Expert: Joan Bardsley, Assistant Vice President, MedStar Health Institute, USA.
- Q: Why does my blood sugar spike in the morning?
- A: There are many reasons for high blood glucose readings.
First, look at food.
First, look at the food. The food the patient ate the night before could be the cause of the elevated blood glucose – for example, if the patient ate more than usual or consumed more food than the medication could control.
The second cause is a medication factor. The patient is taking a medication that doesn’t last all night, or the dose is not enough to control the blood sugar.
Another possibility is that the body naturally responds to low blood sugar. When a patient’s blood sugar drops, the body releases stored sugar – mainly from the liver – and it does so excessively. If a patient’s blood sugar level drops at midnight, the excess sugar can trigger a hyperglycemia the next morning. This phenomenon is known as the Somogyi effect. When a patient’s blood sugar is low, it is best to eat about 15 grams of carbohydrates, then wait 15 minutes and repeat the process.
Another possibility is that the spike in blood sugar is due to the release of hormones between 4 and 7 a.m., which causes a rise in blood sugar. The body needs to balance such high hormone levels by making more insulin. When the body can’t make enough insulin to compensate, blood sugar is high. Patients then need to manage the timing or dosage of their medications.
The risk associated with having high blood sugar in the morning is that it increases the patient’s average blood glucose level (the result of a glycated hemoglobin test). Morning hyperglycemia means that patients need to work harder to keep their blood glucose in the normal range for the rest of the day.
First, the cause of the elevated blood glucose needs to be identified. Talk to your diabetes team ahead of time so that when the patient wakes up, he or she doesn’t panic about the elevated blood sugar. Know your target blood glucose range and know exactly what to do when it rises. Ask the diabetes educator and doctor when it’s time to call the doctor or adjust the dose of medication-for example, if the patient’s blood sugar is above normal for a predetermined period of time.
Develop a diabetes plan with your own team and always be ready to adjust that plan, because diabetes can change over time.