One of the stubborn things about living with diabetes is that you are likely not experiencing morning high blood sugar levels.
It can be frustrating to wake up with high blood sugar when you feel like you’re doing nothing wrong (not to mention you haven’t eaten anything yet that day!).
What causes these hyperglycemic episodes? Is it a dawn phenomenon? Somogyi effect? Insulin pump cannula or diet that was bent during sleepwalk?
In this article, we will explain the various reasons why your blood sugar levels can be high in the morning and what you can do about it.
What is considered high blood sugar in the morning?
Always consult your doctor about your individual blood sugar goals. It can vary throughout your life (depends on whether you experience pregnancy, illness, or hormones or life changes).
However, in diabetic people, the fasting blood glucose level should usually be between 70 and 130 mg/dl.
Hyperglycemia levels, considered high blood sugar, are routinely at the top. Anything above 180 mg/dl after the first meal of the day is a benchmark for hyperglycemic glucose when not fasting.
What is the phenomenon of dawn?
Dawn phenomenon is a biological process that dates back to prehistoric times. It evolves to occur, and humans have more energy in the morning (and therefore more sugar in the blood) to burn the days.
The dawn phenomenon is the body’s hormone shift in the body that is overnight release of anti-regulatory hormones such as growth hormone, adrenaline, cortisol, epinephrine, and glucagon.
This creates morning insulin resistance, where blood glucose levels can rise between 2am and 8am, but it can be offset throughout the day and become frustrated, hungry and suffered by prolonged hyperglycemia levels that are not healthy in the long term.
People without diabetes also have dawning events, but those pancreas increase insulin secretion and prevent hyperglycemic levels.
It is estimated that over 50% of people with diabetes suffer from the dawn phenomenon. However, it is more common in people with type 1 diabetes than in people with type 2 diabetes, and is most prominent in people receiving insulin therapy.
What is the effect of Somogyi?
Meanwhile, the Somogyi effect is the body’s response to hypoglycemia experienced overnight, when the liver releases glucagon to restore blood glucose levels in an emergency, usually very high blood glucose levels.
This is also known as rebound hypoglycemia.
This is very common in people with insulin-dependent diabetes. This is because manually administering insulin to manage blood sugar levels is not a complete science, and experiencing hypoglycemic levels during sleep is a characteristic of life that lived with diabetes.
The Somogyi effect is most common in people with type 1 diabetes and insulin treatment type 2 diabetes.
How can you communicate the difference between the two conditions?
Telling the difference between the two conditions can help prevent the resulting hyperglycemic levels from hurting you in the first place.
If you wear a continuous glucose monitor (CGM) device, scan the time you were asleep.
If your blood glucose levels are steadily rising between 2am and 8am over a few days or weeks, if you have a normal blood glucose level of 70-130 mg/dL before bedtime, you may be experiencing the phenomenon of dawn.
If you scan your blood glucose and notice sudden spikes (without treating hypoglycemia), you will notice somogyi effects.
This occurs when the liver discards glucose into the bloodstream to prevent long-term, dangerous hypoglycemia.
If you don’t have CGM, you should wake up late at night between 2am and 8am and test it a few times to see where your blood sugar levels are heading.
It is best to set alarms and wake up every hour to see if it is low during those times, or to determine if you are experiencing the dawn phenomenon or the Somogyi effect.
How can I prevent these conditions from occurring?
These two conditions have different causes, and different interventions are required to resolve them.
Here are some ways to prevent the onset of dawn phenomenon:
- Don’t eat carb-rich snacks or meals before going to bed
- Exercise before going to bed in the morning or during the day
- If you have multiple daily injections, try switching to nighttime administration instead of taking the medicine in the morning.
- Talk to your doctor about increased insulin-carbohydrate ratios and correction factor (CF) to become more aggressive with your bolus
- Use an insulin pump to set a more aggressive basal speed overnight
Here’s how to prevent the development of Somogyi effects:
- Morning exercise, not afternoon or evening
- There are fewer carbohydrates and foods in the evening, so if there is less insulin on board when you go to bed
- To maintain blood sugar levels, combine high-fat, high-protein snacks at bedtime (think peanut butter and celery)
- Use an insulin pump to temporarily reduce your basal speed overnight to avoid hypoglycemia levels
- Consult your doctor to reduce the insulin-to-carbohydrate adjustment and correction factor (CF) ratio in the evening to reduce aggression and avoid hypoglycemia levels
Learn more about strategies to avoid high morning glucose levels in our guide: How to avoid high morning glucose
Conclusion
Both the dawn phenomenon and the somogyi effect are common conditions experienced by diabetes, particularly insulin-dependent diabetic patients.
Conditions result in the same result, morning hyperglycemia levels, but they have very different causes.
Dawn phenomenon is the natural biological release of hormones between 2am and 8am, which increases insulin resistance and means higher blood sugar levels when you wake up.
On the other hand, the Somogyi effect is rebound hyperglycemia, which involves the liver dumping glucose into the bloodstream to treat severe hypoglycemia experienced overnight.
These issues can be frustrating and can contribute to complications of diabetes over time, which should be avoided at any cost. Though not entirely preventable, their severity can be reduced with a number of strategic tactics.
Taking precautions before bedtime to increase or decrease basic and bolus settings, adjusting snacks and dinner at bedtime, and knowing how long it takes during the day will help reduce hyperglycemia levels in these common but stubborn mornings.
Consult your doctor before adjusting your insulin dose to know which settings are best suited to you and your health goals.
