Hi alfh,
I'll try to give you an overview of why your blood sugar may be high
in the morning plus possible solutions (please click on the links for
full details), but please consult with your health care provider. As
the disclaimer notes at the bottom of this page state, GA is meant for
informational purposes only and does not offer professional medical
advice.
A higher blood sugar in the morning is not all that unusual and it's
important to realize that most of us are automatically provided with a
boost of energy by our bodies as a kick-start to get us up and moving
in the morning and this is known as the "Dawn Phenomenon". People with
diabetes who aren't taking medication may have trouble controlling
this rise in glucose so the blood sugar may continue to rise. The
first step for you to take is to measure your glucose at around 3 am.
If the reading is pretty stable, neither too high or too low, then the
Dawn Phenomenon would be a likely cause as to why you are getting high
readings when you get up in the morning. Exercise and/or a snack
before bedtime may help, but if not, your physician may prescribe
Metformin to inhibit glucose production. However, if your glucose is
too low at 3 am, you could be experiencing the "Somogyi effect"
(unlikely but possible). The Somogyi effect would just mean that your
high readings in the morning are being caused by the untreated
nighttime hypoglycemia.
>> Overview
American Diabetes Association (ADA)
Question: "My mom has type II diabetes. Her blood sugar is high in the
morning before breakfast (150-200mg/dl) and HBA1c is good 5.8-6.3.
Does she need to be taking medication? If yes, what kind of medication
is the best for her?"
ADA: "This is a great question, because high pre-breakfast sugar
levels can be puzzling. There are two common reasons for this
occurance. One relates to hormones that are released in the early part
of sleep (called the Dawn Phenomenon) and the other is from taking too
little insulin in the evening. Since your mother is not currently
taking insulin, then her rise in sugar levels may be due to the "Dawn
Phenomenon" which usually occurs between the hours of 3am and 8am. In
most people, glucose levels rise just enough to provide the body with
enough energy needed to wake up and start the day. Any excess glucose
is handled by a burst of insulin. However since your mother has type 2
diabetes she cannot properly use available insulin to respond to this
rise in blood glucose. As a result, blood glucose levels continue to
rise to abnormally high levels and cause hyperglycemia (high sugar
levels). Prior to starting initial or additional medications, it would
be interesting to know her bedtime blood sugar levels; if she is not
eating before bedtime, then her blood sugar may be too low causing a
compensatory increase in glucose, therefore making her AM reading
high. If her levels are low at bedtime, tell her to eat a snack
containing carbohydrates to see if this helps."
http://www.diabetes.org/liveonline/transcript.jsp?chatid=4
Waking up with High Blood Glucose Levels
The Dawn Phenomenon and the Somogyi Effect
http://diabetes.about.com/od/monitoringdiabetescontrol1/a/downsomogyi.htm
"The Somogyi effect is most likely to occur following an episode of
untreated nighttime hypoglycemia, resulting in high blood sugar levels
in the morning. People who wake up with high blood sugar may need to
test their blood glucose levels in the middle of the night (for
example, around 3 AM). If their blood sugar level is falling or low at
that time, they should speak with their health-care team about
increasing their food intake or lowering their insulin dose in the
evening. The only way to prevent the Somogyi effect is to avoid
developing hypoglycemia in the first place."
http://www.diabetesselfmanagement.com/article.cfm?aid=388&sid=6&sk=9AAD
I was recently diagnosed with type 2 diabetes type 2 diabetes, take
Avandia at bedtime, and when I check my blood glucose before eating in
the morning, it is 129 mg/dL [7.2 mm/L] or higher. Later in the day or
evening (at least two hours after eating), it is in around 110 mg/dL
[6.1mm/L]. It seems counterintuitive to me that it should be regularly
so high in the morning. Is there an explanation?"
"This is probably due to what is called the "dawn phenomenon." The
dawn phenomenon is a normal physiological process in which certain
hormones in your body work to raise blood glucose levels before you
wake up. These so-called counterregulatory hormones including
glucagon, epinephrine, growth hormone, and cortisol, work against the
action of insulin. They stimulate glucose release from the liver and
inhibit glucose utilization throughout the body. The result is an
increase in blood glucose levels, ensuring a supply of fuel in
anticipation of the wakening body's needs..."
http://www.diabetesmonitor.com/dqa/2005/2005_01_01.htm
>> NOCTURNAL READING
Why is my morning bg high? What are dawn phenomenon, rebound, and Somogyi effect?
"There are three main causes of high morning fasting bg. In decreasing
order of probability they are insufficient insulin, dawn phenomenon,
and Somogyi effect (aka rebound). Insufficient or waning insulin is
simple. If the effective duration of intermediate or long acting
insulin ends sometime during the night, the relative level of
circulating insulin will be too low, and your blood sugars will rise."
The best way to sort it out is to test every couple of hours from
bedtime to morning.
*If your bg rises all, or much of the night, it is a lack of circulating insulin.
