Why is My Blood Sugar High in the Morning?

There’s nothing quite like the sinking feeling of waking up, testing your blood sugar, and seeing a number that’s much higher than you expected. You’ve been diligent with your eating habits, you take your medications as prescribed, and you have even been getting a decent night’s sleep. So why the frustratingly high reading before you’ve even had your first bite of breakfast?

If this scenario sounds familiar, you are not alone. This is a common experience for many people living with diabetes, and it can be confusing and discouraging.

In this article, we’ll delve into the science behind these elevated morning blood sugars, help you understand the potential causes, and most importantly, provide you with a few simple strategies to help you take control of your morning blood sugars.

Possible contributing factors: The dawn phenomenon and the Somogyi effect

If late-night binges aren’t typically an issue for you, the primary suspects could be one of two physiological occurrences: the dawn phenomenon or the Somogyi effect. Let’s explore each in more detail.

The dawn phenomenon

The dawn phenomenon is a natural, early morning surge in hormones (including growth hormone, cortisol, glucagon and epinephrine) that typically occurs between 2 a.m. and 8 a.m. This hormonal surge signals the liver to release more glucose into the bloodstream. This is your body’s way of preparing to wake up, providing a natural energy boost for the day ahead.

For people with diabetes, the body either doesn’t produce enough insulin or doesn’t use the insulin effectively enough to counteract the natural release of glucose. This leads to an increase in blood sugar levels.

The Somogyi effect (rebound hyperglycemia)

The Somogyi effect, also known as rebound hyperglycemia, is characterized by a high morning blood sugar level that follows an overnight episode of low blood sugar (hypoglycemia).

When your blood sugar drops too low, your body’s protective counter-regulatory hormones (glucagon, epinephrine, cortisol and growth hormone) kick into high gear. These hormones signal the liver to release stored glucose, resulting in elevated blood sugar levels.

This is said to be triggered by factors such as taking too much insulin before bed, not consuming an adequate nighttime snack or engaging in intense evening exercise without adjusting medication or food intake.

Recent research utilizing continuous glucose monitors (CGMs) has caused some experts to question the Somogyi effect. CGM devices provide a comprehensive view of overnight blood sugar fluctuations, which has revealed that the drop in blood sugar followed by a high blood sugar may actually be less common than previously believed.

The most significant difference between the Somogyi effect and the dawn phenomenon is that the Somogyi effect is caused by an initial low blood sugar level, while the dawn phenomenon is a direct result of the body’s natural processes.

Other contributing factors

Sometimes there are other factors that come into play such as not enough basal (background) insulin, inconsistent insulin dosing, insulin resistance, late night meals or snacks, illness, stress, poor sleep, or the impact of other medications such as steroids that could be causing elevated morning blood sugars.

What you can do: Strategies for management

Tackling high morning blood sugar levels requires careful monitoring combined with lifestyle, dietary, and potentially medication adjustments.

Monitor and track your blood sugars

Consistent monitoring is key to determining what is really happening in those overnight hours. For a few nights, consider testing your blood sugar before bed, then again between 2 a.m. and 3 a.m., and immediately when you wake up. This helps paint a clearer picture of what’s happening overnight.

Record all your blood sugar readings, along with notes on meals, activity and medication times and amounts. This data will help identify patterns and potential triggers, providing you and your healthcare team with valuable insights.

You can also use a CGM to gain a clearer picture of what is happening to your blood sugar levels throughout the day and overnight.

Make dietary adjustments

Minor changes to your evening eating habits can sometimes make a big difference. Experiment with reducing or adjusting the amount and type of carbohydrates you consume at dinner. Opt for a protein-rich meal with complex carbs that release glucose more slowly.

If you suspect that you may be going low overnight, a small, protein-rich or low-carb snack before bed might be beneficial. This can help stabilize your blood sugar through the night.

Avoid sugary or high-carb drinks and treats before bed. Foods and drinks high in carbs and sugar can cause a rapid spike in blood sugar that may linger into the morning.

Lifestyle modifications

Beyond diet and medication, your daily habits play a significant role in controlling your blood sugar. Engaging in regular exercise can improve insulin sensitivity and help regulate blood sugar.

Chronic stress can also impact blood sugar levels, so consider incorporating mindfulness, meditation or yoga into your routine to help manage stress.

Lastly, aim for a consistent sleep schedule and practice good sleep hygiene. Quality sleep is crucial for overall health and blood sugar regulation.

Insulin and medication adjustments

Even when you’re managing your diabetes diligently, your body sometimes needs a little extra support from medication. Here are some strategies your doctor might suggest:

• Basal insulin adjustments: Your doctor may recommend changing the dose or timing of your long-acting (basal) insulin. In some cases, splitting the dose could provide more consistent coverage throughout the night.
• Insulin-to-carb ratios: It might be helpful to re-evaluate your insulin-to-carb ratios, especially for evening meals. This helps ensure your insulin dose accurately matches your carbohydrate intake.
• Considering other medications: Discuss with your doctor if other medications could be right for you. Some medications are specifically designed to help with the dawn phenomenon or improve your glucose control overnight.

Communication with your healthcare team

Do not try to self-diagnose or adjust your medications alone. This can be dangerous and might even make things worse. When you have an appointment with your healthcare team, bring your detailed blood sugar log or CGM reports, as well as a list of questions or concerns. The more information you provide, the better your team can assist you.

Be sure to share your observations about morning highs if you experience them regularly. This information is key for your doctor to determine what the cause could be, leading to a more targeted and effective treatment plan.

Remember, you should never adjust your medication without professional guidance unless your doctor has given you specific permission to do so. Your doctor can help you safely fine-tune your treatment plan.

In summary

Waking up to high blood sugars can be a frustrating start to the day, however this is a very common and manageable challenge for people with diabetes. Consistently monitoring your blood sugar at various times can help you identify patterns and trends in your blood sugar levels. Most importantly, talk to your healthcare provider. They are your best resource for helping you determine the causes and making safe, effective medication adjustments if needed.