How Can High Blood Sugar Levels In The Morning Be Controlled
Once you and your doctor determine how your blood sugar levels are behaving at night, he or she can advise you about the changes you need to make to better control them. Options that your doctor may discuss depend on the cause of the morning high blood sugars.
For dawn phenomenon:
- Changing the timing or type of your diabetes medications
- Eating a lighter breakfast
- Increasing your morning dose of diabetes medication
- If you take insulin, switching to an insulin pump and programming it to release additional insulin in the morning
For Somogyi effect:
- Diabetes Forecast. Why Is My Blood Glucose So High in the Morning? Accessed 8/8/2018.
- American Diabetes Association. Somogyi effect, also called rebound hyperglycemia Accessed 8/8/2018.
- National Center for Biotechnology Information. Dawn Phenomenon. Accessed 8/8/2018.
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Somogyi Phenomenon Rebound Hyperglycemia
The Somogyi phenomenon describes a rebound high blood glucose level in response to low blood glucose.
Amongst those people with diabetes who manage their blood glucose using insulin injections , this may take the form of high blood sugar in the morning due to an excess amount of insulin during the night.
The Somogyi effect is controversial despite being widely reported.
What Happens In The Somogyi Effect
The Somogyi effect is the response of the bodys defence mechanism to the long period of low blood sugar in a person suffering from type-2 diabetes. This can occur after vigorous exercise or if the person has taken more insulin than required, before going to bed.
Insulin is a hormone naturally produced by the pancreas, which helps in maintaining the levels of glucose in the blood.
Due to the sudden drop in blood sugar levels, various hormones such as growth hormones, and stress hormones are released in the body, which triggers the release of glucagon, a hormone produced by the pancreas. Glucagon counteracts the action of insulin and promotes the production of glucose in the liver by converting glycogen into glucose, resulting in increased blood sugar levels.
Simultaneously, the stress hormones keep the blood sugar levels high by not allowing the body cells to respond to insulin, resulting in insulin resistance.
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Morning High Blood Sugar: More Food For Thought
Sure, its a pain to have to wake up in the middle of the night to check your blood sugar. Remember, though, that this isnt forever. If you can do this for at least three nights, you should get a clearer picture of whats happening. Pick nights when you feel well , you arent planning to exercise between dinner and bedtime, and your bedtime blood sugar is around 150 or so .
Experiment a little with bedtime snacks, as mentioned above. You may find that not eating a snack helps with your morning blood sugar on the other hand, eating a reasonable carb-containing snack may help, too.
Pay attention to high-fat dinners and how they may affect your morning readings. Fat doesnt directly affect blood sugars, but it can increase insulin resistance and also slow the digestion of carbohydrate. This means that four, six or eight hours later, youll see the effect of that fatty meal on your blood sugars. Theres also some evidence that saturated fat can increase or worsen insulin resistance, as well.
Dont overlook the role of stress on your diabetes control, too recent or extreme stress, whether it be issues at work or at home, an illness, or a recent medical procedure, for example, can affect your blood sugars.
Want to learn more about the dawn phenomenon and Somogyi effect? Read Controlling the Dawn Phenomenon and Somogyi Effect.
If You Think Youve Experienced The Somogyi Effect
Unfortunately, there are many things that could cause a high blood sugar in the morning.
Pinpointing the many variables that might have affected your blood sugar isnt simple, and the Somogyi Effect probably isnt happening to you over and over without you waking at some point during the night due to normal symptoms of hypoglycemia.
First, talk to your healthcare team or a diabetes educator about your concern and the potential Somogyi Effect.
Secondly, set an alarm for a few nights to wake up once or twice in the middle of the night and check your blood sugar.
Thirdly, share your blood sugar results with your healthcare team to pinpoint any evidence of the Somogyi Effect. This will help you then make adjustments in your insulin or other medications.
Lastly, if youre not already using a CGM, start the conversation with your healthcare team. A CGM can immediately provide life-saving insight into blood sugar mysteries like this.
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Somogyi Effect: Rebounding From A Low
The Somogyi effect, also called the rebound effect, is named after Michael Somogyi, a Hungarian researcher who first identified it. The claim behind this effect is that the blood sugar goes low overnight. This drop triggers the release of counterregulatory hormones, such as adrenaline, cortisol, growth hormone and glucagon, which, in turn, signal the liver to release glucose. The result? Blood sugars rebound and are higher than desired in the morning. The theory, too, is that those hormones create insulin resistance, so that its sometimes harder to lower those morning readings.
Interestingly, scientists question the Somogyi effect some studies have failed to prove its existence. Other studies, however, have shown that this occurrence happens in those with Type 1 diabetes.
How Is The Somogyi Effect Different From The Dawn Phenomenon
Another phenomenon known as the dawn phenomenon has been confused with the Somogyi effect since both of them result in blood sugar spikes in the morning. However, there are many differences between them which include:
- Dawn phenomenon or dawn effect is a state where a person diagnosed with diabetes experiences increased blood sugar levels in the morning due to the inability of the pancreas to release insulin at night to maintain the blood glucose. On the other hand, the Somogyi phenomenon occurs due to the release of counter-regulatory hormones to cope with the low glucose levels at night.
