High BGs in the morning

[2high]

I have no idea why, but my bgs are constantly high in the morning lately, ranging between 13mmol/l and 26mmol/l, and its driving me nuts.

My lantus is fine, and my basal is (apparently) correct
I have been testing an hour before bed, and again just before going to sleep to make sure I'm stable and at a decent level to make sure I'm not hypoing over night.
I have tried having a low carb/protein snack before bed and having a low-dose bolus with it


If I wake and test at 3 am I am fine, but jump hugely in the last 3 hours of sleep... has anyone got any suggestions WHY??

[Noemie]

I dont know why but i know it used to happen to me a lot. some times i was wakin up in hypo around 4am, but not all the time.
My doc (not NHS doc btw) made me change my Lantus from 24 to 28u, and since then i've been fine (unless i was having chocolate spread b4 goin to bed :whistling :tee: ). They insisted i didnt change the Humalog shot.

How long has it be goin on? How many units r u on?

[2high]

I dont know why but i know it used to happen to me a lot. some times i was wakin up in hypo around 4am, but not all the time.
My doc (not NHS doc btw) made me change my Lantus from 24 to 28u, and since then i've been fine (unless i was having chocolate spread b4 goin to bed :whistling :tee: ). They insisted i didnt change the Humalog shot.

How long has it be goin on? How many units r u on?

Ummm, about 2 weeks now. Used to happen all the time on Protophane, but not til now on Lantus.

I take 36u of Lantus at 10.30pm

[spike]

I have no idea why, but my bgs are constantly high in the morning lately, ranging between 13mmol/l and 26mmol/l, and its driving me nuts.

My lantus is fine, and my basal is (apparently) correct
I have been testing an hour before bed, and again just before going to sleep to make sure I'm stable and at a decent level to make sure I'm not hypoing over night.
I have tried having a low carb/protein snack before bed and having a low-dose bolus with it


If I wake and test at 3 am I am fine, but jump hugely in the last 3 hours of sleep... has anyone got any suggestions WHY??


Pumping will fix all that, Kit. that's precisely why i went on a pump after 18 years of never getting basal insulins to do the job of covering DP.

[Cyborg]

Sounds like DP, but hard to be sure. Only 2 more weeks 'till pumping, hang in there!

[JediSkipdogg]

It's called the dawn phenomenon and somogyi (somethin like that) effect. The Somogy is you going low sometime overnight and not knowing it and your liver kicking in to dump glucose out. It then dumps too much out and you go high.

The dawn phenomenon is your BG starting to rise from lack of useful carbs in your body during that hours. Many find that if they have some long lasting carbs at bedtime, they will be fine throughout the night and not have a problem.

Another possibility is alcohol since it does an up down up effect. If one drinks a mixed drink, their BG will go up at first till the alcohol kicks in at which point it will go down. THen the liver will kick in from the low and make you go up again.

Finally, it could be the lantus not working 24 hours. If you take it in the morning that could be a definite problem and many find they have to split it to get full coverage. The body wants insulin or the BG goes up, even if it's half as much as normal for an hour, that will help control it some.

Those are my theories from right after I woke up. So if they don't make sense, blame it on the cat.

[Cyborg]

DP isn't necessarily caused by lack of carbs. It's partly due to a natural release of hormones that occurs before or after waking. One or more of these hormones triggers the liver to create glucose.

[2high]

It's called the dawn phenomenon and somogyi (somethin like that) effect. The Somogy is you going low sometime overnight and not knowing it and your liver kicking in to dump glucose out. It then dumps too much out and you go high.

I test at 3am and am fine then, so i dont think thats happening...

The dawn phenomenon is your BG starting to rise from lack of useful carbs in your body during that hours. Many find that if they have some long lasting carbs at bedtime, they will be fine throughout the night and not have a problem.
tried that too...

