Joan Bardsley, RN, CDE, is an assistant vice president at MedStar Health Research Institute.
Q. Why does my blood sugar spike in the morning?
A. There are many reasons for a high reading.
First, look at food. What you ate the night before may be behind the blood sugar spike -- for example, if you ate much more than you usually eat, or if the amount of food was more than your medications are made to handle.
A second cause could be your medicine. Perhaps the medications you take aren't lasting through the night, or the dose isn't high enough to keep your blood sugar in check.
Another possibility is one that happens naturally in the body in response to low blood sugar. When your blood sugar drops, your body releases stored sugar -- mainly from the liver -- and overcompensates. If your blood sugar level drops in the middle of the night, this overproduction of sugar can cause a high level in the morning. This is called the Somogyi effect. When your blood sugar is low, it's best to eat about 15 grams of carbohydrates, and then wait 15 minutes before repeating the process.
Or, the spike could be due to the release of hormones between 4 a.m. and 7 a.m. that raise blood sugar. Your body needs to balance these high hormone levels by making more insulin. When it can't make enough insulin to compensate, your blood sugar will be high. You may need to manage the timing or amount of your medicine.
The risk of having high blood sugar in the morning is that it can raise your average blood sugar levels, as measured on the hemoglobin A1c test. And starting out high in the morning means you'll have to work harder to keep your blood sugar in range for the rest of the day.
The first thing to do is find out what caused the blood sugar increase. Talk with your diabetes team ahead of time, so if you wake up and your blood sugar is high, it's not a panic situation. Know your target blood-sugar range and exactly what to do when it's elevated. Ask your diabetes educator and doctor when to call the office or adjust your medicine dose -- for example, if your blood sugar is over a certain level for a predetermined amount of time.
Create a diabetes plan with your team, and then be ready to adjust that plan, because diabetes can change over time.
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