- In the Somogyi phenomenon, there is a state of low blood sugar level which is followed by early morning hyperglycemia. However, in the dawn phenomenon, no hypoglycemic episodes are reported.
- In the dawn effect, the blood sugar levels stay high throughout the night. On the other hand, in the Somogyi effect, the blood sugar levels drop at some point during the night.
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How Does Dawn Phenomenon Work
For people with diabetes, dawn phenomenon is problematic because your body isnt able to naturally correct for insulin changes during the night. This often creates consistently high blood glucose levels in the morning. Estimates show that dawn phenomenon occurs in about 50% of people who have type 2 diabetes.
How To Manage Dawn Phenomenon
There is a short list of things you can do on your own to help reduce morning blood sugar highs. The list includes:
- Take medication or insulin at bedtime instead of at dinnertime.
- Eat dinner earlier in the evening.
- Get some exercise after dinner.
- Avoid snacks that contain carbohydrates at bedtime.
If these dont work, your physician may recommend:
- Trying a different medication.
- Moving from oral medication to insulin.
- Changing the type or dosage of insulin you take.
If you find that your blood sugar is consistently high in the morning or you see signs that it might be sweating, intense hunger, lightheadedness, shaking or anxiety, or dramatic mood swings it is important to talk to your doctor.
Managing glucose spikes is vital because even a small increase in blood sugar can greatly increase the risk of diabetes-related complications including heart disease, stroke and neuropathy .
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The Dawn Phenomenon And Somogi Effect In Diabetes
Morning blood sugar levels. Its a topic we always get questions around.
Namely, why on earth are my morning levels so HIGH when Ive eaten nothing since yesterday. Surely they are meant to be their lowest first thing in the morning?
While its easy to assume that this would be the case, theres more to the picture than you know.
In particular with type 2 diabetes, there are two factors that raise blood sugar overnight. These are known as the Dawn Phenomenon and the Somogyi Effect.
Is Your Elevated Morning Blood Sugar The Dawn Phenomenon Or Too Many Carbs
To understand if elevated morning blood glucose numbers are a result of the dawn phenomenon or from too many dietary carbohydrates, make sure you test multiple times throughout the day.
First and foremost, you should be familiar with what your fasting glucose looks like. Whether it be your most recent lab values from the doctor or checking your glucose with a meter, the best way to know where your fasting glucose falls is to measure it, and to test it on a few different days.
Similarly, testing your glucose throughout the day, before and after meals, and before you go to bed can help you understand how your body responds to the food you eat.
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How Do I Know If High Morning Readings Are Due To The Dawn Effect Or The Somogyi Effect
The best way to find out is to do some overnight monitoring. Here are some overnight monitoring tips steps to identify if your high morning blood glucose is due to the Dawn Effect or Somogyi Effect:
- Start your overnightchecks at least three-to-four hours after your last meal
- Refrain from eating during the overnight check unless you need to treat a low blood sugar. Avoid drinking alcohol.
- In the middle of your sleeping cycle. For example, if you sleep from 11pm to 7am, you would check around 3am. If you skip this step, you will not have enough information to sort out what is happening.
- If you use a continuous glucose monitor, check your overnight history in the morning
The results of your overnight check should reveal whether you are experiencing the dawn or the Somogyi effect. You may need to repeat your overnight monitoring one or two times to confirm.
How Do You Know Which One You Have
Your doctor will want to find out why youâre waking up with high blood sugar before they tell you how to treat it. This means theyâll ask you to test your blood sugar in the middle of the night — around 2 or 3 a.m. — for several nights.
If your levels are always low during that time, itâs probably the Somogyi effect. If not, itâs likely the dawn phenomenon. Knowing which is which will help your doctor come up with a plan to address it.
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Ask A Dces: Dawn And Somogyi Effect: Morning High Blood Sugars Explained
Do you ever wish you could ask a diabetes care and education specialist anything about type 2 diabetes? In our new monthly Ask a DCES column, you can get your most burning questions answered from a DCES professional on various topics, including diet, medication, exercise and mental health. Want to submit a question to us? Email us at hello@beyondtype2.org!
Dear DCES: I have noticed that I go to bed with my blood sugar looking good but I wake up with much higher blood sugar than I expected. Why is this the case?
Dear Reader: I know waking up with higher-than-expected blood sugars can be frustrating for you. There could be various reasons for this, but I am going to focus on two common ones.
The first one is known as the Dawn Effect. Everyone has a body clock that responds to daytime and nighttime. When dawn arrives and the sun starts to come up, your body reacts by secreting hormones that get you ready for your day. These hormones cause a rise in blood sugar that is harder for your body to compensate for if you have diabetes.