*If it is stable all night, but rises sharply sometime before you
wake in the morning, it is dawn phenomenon.
*If your bg declines to the point of a hypoglycemic reaction, it is
*possibly* Somogyi effect."
http://www.faqs.org/faqs/diabetes/faq/part2/section-13.html
"Checking your blood glucose at 3 AM can also reveal whether your high
morning levels are caused by low levels during the night."
http://www.diabetesselfmanagement.com/article.cfm?sid=5&tid=31&stid=51&aid=753&sk=9AAD
"Nocturnal (3-4 am) blood glucose: A glucose reading in the middle of
the night will disclose hypoglycemia as a result of insulin therapy.
This will establish the diagnosis."
http://www.emedicine.com/med/topic2098.htm
"...To sort out whether an early morning high blood sugar level is
caused by the dawn phenomenon or Somogyi effect, check blood sugar
levels around 2 a.m. to 3 a.m. for several nights.
*If the blood sugar level is low at 2 a.m. to 3 a.m., suspect the Somogyi effect.
*If the blood sugar level is normal or high at 2 a.m. to 3 a.m., it's
likely the dawn phenomenon.
http://www.uhseast.com/138509.cfm
>> DIET / EXERCISE
"What to do? Talk to your doctor and your nutritionist and/or your
diabetes educator. Make sure your diet plan includes the right
proportion of fats, protein, and carbohydrates. See if a session of
exercise right before bedtime can help bring down those early morning
numbers. Some people may find that a protein-rich snack right before
retiring can also have a positive effect on the fasting blood glucose
the next morning."
http://www.vegparadise.com/bean8.html
"Eating a snack before bedtime. Some cases of dawn phenomenon are a
response to lower blood glucose that occurred earlier. This is a type
of ?rebound effect? that results in high blood glucose following low
blood glucose. Their physicians may advise such patients to smooth
such glucose roller coasters by eating a snack before bedtime."
http://diabetes.healthcentersonline.com/glucose/dawnphenomenon4.cfm
Diet and Exercise
"Dawn Phenomenon. Very early each morning, the body releases hormones
that wake you up and tell the liver to release stored glucose to give
you energy to start the day. These hormones also inhibit insulin. The
result is that glucose level rises between 4 a.m. and 8 a.m., a
reaction known as the dawn phenomenon. Dawn phenomenon is the reason
why blood glucose levels are often unusually high when you wake up. If
your glucose levels are high each morning, talk with your health care
team. You may need to modify the dose or type of insulin you take
before bed. You may need to get up around 3 a.m. and take insulin. Or
you may need to eat less at breakfast or increase your morning insulin
dose."
http://www.emc.maricopa.edu/academics/physed/wellness/diet_diabetes.html
"Sometimes, episodes of high blood sugar in the morning are rebounds
from low levels during the night. In these cases, eating a snack to
prevent episodes of low blood glucose can also prevent high levels.
Because you do not take insulin or drugs that can cause low blood
sugar, eating a snack would not help. (Eric A. Orzeck, M.D., C.D.E.,
Clinical Associate Professor, Baylor College of Medicine, Houston,
Texas)"
http://www.diabetesselfmanagement.com/article.cfm?sid=5&tid=31&stid=51&aid=753&sk=9AAD
>> METFORMIN
"Elevated blood glucose levels in the morning may be a sign that your
diet and exercise program is not sufficient to manage your diabetes.
Theoretically, you may be able to lower your morning blood glucose
level by exercising?starting around 4 AM?to burn up the extra glucose.
This is probably not practical, so you may need to add drugs to your
treatment program. Metformin (brand name Glucophage) has been used
effectively by people with problems similar to yours. It blunts
glucose production by the liver."
http://www.diabetesselfmanagement.com/article.cfm?sid=5&tid=31&stid=51&aid=753&sk=9AAD
"Many people can control type 2 diabetes with diet alone or diet and
exercise. Following a specially planned diet and exercising will
always be important when you have diabetes, even when you are taking
medicines. To work properly, the amount of metformin you take must be
balanced against the amount and type of food you eat and the amount of
exercise you do. If you change your diet, your exercise, or both, you
will want to test your blood sugar to find out if it is too low. Your
health care professional will teach you what to do if this happens."
http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202756.html
"Taking metformin. This antidiabetic agent curbs glucose production by
the liver, and has been used effectively to treat patients with dawn
phenomenon. For more information, see Biguanides."
http://diabetes.healthcentersonline.com/glucose/dawnphenomenon4.cfm
"Biguanides are antidiabetic agents that lower glucose (blood sugar)
levels in the body by ensuring the liver does not make too much
glucose. They also slow the absorption of glucose from food in the
small intestine and increase the sensitivity of muscle tissue to
insulin, a hormone that carries glucose from the bloodstream into the
cells. This allows for better absorption of glucose."
http://diabetes.healthcentersonline.com/diabetesdrugtreatments/biguanides.cfm
Additional Links of Interest
Dr. Bernstein's Diabetes Solution : A Complete Guide to Achieving
Normal Blood Sugars
[Chapter 6 discusses the dawn phenomenon]
http://www.amazon.com/exec/obidos/tg/detail/-/0316093440/
Non-insulin-dependent diabetic patients (NIDDMs) do not demonstrate
the dawn phenomenon at presentation.