Another possibility is alcohol since it does an up down up effect. If one drinks a mixed drink, their BG will go up at first till the alcohol kicks in at which point it will go down. THen the liver will kick in from the low and make you go up again.
i don't drink EVER during the week!!

Finally, it could be the lantus not working 24 hours. If you take it in the morning that could be a definite problem and many find they have to split it to get full coverage. The body wants insulin or the BG goes up, even if it's half as much as normal for an hour, that will help control it some.
I take my Lantus at night...

Those are my theories from right after I woke up. So if they don't make sense, blame it on the cat.
**** Cat!

Thanks everyone... All valid points Jedi, but unfortunately I've covered all those bases...

[MJM]

I've asked the diabetic team about this as it's happened to me only in the last Month. They said it was "The Morning High" and it happens to a lot of people. I've been trying for a few weeks now to overcome it and I think I might have succeeded. I select a Basal Pattern that increases my basal between 5am to 8am to .8 units per hour (normal .4 units). I'm keeping my fingers crossed but it seems to sort the problem.

[Cyborg]

That's pretty much how it's handled with the pump. Problem is handling it without a pump...

[JJeenn]

I have this same problem. I noticed that when I first went on Lantus it sort of disappeared for a few months, but then came back. I'm high pretty much every single morning, no matter what I do.

Last night I was 7.2 before bed, 7.9 at 3:00am, 11.9 at 6:00am when I woke up by accident (stupid time change), and 15.1 (!!) an hour later at 7:00am.

This is one of the main reasons I'm hoping to get a pump in the next month or two. My endo says that's the only fix, since we've tried everything with snack/no snack and adjusting Lantus, splitting it into two shots, etc., and nothing's helped.

[JediSkipdogg]

DP isn't necessarily caused by lack of carbs. It's partly due to a natural release of hormones that occurs before or after waking. One or more of these hormones triggers the liver to create glucose.

But many, not all, the addition of high fat carbs before bed seems to help. So to me, that makes me believe that it can be a partial lack of carbs.

[Cyborg]

But many, not all, the addition of high fat carbs before bed seems to help. So to me, that makes me believe that it can be a partial lack of carbs.

I think you may be confusing the 2...

[JediSkipdogg]

I think you may be confusing the 2...

which two?

[Cyborg]

which two?

dawn phenomenon and somogyi effect

[JediSkipdogg]

dawn phenomenon and somogyi effect

No I'm not, I explained above what the two are.

Somogyi effect is a rebound of the liver dumping glucose to recover from a low. The way to prevent that is to make sure one doesn't go low during the night.

Dawn Phenomenon is the body doing a number of things, mainly releasing hormones during fasting. This process only occurs during a fasting cycle when the body is in a low energy state (sleep.)

Eating carbs before bed will help BOTH of the above lessen out. For the first one it will keep the BG at a higher number and this was a huge problem with NPH. Now, just some people have natural lows at night. So eating carbs raises the BG to above normal levels for a period of time. For the DP, it slows or prevents the release of those hormones at night during that fasting state and prevents glycogenolysis and gluconeogenesis.

[Cyborg]

DP is not tied to gluconeogenesis...

[JediSkipdogg]

DP is not tied to gluconeogenesis...

From one site....Dawn Phenomenon (http://www.diabetic-talk.org/dp.htm)

"So, what does all this have to do with a high fasting BG? Overnight, usually between 4am and 11am, your body releases some hormones. These are Growth Hormone (GH) from the anterior pituitary gland, cortisol from the adrenal cortex, glucagon from your pancreatic alpha-cells, and epinephrine (adrenalin). These hormones cause an increase in insulin resistance, raising your BG. In addition, these hormones trigger glycogenolysis and gluconeogenesis, adding stored or new glucose to your bloodstream."

There's more too, don't feel like copying them all....

[Cyborg]

As someone with DP, I can tell you that I get DP whether I eat or not before going to bed. In fact, if I do eat my bg usually goes up since I don't like to bolus too much before bed. When I wake in the morning my bg will be extremely high from the DP on top of the eating too late...

