granted, many people have higher blood sugar even if it was within normal range before bedtime. Even so, don’t go to bed with high blood sugar. And don’t just count on your current insulin dose to handle it.
Snacking Before Bedtime
If you have diabetes, late-night snacks aren’t necessarily off-limits — but it’s important to make wise choices.
Late-night snacks add extra calories, which can lead to weight gain. And if you snack after your evening meal — especially if the foods contain carbohydrates — you may wake up the next morning with a high blood sugar level.
➡ If you’re hungry after dinner, choose a “free” food, such as:
- One sugar-free frozen cream pop
- Five baby carrots
- One cup of light popcorn
- A small handful of goldfish-style crackers
- A handful of nuts like cashews, almonds, walnuts
- Or swap the snack for a piece of gum or small hard candy
These “free” foods have few, if any, carbohydrates and calories, so they won’t contribute to weight gain or increased blood sugar.
If you take insulin or other diabetes medications and feel that you must snack before bedtime to prevent low blood sugar (hypoglycemia) during the night, talk to your doctor. He or she may recommend adjusting the dose of your medications to prevent the need for a late-night snack.
➡ Take basal insulin. Taking basal insulin (which means “long-acting insulin”) at bedtime could help, but be sure to clear any changes in dosing with your physician before you try it.
➡ Adjust your medication. If in fact, your high morning blood sugar is a rebound response to a low blood sugar level while you’re asleep, you might need to change the dose of any medication you take in the evening that could be causing low blood sugar.
Talk to your doctor about whether your medication schedule should be adjusted to treat morning highs.
➡ Have a healthy snack before going to bed.
- For those experiencing the Somogyi effect, a healthy mixed snack of protein and carbohydrates could help prevent your blood sugar roller coaster at night.
I would recommend that you work with a certified diabetes educator or a registered dietitian if you’re not sure how to fit a pre-bed snack into your daily diet.
➡ Increase your physical activity.
- Being physically active during the day can help you manage blood sugar more effectively in general.
- If your diabetes is treated with insulin or you have a concern about low blood sugar, find out how to exercise safely before increasing your physical activity.
High morning blood sugar levels are a concern, especially if they happen regularly and make it hard to meet your blood sugar goals. But taking steps to discuss these morning highs can improve your overall diabetes management and prevent diabetes-related complications.