Why is my blood sugar high in the morning?

Do you sometimes wake up after a peaceful sleep and still get the morning highs? This rise in blood sugar level occurs in everyone, irrespective of them being diabetic or not. If a person does not have diabetes, then their body produces insulin, the hormone secreted by the pancreas to control the amount of glucose in the bloodstream. It enables the cells to utilize glucose for energy production. But if a person is diabetic, then they might face some uneasiness due to the morning highs. This is because diabetic people cannot respond as well to the glucose regulating hormone as people without the condition. Let us have a look at the causes of high morning blood sugar in the bloodstream.

What causes high blood sugar levels in the morning?

Generally, high blood sugar levels in the morning are witnessed as a result of high carb snacks right before going to bed, or inadequate diabetes medications.

Other reasons for high morning blood sugar levels are:

• Dawn Syndrome
• Waning insulin
• The Somogyi effect

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What is Dawn Syndrome?

Dawn Syndrome leads to high blood sugar level in the morning through the natural changes taking place in the body during sleep. In the night, when we are asleep, our energy requirements decline. As a result, the glucose production is lowered and blood sugar drops. This lowers the release of insulin. During the early hours, our body needs to prepare to wake up and get out of bed. For this, we need energy.

During the wee hours, body releases hormones which are counter-regulatory in nature, such as, glucagon and epinephrine. These hormones make the body more insulin resistant. At the same time, cortisol and growth hormone compel the liver to boost the glucose production to meet the energy requirement for getting up in the morning.

All these factors together raise the level of blood sugar in the morning or “dawn”. This is the dawn phenomenon or the dawn effect. According to the American Diabetes Association, the dawn phenomenon comes into action between 5am and 8am.

In people with diabetes, the causes of Dawn phenomenon depend on whether the person has Type 1 or Type 2 diabetes.

• Type 1: Studies reveal that the release of counter-regulatory hormones during the night can trigger the dawn phenomenon. These hormones counter the effects of insulin. Also, the production of insulin decreases while sleeping. This ultimately pushes the sugar level up and the person notes high morning blood sugar.
• Type 2: In this case, it is the body's inability to produce insulin, or react to it effectively, which triggers the dawn phenomenon.

Waning insulin

If the insulin level falls very low while you are asleep, it could lead to a high blood glucose level in the morning. There could be several reasons for low insulin, the most common factor being your insulin pump settings not providing enough basal insulin overnight or your long-acting insulin dose being too low.

Another key factor to keep in mind is the insulin duration- the time period for which the drug works. If this duration doesn't last through the night, it would, insufficient to control the sugar levels, will lead to that morning high. So, make sure that you do not inject your long-acting insulin too early for it to last through the night.

Somogyi Effect

Somogyi effect is the body's response to low blood sugar (hypoglycemia/rebound hyperglycemia) during the night, which can give the morning highs. This low blood sugar level can be a result of either missing evening meal or taking too much insulin after the dinner. In this case, the body tries to compensate for it by producing more glucose. Sometimes, it overcompensates and we wake up with high blood glucose levels.

Signs of morning high blood sugar levels

The symptoms of high blood sugar level may include:

• Thirst and a frequent need to urinate (happens in heyperglycemia)
• Headaches
• Tiredness
• Blurred vision
• Hunger
• Disturbed concentration
• Early-stage insomnia
• Gum disease

What are Normal Blood Sugar Levels?

For a person without diabetes:

The normal sugar level in blood ranges from 70 mg/dl to 99 mg/dl (3.9-5.5 mmol/L).

1 to 2 hours after a meal, the sugar level below 140 mg/dl (7.8 mmol/L) is considered normal.

Haemoglobin A1c reading of less than 5.7% is considered normal.

For a diabetic person (as per the official American Diabetes Association recommendation):

The sugar level in blood ranges from 80 mg/dl to 130 mg/dl (4.4-7.2 mmol/L).

1 to 2 hours after a meal, the sugar level should be less than 180 mg/dl (10.0 mmol/L).

Haemoglobin A1c reading should be less than 7.0%.

Can fasting too long raise blood sugar?

Fasting means abstaining from eating or drinking anything but water for eight hours. After fasting, a carbohydrate metabolism test is conducted which measures blood glucose levels.

While fasting, blood sugar levels can drop very low. This prompts the secretion of the hormone glucagon, which increases the blood glucose level. A normal person can balance these increased glucose levels by secreting insulin.

But diabetic people either can't produce enough of this hormone to balance the glucose levels (Type 1 diabetes) or they're not able to use the hormone effectively (Type 2 diabetes). Eventually, diabetic people will have higher blood sugar levels after fasting.

Fasting for too long would force the body to turn to the stored fats for energy. So, to fulfil the energy requirement, our body will start converting fats to glucose. Ultimately, the glucose levels will show noticeable increase.