[JediSkipdogg]

As someone with DP, I can tell you that I get DP whether I eat or not before going to bed. In fact, if I do eat my bg usually goes up since I don't like to bolus too much before bed. When I wake in the morning my bg will be extremely high from the DP on top of the eating too late...

And since when was diabetes an equal problem for all disease? Why do I spike above 400 in the morning but return to normal within 4 hours? Why does my bro have the same carb ratio all meals of the day? I have a different breakfast and then a different dinner (if I skip lunch)? What affects one, doesn't affect all.

[BlueSky]

My understanding is that DP effect is part of the circadian rythm, which is pretty consistent. And eating before bed won't do much to change the insulin resistance increasing aspect of it. But glycogenolysis can be inhibited to some extent by a pre-bed snack, to the extent that it increases insulin levels. Glycogenolysis is initiated by Glucogen, the production of which is shut down when insulin levels rise. This happens when non-insulin-dependent T2s have a snack. Problem is that insulin levels of T1s doesn't increase when glucose enters the bloodstream, unless if you bolus for the snack.

So much for the theory. I have seen different experiences described by both T1s and T2s. My experience (as a T1) has been that, while a pre-bed snack can pre-empt the Somogyi effect, it doesn't do anything for the DP. :rolleyes:

[2high]

As someone with DP, I can tell you that I get DP whether I eat or not before going to bed. In fact, if I do eat my bg usually goes up since I don't like to bolus too much before bed. When I wake in the morning my bg will be extremely high from the DP on top of the eating too late...

Thats exactly what happened when I tried a bedtime snack... 3 mornings in a row...

[sviskan]

I have a problem with being high in the mornings too. I have been pumping for five months now and the problem seems to disappear from time to time but it allways comes back. Recently I had a low every night, so I changed the basal from 0,6-0,7 u/h to 0,5-0,6 u/h. But then the last couple of nights I have had very high readings in the morning allthough my go to bed readings were fine.

Last night I ate two slices of pizza (I know not the best thing for diabetics) at 20.30. Then I messured my bg:

22.00 11,4 or 205; I took 1 extra unit
23.00 9,4 or 169
01.00 7,4 or 133
03.00 8,6 or 155; I felt lousy and took 0,5 extra unit
05.00 6,2 or 112
07.00 6,2 or 112
08.30 9,3 or 167

My basal is:
05-10: 0,6 u/h
10-17: 0,5 u/h
17-19: 0,6 u/h
19-23: 0,7 u/h
23-00: 0,6 u/h
00-05: 0,5 u/h

Please, give me some advice to what I can try to do.

[Cyborg]

Looks like your bg went up between 1-3 am. Is this a pattern you can reproduce regulary? Can you try the test again without eating so late. It might be helpful if you shifted the test times by an hour also... Good luck.

[SueM]

Many people say they get better results by splitting their lantus dose in 2. Could just be that the lantus is not working 24 hrs for you.

[xMenace]

It's called the dawn phenomenon and somogyi (somethin like that) effect. The Somogy is you going low sometime overnight and not knowing it and your liver kicking in to dump glucose out. It then dumps too much out and you go high.

The dawn phenomenon is your BG starting to rise from lack of useful carbs in your body during that hours. Many find that if they have some long lasting carbs at bedtime, they will be fine throughout the night and not have a problem.

Another possibility is alcohol since it does an up down up effect. If one drinks a mixed drink, their BG will go up at first till the alcohol kicks in at which point it will go down. THen the liver will kick in from the low and make you go up again.

Finally, it could be the lantus not working 24 hours. If you take it in the morning that could be a definite problem and many find they have to split it to get full coverage. The body wants insulin or the BG goes up, even if it's half as much as normal for an hour, that will help control it some.

