Although high blood sugar in the morning is quite common and is not a major problem if it occurs from time to time, consistently high morning levels require attention.
First of all, it is necessary to identify the culprit in order to thwart it with appropriate treatment.
Morning hyperglycemia can occur due to the following 3 distinct causes:
1. Dawn phenomenon. Natural body processes make glucose rise in the morning, regardless of whether you have diabetes or not. It typically happens between 2 and 8 a.m. when the body starts to release stored glucose, getting ready for the day to come. At the same time, it releases counter-regulatory hormones, like cortisol, epinephrine and glucagon, which can interfere with insulin. If you are not diabetic, the body just produces more insulin to balance morning hormonal changes and compensate for this boost in blood sugar. And you even don’t notice this happening.
However, if you are diabetic, your body responds to insulin differently and your fasting glucose levels can go up even if you are on a strict diet. In addition, this is happening when your diabetes medication doses received the day before are wearing off.
The dawn effect is usually treated with diabetes medication change or addition. If you have type 1 diabetes, you may need adjustments in insulin dosage.
2. Somogyi effect. If you receive a diabetes medication or insulin in the evening, this can trigger a hypoglycemic reaction when you are asleep. It is also possible to have low blood glucose while sleeping due to not eating enough or drinking too much. To overcompensate for this, your body will produce stress hormones to prompt the liver to release the stored glucose in larger amounts than usual. Although, this way the body tries to rescue us from dangerously low blood glucose, this system is not perfect for diabetics. If this is the cause of your high blood sugar in the morning, you may experience the symptoms of hypoglycemia, including restless sleep, excessive sweating at night and headache in the morning time. If you increase your diabetes medication in the evening to lower the morning readings, but they still keep going up, you are more likely to suffer from the Somogyi effect, which can be managed with reducing your evening insulin dose or eating a snack of protein and carbohydrates before going to bed.
3. Waning insulin. If you are on insulin and your morning readings are high, this can be due to your insulin wearing off too quickly. In this case, you may need a dosage adjustment or change in insulin injection time to prevent the morning highs.
To find the exact cause it will be necessary to check your blood sugar levels for several days in a row before going to bed, between 2 and 3 a.m. and at wake-up. If:
- your sugar readings are even from bedtime until 3 a.m., but are higher in the morning, most probably you are having dawn phenomenon;
- your blood glucose is low at 3 a.m. but high in the morning, you are probably having the Somogyi effect;
- your blood glucose is elevated at 3 and then is even higher in the morning, it suggests waning insulin.
All-time high morning blood sugar is a concern. However, taking measures to address these highs can improve your diabetes management and prevent diabetes-related complications. But never endeavor to correct it on your own, even if you think you’ve identified the reason behind your morning readings. Keep in mind that there are dozens of variables that can affect blood sugar at any one time – from exercising to the size of your meal. Therefore, there’s much to investigate before deciding by what phenomenon you are affected. Discuss it with your endocrinologist instead. He will find the treatment plan to get you back on track.