"Feet on the Floor"

Many of us experience our blood sugar rising just before or after we wake up in the morning which some refer to as “feet on the floor” syndrome. The explanation is that the liver releases sugar to give you energy for the day. Yesterday, I didn’t eat or give any insulin and just watched my blood glucose go up. Blood sugar went from 85 to 164 which I tested with my Contour Next. This seems really high for FOF syndrome. Has anyone quantified this phenomenon? How much does it go up for you?

Over how long?

About two hours.

I haven’t figured out how to manage mine yet but I see the same thing. It is not uncommon for me to be in the 180s if I don’t do something about it. Mine starts between 5am and 6am and I usually wake up and dose around that time, and then go back to sleep for an hour or so. I’m sure it is helping but it isn’t managing it by any means.


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OK. I’ve found that eating (and of course bolusing) takes care of it. If I just sit there at breakfast time hoping basal will take care of a rise,it’s not gonna happen. And if I wake up a bit low,it will rise up on it’s own. However,I can’t raise the basal rate lest I have mornings where I’d get very low. It’s a fine line for my overnight basals.

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It has a name: Its called cortisol and is a glucocorticoid. Cortisol and friends clean up circulating insulin in addition to mobilising glucose. I bolus with fiasp a couple of units, if I dont then it takes 5 times that amount to bring it back down. If i let mine go it will rise to 14mmol (multiply by 18 for mg/dl). Also it can occur that high blood pressure with or without glucocorticoid systems can also have a similar effect. If I stay in bed all day there is no rise in BG, but the moment I get up whether 8am or 3pm then cortisol and co start pushing up my BG. FOTF.

Thanks all. As I wake up my BG is dropping. It could be around 100 all night and it will start dropping and keep dropping to as low as 80 before it begins its rise. That’s why I don’t dare to give myself a bolus. But then it will rise and it’s too high. I thinking eating something right away and giving a bolus is the best course of action.

That sounds like standard dawn phenomenon?

I have this problem but the frustrating thing is there is no pattern. Sometimes it happens before I get up, sometimes an hour after I get up and most times it doesn’t happen. So I can’t really set a profile for it, I just have to do a correction to bring it into line. Yesterday it started around 9 and just kept climbing until 12. No food since 8:30 the night before, and all corrections did nothing. Today went down to 70 so had to eat.
Many people get that rise as soon as they get up, hence feet on floor name. And some have that rise at the same time everyday. Which again is what makes this a challenging disease to deal with each and everyday.
I have stopped worrying about. If there isn’t a clear pattern developing, I just correct in the moment and move on. But if you get up at the same time everyday and this is your pattern, you can make some adjustments. Good luck!

Ditto. With cgms, there is less need to pre-program or tweak for a “pattern”.

My DP used to be consistent and pretty high. I would give 3 times my basal dose for a couple of hours on my pump and sometimes still have to give some more. But it was pretty consistent starting between 6-6:30 am.

Then it started tapering off and sometimes I wouldn’t get it hardly at all, but if I didn’t then I would get FOTF just as aggressive without eating and without ever dropping low.

And now the last 3 months have been aggravating as I either have DP in various strengths, or I have FOTF in various strengths or I have a mix of both or I have DP that hits at 1, 2 or 3 in the morning, or a nice flat line… I’ve given up trying to find enough of a pattern and just dose per night/morning as to what is going on. If I wake up in the middle of the night I check my CGM and that means half the time giving myself a correction. But I don’t set my alert lower than 180 to catch it as I value my sleep and after a few nights of it going off 2 to 4 times I said forget it!

But the no pattern thing is the worse!!!

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I agree that no pattern is worse. That’s why it is just s important to react as it is to plan when it comes to managing diabetes.

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I experience feet on the floor and/or dawn phenomena BG rises almost every day. I place myself in the “reaction” camp on this. I use Afrezza for this. It’s fast and has a short tail of action. I wait until I notice a sustained CGM rise. For me, that’s three dots in a row rising about 3 mg/dL per 5 minutes. If I didn’t have access to Afrezza, I would use intramuscular correction injections. I can often cap this rise to < the 120 mg/dL level.

@Terry4 I have an appointment coming up with the diabetic educator which I believe might be able to put in the request for afrezza. If not I see the endo next month.

I had been thinking about trying it but after watching my BG go up to 170 a few mornings ago before It finally started to come down it made up my mind! I had not a clue without eating why it decided to go up so high and hadn’t taken enough to combat that kind of rise. Then the next day I had a pod/site failure and went up to over 200 before it started to come down.

I was not a happy camper, I haven’t seen a 170 during the day and especially a 200 for a while, so reality threw me a punch lol! At night I would have rolled my eyes and know it happens to me sometimes.

I definitely experience feet on the floor (in my mind this is separate from dawn phenomenon in that it doesn’t occur until I’m up out of bed, whatever time that may be on any particular day). If I wake up with my blood sugar over 140, I’ll take two units of fast acting to combat the rise, one unit if below 140 UNLESS I drank alcohol the night before - in that case I won’t take any fast acting.

Not an exact science and doesn’t always work out perfectly for me but that’s what I’m doing for now.

RHOSF, would you take any fast acting insulin getting out of bed if BG at 80-100?

@rcarli Yes, I’d likely take one unit unless I was lower than 70. In that case I’d wait for the inevitable rise to start, and take 1 unit then.

This morning I woke up around 85 at 7:15am, took 1 unit fast acting along with my long acting, and that kept me smooth until I ate a late breakfast of a banana and coffee around 11am and bolused again for that.

I had a relatively stressful morning at work, so I was happy to see my blood sugar remain stable through that!

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I have my basal rate set to go up about 75% starting a couple hours before i usually get up for this reason. It is easy for it to spike by 50 - 60 or more points if I don’t. So far I have managed to mostly negate it, though on occasion it cases a low int he morning.

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I programmed my pump for extra basal before waking. Then a low carb ratio plus extra insulin for my before breakfast dose.