Those are my theories from right after I woke up. So if they don't make sense, blame it on the cat.

Last week I had to be at the hospital an hour away at 6:30am for my surgery. Here's my sugars with no food or adjustments except as mentioned

3am 3.3 / 59 (suspend 1 hr)
4am 4.5 / 81
5am 9.6 / 173
6:30am 8.5 / 153

My basal til 5am is .6 and at 5am jumps to 1.5.

Very consistent with these assessments. Pump!!!

[Gangrel]

I am struggling with the same thing too. There are times where I check at 2 or 3 am (my own **** cat!) and I'll be 8 or 9. Then I'll be up to 15+ in the morning. The maddening thing is that it isn't consistent.

At my last endo appt this concerned her as my mornings were higher then they should be, but my A1C was 6.8. her theory was the liver dump too. So lately I've been making sure I take my NPH at 9pm, and testing from 2-3 am to see where I'm at, and then again in the morning. If the 2-3am one is too low, I'm going to lower my NPH intake, which is at 32 currently......

Though I think sometimes my problem is weak will power. When I wake up to feed the cat, I think I'm also absent mindedly eating something myself! which of course will screw me up.....

[sviskan]

Thank you Cyborg. I now got my night basal under control again, and my morning sugar is fine. Lets hope it stays this way for a long time.

[TenderVittleS]

The only thing I can recommend is 2-3 units more of Lantus at night or split Lantus shots but you'll have to adjust if you split them, Good Luck!

[Cyborg]

Thank you Cyborg. I now got my night basal under control again, and my morning sugar is fine. Lets hope it stays this way for a long time.

You're Welcome. :) Glad it's working out for you. It is so much easier with a pump...

[momof6]

This is another headache for me. My son's bs can be 71 at bedtime(like last night) and 208 in the morn. 100 at night 240 in the morn. When I give more nph, and check it at night while he's sleep, it goes too low(30's and 40's) Since the lows are much more dangerous, it's frustrating, because at this point I don't know how much is too much and how much is too little.

[JediSkipdogg]

A few questions mom.....

When you adjust, can you adjust by 1/2 unit or do you adjust for full units?

Have you tested him on those nights where he's good at bed, then high in the morning? A test every 2 hours then would reveal if he's dropping to low and his liver is dumping glucose and rebounding him high. That would be why when you give him more NPH he goes extremely low because it may be too much for the liver to recover from.

Those are my thoughts.

[spike]

This is another headache for me. My son's bs can be 71 at bedtime(like last night) and 208 in the morn. 100 at night 240 in the morn. When I give more nph, and check it at night while he's sleep, it goes too low(30's and 40's) Since the lows are much more dangerous, it's frustrating, because at this point I don't know how much is too much and how much is too little.

You are mentioning bg excursions that cry out for a pump, but you already know that, as I've discussed it with you. That's the only solution for many diabetic children and adults with dawn phenon. Shots can't maintain a level bg level from 9PM to 6 AM for those with DP.

[belyro]

This is another headache for me. My son's bs can be 71 at bedtime(like last night) and 208 in the morn. 100 at night 240 in the morn. When I give more nph, and check it at night while he's sleep, it goes too low(30's and 40's) Since the lows are much more dangerous, it's frustrating, because at this point I don't know how much is too much and how much is too little.

Have you talked to your son's doctor about Levemir? I'm on Levemir - 2 shots a day - and it makes my nighttime bloodsugars VERY stable. I'm not sure if there would be special considerations with this because he's young, though.

If you'd like to discuss it more with me, send me a private message and we can talk.

[spike]

Have you talked to your son's doctor about Levemir? I'm on Levemir - 2 shots a day - and it makes my nighttime bloodsugars VERY stable. I'm not sure if there would be special considerations with this because he's young, though.

If you'd like to discuss it more with me, send me a private message and we can talk.

Levemir might help yours level out, but it won't do a thing for someone with a high degree of DP.