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=3042344&dopt=Abstract
This has been an interesting question to research and I hope my answer
hits the spot. If you have any questions, please post a clarification
request and wait for me to respond before closing/rating my answer.
Thank you,
hummer
Google Search Terms Used: "dawn phenomenon" "somogyi effect" diabetes
control diet exercise high blood suger morning |
Clarification of Answer by
hummer-ga
on
05 Nov 2005 09:48 PST
Hi alfh,
Well, I've been searching much of the morning for a recommended herbal
supplement, but really haven't had much luck. What comes up time and
again is fat/protein snacks and so if I were you, I would try the
tablespoon of peanut butter before bed for a week or two (no bread or
crackers with that).
What can I do to prevent or correct this high blood glucose in the morning?
"If you wake up high because your blood glucose levels are high
overnight (Dawn Phenomenon) try the following:
Limit your carbs at night and eat a small snack of fat and protein
before bed, like a tablespoon of peanut butter, or some cheese and/or
meat. No carbs, just protein and fat in that snack."
http://diabetes.about.com/od/monitoringdiabetescontrol1/a/downsomogyi.htm
I'm reluctant to post anything that is not from a reliable source and
backed by a scientific study, but here is one product that claims to
help morning highs, however, they talk about lows at night.
7. How does ExtendBar help prevent high blood sugar (hyperglycemia) in
the morning?
"What many people with diabetes don't understand is that having your
blood sugar drop too low during the night, can actually cause your
blood sugar to be high first thing in the morning, even before you
eat. That's because as you sleep, your blood sugar level naturally
drops. When your blood sugar level gets too low during the night, your
liver releases glycogen (a stored form of glucose) into your blood
stream. This quickly raises your blood sugar levels, often causing
high blood sugar.
When eaten as a bedtime snack, ExtendBar can help prevent your blood
sugar level from dropping low enough to trigger the release of
glycogen from your liver. In fact, in a clinical study where ExtendBar
was eaten as a bedtime snack, morning blood sugar levels were an
average of 28% lower."
http://www.extendbarworks.com/about/faq_main.asp#7
ExtendBars and the Dawn Phenomenon
http://www.mendosa.com/extendbar.htm
For me, if the peanut butter doesn't help, it's definitely time to
speak with your physician and to perhaps consider metformin (sorry, I
realize it's not what you want but it's a relatively safe drug - see
the link for more details).
Biguanides (Glucophage)
Glucophage (chemical name is metformin) is the only biguanide on the
U.S. market, and has been available since 1995. However, Glucophage
has been used around the world for over 30 years. Glucophage is a very
effective medication and works mainly by preventing the liver from
overproducing too much glucose. In the normal non-diabetic state one
of the important jobs of the liver is to produce just enough glucose
to keep the body functioning normally. However, in people with
diabetes, the liver inappropriately overproduces glucose, mainly at
night. This overproduction of glucose at night leads to elevated blood
glucose levels, especially in the morning. This is one reason why
Glucophage especially improves the fasting or pre-breakfast blood
glucose value."
Benefits
* Effective at lowering glucose levels, especially in the morning
* Does not cause weight gain
* Does not cause hypoglycemia or low blood sugar
* Improves cholesterol levels
Shortfalls
* May cause stomach upset, especially when starting therapy (usually
not a big problem)
* Must be cautious if kidney disease is present
* Must be cautious if congestive heart failure is present
* Must temporarily stop treatment with Glucophage if you become
seriously ill or require an x-ray study using dye (see text)
http://www.icontroldiabetes.com/Education/Treatment/medications.htm
Here are a few more websites of interest but they really aren't what
you are looking for.
Melatonin May Improve Metabolic Syndrome by Regulating Sleep-Wake Cycle
http://www.vrp.com/art/1139.asp
Hypothesis: Shifting the Equilibrium From Activity to Food Leads to
Autonomic Unbalance and the Metabolic Syndrome
http://diabetes.diabetesjournals.org/cgi/content/full/52/11/2652
Glucosium
http://www.glucosium.com/
I tried, Alfh, but I have other commitments so I must call it quits
for today. If anything else pops up, I'll let you know. By the way,
Stevia may be a good sweetener but I can't find anything which says it
can be used to regulate your glucose.
"Stevia extract is 200-300 times sweeter than sugar and has no
calories and has little if any effect on blood glucose."
http://www.mendosa.com/diabetes_update_30.htm
David Mendosa's website looks like a good one to browse around.
Regards,
hummer
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