Why fasting sugar is higher than pp?

Fasting sugar higher than postprandial (pp) levels is termed as fasting hyperglycaemia. Fasting blood glucose level is determined by the insulin secretion, and whether the body is responding to it. PP sugar level is measured after the meal, hence it depends on the meal and our metabolism.

Generally, fasting sugar is lower than pp. But if this scenario is reversed, then it means that the body is not producing enough insulin, or not responding to it properly. This could be a sign of a serious health issue and in such a situation, the person should contact a doctor.

Is 135 blood sugar high in the morning?

The normal blood glucose level in the morning is 70 mg/dl – 99 mg/dl. Comparing with this range, 135 is a considerably high level. This could be a sign of diabetes in the person.

If my blood sugar is high in the morning, should I eat breakfast?

Yes. You should eat breakfast to bring the sugar level back to normal.

Why is the blood sugar high in the morning with gestational diabetes?

High blood sugar during pregnancy in women is known as gestational diabetes. During pregnancy, there is a hormonal rush which can interfere with working of insulin, hence creating a hinderance in controlling the level of sugar in the blood. This leads to gestational diabetes.

How can I lower my Morning blood sugar?

• Eat dinner earlier in the evening.
• Do some physical activity after dinner, like going for a walk.
• Get your medication medically reviewed by doctor.
• Eat breakfast. It helps bring your blood sugar back to normal, which tells your body that it's time to rein in the anti-insulin hormones.
• Eat a snack with some carbohydrates and protein before bed.
• Consult a registered dietitian for a medically reviewed diet plan.
• On diagnosis of diabetes, immediately consult a doctor who will provide medical advice and medications.

Why is my blood sugar high even with insulin?

This could be a consequence of Type 2 diabetes, where the body does not respond to insulin in the way it should. Hence people with type 2 diabetes experience high levels of sugar in bloodstream, even with insulin.

Another explanation could be Somogyi effect. If a person takes too much of insulin, it would result in low blood sugar level. This would initiate the somogyi effect, leading to high blood sugars.

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How do I prevent morning hyperglycemia?

Morning hyperglycemia can be prevented by:

• Decreasing the dose of diabetes medications that are causing overnight lows
• Adding a bedtime snack that includes carbs
• Doing evening exercise earlier
• If you take insulin, switching to an insulin pump and programming it to release less insulin overnight

How to Control Morning Blood Sugar Levels Without Medication?

To maintain normal blood sugars, one should adopt healthy habits. The most important thing is a healthy diet. Include carbs and proteins in your evening snack. Along with that, fitness exercise must be a critical part of your schedule.

FAQ

What should my blood sugar be when I wake up?

The normal sugar level in blood in the morning is 70 mg/dl – 99 mg/dl (3.9-5.5 mmol/L).

How long does it take to lower fasting blood sugar?

For people without diabetes, it generally takes 1-2 hours after eating to lower the fasting blood sugar. For diabetic people, insulin is required to lower the fasting sugar levels.

Why does my blood sugar go up in the morning without eating?

While sleeping, the energy requirement is low. Hence the production of glucose decreases. Also, because of the secretion of growth hormones, the production of insulin is suppressed.

As the early morning hours approach, the liver produces more glucose to provide the extra energy required to wake up. This leads to high morning blood sugar. This is commonly known as dawn phenomenon. Another reason might be somogyi effect.

How soon after waking up should I test my blood sugar?

You should immediately check your blood sugar level after waking up, before doing any other activity. If it is low, you can drink some juice or milk. If it is high, you can take insulin and let it work for an hour before breakfast.

How to Avoid High Morning Blood Sugar?

Cleveland clinic suggests the following methods to avoid high morning blood sugar:

For dawn phenomenon:

• Changing the timing or type of your 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:

• Decreasing the dose of diabetes medications that are causing overnight lows
• Adding a bedtime snack that includes carbs
• Doing evening exercise earlier
• If you take insulin, switching to an insulin pump and programming it to release less insulin overnight

My blood sugar is over 200. What should I do?

When sugar level in blood is very high, the fastest way to lower it is to take fast acting insulin. Another fast and effective solution is exercise. If nothing works, the person should immediately go to a hospital.

General Medication Guidelines for People with Diabetes

As per the guidelines issued by the Cleveland clinic, following things should be kept in mind while taking diabetes medication:

• Inform your doctor about your allergies.
• Take the medication in proper dosage. Don't skip or stop taking the medicines unless told by the doctor. One should take the treatment seriously.
• Keeping a medicine calendar/log book might help you to remember if you have taken your medication.
• Do not wait until you are completely out of medication before filling your prescriptions.
• Check your blood sugar from time to time.