4 December 2012Why is My Blood Glucose So High When I Wake Up?

It doesn't seem fair, does it? You haven't eaten anything all night and you still wake up with high blood glucose! What is going on and how can you lower it? For those of you with diabetes, this post is for you!


Your body strives to keep blood glucose (BG) within a safe range, but with diabetes the balance is disturbed. The insulin your pancreas produces might not be sufficient to cover your BG lowering needs. As well, the insulin it does produce might not be handled properly by target body cells. And to make matters worse, your liver might be on glucose production overdrive. All of this results in your body's failure to control BG overnight as well as after meals or snacks. For more basic information about diabetes, please be sure to read my article, Diabetes Basics at MyNetDiary's library.

Dawn Phenomenon

Due to normal daily changes in our body's release of hormones during sleep and wake cycles, BG typically starts to rise in the very early morning – starting about 3 AM - and continues to rise as the morning progresses. For folks without diabetes, insulin production simply increases and takes care of the rising BG. However, for folks with diabetes, unless there is medication on board to cover this early morning rise, BG will eventually rise out of target range by the time they wake up. The classic pattern is to see BG within target range at both bedtime and during the middle of the night, and then see a high fasting BG.

If you have noticed that your fasting BG is creeping up over time and is no longer within target range despite sticking to a carb controlled eating plan and taking your diabetes medication as prescribed, then it might be time to talk with your doctor about your diabetes medication. The type, dose, and/or timing might need to be adjusted to better handle that early morning BG rise. Typical fasting target range is 70 mg/dL - 140 mg/dL but work with your health care provider for a target range that is right for you.

To help your doctor, keep thorough records of your BG, food/beverages, exercise, and diabetes medication use. Include an accurate time stamp for all of these logs. If you use MyNetDiary, print out your reports and bring them to your appointment. Please see Tracking Diabetes with MyNetDiary at MyNetDiary's library for more information.

Somogyi Effect

Did you know that a high fasting BG can be caused by experiencing hypoglycemia (BG < 70 mg/dL) in the middle of the night? It is called the Somogyi Effect – named after the researcher who discovered it. Hypoglycemia can be caused by too much insulin, too few carbs, too much alcohol, and/or extra exercise. When hypoglycemia occurs, the body increases release of hormones that increase BG production. The typical pattern is this: BG within target at bedtime, low in the middle of the night, and then high by morning. You might want to set an alarm to test your BG in the middle of the night to rule this out. If this is happening to you then please do not delay in seeing your doctor as soon as possible. Hypoglycemia is not safe and sleep can reduce a person's ability to detect it – not everyone wakes up when they experience it!

Just Ate Too Much the Night Before?

If you had a late night high carb snack, then it is possible that your fasting blood glucose is high simply due to poor food choices in the presence of insulin resistance. As well, a large late night dinner high in fat can delay digestion and absorption of the carb content of the meal enough so that your post-meal rise in BG is going like gang busters around the time the Dawn Phenomenon is kicking in.

Need help controlling carbs at meals? You can start with a typical goal of 30-45 grams total carbs if you are an adult woman or 45-60 grams if you are an adult man. Try limiting your bedtime snack to 11- 20 grams total carbs. Discuss individualized meal and snack goals with your healthcare provider! If you have diabetes, ask your doctor for a referral to a Certified Diabetes Educator (CDE). This type of specialist is trained to help patients manage all aspects of their diabetes care while coordinating with the patient's primary care provider or endocrinologist.

Katherine Isacks, MPS, RD, CDE
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Disclaimer: The information provided here does not constitute medical advice. If you are seeking medical advice, please visit your healthcare provider or medical professional.


Diabetes/Blood glucose

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