What Is Dawn Phenomenon
The dawn phenomenon happens to almost everyone with diabetes and happens as a result of your bodys natural circadian rhythm. Blood sugars rise when your body gets ready for you to start the day. Your liver will produce glucose to help fuel your day around the time you typically wake up. But, if youâre living with diabetes, your pancreas cannot produce enough insulin to keep up or the insulin is not as effective as it should be, and as a result blood sugars do the opposite of morning hypoglycemia, and instead rise around the time youâll be waking up.
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How You Can Help Pinpoint The Problem
If you find that your blood sugar is consistently high when you wake up, you can help diagnose the issue by checking your blood sugar levels during the night.
Dr. Hasan suggests that you set your alarm for 2 or 3 a.m. for a few nights in a row to see what the levels are like during that time. If theyre high then, thats probably a sign of dawn phenomenon, she says.
What Causes High Morning Blood Sugars
Two main culprits prompt morning highs: the dawn phenomenon and waning insulin. A third, much rarer cause, known as the Somogyi effect, may also be to blame.
The occasional morning high will have little impact on your A1C, a measure of your average blood sugar levels over time that indicates how well managed your diabetes is. But if those highs become consistent, they could push your A1C up into dangerous territory.
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Its important to maintain a healthy body weight. You should also make sure that you drink plenty of water, and limit your intake of sugary drinks. In addition, make sure that you get regular exercise. You should also avoid alcoholic beverages. Lastly, you should avoid alcohol. These beverages contain high amounts of sugar. If you dont drink enough, youre not doing anything to prevent diabetes. Besides, drinking alcohol can be harmful to your health.
The most important thing to do is to follow the recommended diet. Eat more healthy foods that have low amounts of fat and high amounts of fiber. The best way to lose weight is to lose 7 percent of your body weight. If youre overweight, you should try to lose 14 pounds to reduce your risk of developing type 2 diabetes. However, you should not attempt to lose weight while pregnant. Talk to your doctor about what kind of weight is safe for you.
Besides high blood glucose, diabetes can also affect the nerves and skin. It may affect your sexual response and your nervous system. It can also affect your fertility. Women with diabetes are more likely to miscarry or have a baby with a birth defect. It can cause a person to have difficulty hearing and sleep. If the condition is left untreated, it can lead to type 1 diabetes and can even lead to amputation.
What Causes The Dawn Phenomenon
Although the exact underlying causes of the dawn phenomenon are still unclear, we know that hormones play a large part. These hormones follow a circadian rhythm, or a daily cycle, and increase during our waking hours, the early morning.
The hormones that promote glucose release into the blood include:
- Epinephrine : Known as the âfight or flightâ hormone, adrenaline increases blood flow to the muscles.
- Cortisol: Known as the âstress hormone.â
- Glucagon: Signals the liver to release glucose into the blood.
- Growth Hormone: Important for repair and regeneration.
Two key processes occur in the liver overnight that result in the release of glucose into the bloodstream and contribute to increased morning blood glucose:
1) Glycogenolysis, the breakdown and release of stored glucose
2) Gluconeogenesis, the creation of glucose from components of protein or fat.
And last but certainly not least, insulin is another hormone that plays an important role here. When blood glucose rises, insulin is released and helps move glucose out of the blood and into cells for immediate energy use or storage.
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How Is It Determined If The Dawn Phenomenon Or Somogyi Effect Is Causing The High Blood Sugar Levels
Your doctor will likely ask you to check your blood sugar levels between 2 a.m. and 3 a.m. for several nights in a row. If your blood sugar is consistently low during this time, the Somogyi effect is suspected. If the blood sugar is normal during this time period, the dawn phenomenon is more likely to be the cause.
Some additional clues that the Somogyi effect may be the cause include nightmares, restless sleep and overnight sweating as these are all signs of low blood sugar levels.
Does The Somogyi Phenomena Only Occur During The Night
Sometimes the Somogyi rebound will occur when the person with diabetes is awake.
They may notice initial symptoms of low blood sugar or a rebound.
Waking up during the night is a clear symptom of the Somogyi effect.
The evidence indicates that most people with type 1 diabetes who experience nocturnal Somogyi effect do not usually wake up.
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Causes Of The Somogyi Effect
If you have diabetes, you may use insulin injections to manage your blood sugar levels. When you inject too much insulin, or you inject insulin and go to bed without eating enough, it lowers your blood sugar levels too much. This is called hypoglycemia.
Your body responds to hypoglycemia by releasing hormones like glucagon and epinephrine. These hormones raise your blood sugar levels. Therefore, the Somogyi effect is sometimes referred to as the rebound effect.
The Somogyi effect is widely reported. But theres little scientific evidence to support it.
Its relatively easy to test for the Somogyi effect. For several consecutive nights:
- Check your blood sugar just before bed.
- Set an alarm to check it again around 3:00 a.m.
- Test it again upon waking.
If your blood glucose is low when you check it at 3:00 a.m., its likely the Somogyi effect.
You can also ask your doctor about using a continuous glucose monitoring system. Your doctor will insert a tiny glucose sensor under your skin. It sends information to a monitoring device that tracks your glucose levels and lets you know when levels are too high or too low.