Is there a way to reduce or eliminate the waking up phenomenon?

I experience sometimes a very annoying phenomenon. 10 minutes before I wake up, my BG starts to increase. Sometimes it is only modest and goes back down, but sometimes it can increase by up to 70 mg/dL . Note that this is distinct from the dawn phenomenon (= BG rises in the early morning during your sleep) and the feet-on-floor phenomenon (= BG rises when you stand up).

What’s annoying about this is that it happens irregularly. I’ve had it yesterday and today, but the day before I didn’t, so I can’t just automatically inject 1-2 units right after waking up - I have to wait and see whether or not it actually rises. I injected 1,5 units today after it steadily rose from 85 to 117 mg/dL. Now it has been hovering at 120 mg/dL for almost an hour, meaning that without the injection I’d probably be at 150 or 160 by now.

Are there any suggestions how to minimize the occurrence of this phenomenon? I did not sleep that well the past few days, and I had a slice of bread yesterday at 11 PM, so I am thinking that better sleep plus strict ban on carbs after, say, 8 PM could do the trick.

I am struggling with similar challenges. It’s known that lack of good sleep causes insulin resistance to rise. You make a good observation that the irregularity of that change in insulin resistance makes it more complex to manage.

I have not fixed my situation yet but I have some ideas. For me, the two most potent tactics for increasing insulin sensitivity are fasting and exercise. I agree with your idea about eliminating any evening snacks is a good one. I would start with that and see how it goes. Perhaps adding a 20-30 minute walk in the evening could help, too.

If those two tactics don’t do the trick, maybe you could try skipping dinner once. I’ve often found that skipping a single meal can exert good blood glucose effects for more than one day. Have you ever noticed how well behaved your blood glucose is when you fast for a blood draw?

It sounds like you are experiencing a waking BG-rise but the intensity of that rise can’t be anticipated. How about if you take just a portion of that pre-emptive insulin dose and then only follow up with the rest of it once the extent of the rise becomes more apparent? Maybe take one unit of insulin right away and then add another unit if you exceed a certain BG level.

These kind of problems are harder to solve since they are caused by more than one factor. You need to experiment to see what works for you. You can help keep track of what you do and how well it works by recording the details on paper or computer. It will make later analysis easier.

Diabetes is a dynamic disease. Once you fix this problem, you’ll often see some variation of it later. The important thing is to get right on it and act.

I think this is an advanced level skill-set. In the past, I’ve struggled with this type of scenario for months. Now I can usually fix it within a week. It takes observation, experimentation and persistence. It is well worth the effort, however. This is a skill that will serve you again and again. Keep on trying; you can do this!


While this example from two nights ago does not apply directly to your case, it demonstrates how a loss of sleep can drive insulin resistance. It also shows how a little analysis and timely action can turn things in your favor. Looking back, I concluded that I should have delivered the correction insulin sooner. But I didn’t know I was going to climb that high and I didn’t want to over-react.


When I woke up early again this morning, I concluded that the same scenario as yesterday was about to play out. Except I was going to change my tactics.

My plan was to deliver the correction bolus of Afrezza earlier so as to prevent the hyperglycemic rise. At 3:53 a.m. my blood sugar surged from 91 to 96 to 101 (5.1, 5.3, 5.6) in 10 minutes. This looked a lot like the beginning of the blood sugar jump 24 hours earlier.

So I delivered 4 units of Afrezza at 4:09 a.m. That did the trick. My BG line is still going sideways in the low 90s (5s).


I’m convinced that if I didn’t take action with an insulin correction when I did this morning, yesterday’s scenario was about to play out again and drive my blood sugar above my target range for 2.5 hours. Note that this morning’s correction dose was given an hour earlier than yesterday’s correction and it was only 1/2 the total correction dose. Insulin timing is a big deal.

I’m working on my broader sleep problem. I had been taking three different meds to help me sleep. I recently decided with the help of my naturopathic physician to stop these medications in a slow titrated fashion. I stopped the last med five days ago and I’m feeling the fallout from that action. I hope to persist and be able to soon sleep through the night and eliminate sleep loss insulin resistance.

I hope you can take some comfort in knowing that many of us experience variations of the same thing. Whether it’s Dawn Phenomenon or Feet to Floor Phenomenon, the solution is the same.

For pump users, increase basal dose to compensate for anticipated BG rise, and bolus on top of that as required. I’ve doubled my 3am-7:30am basal rate, in addition to a 1 unit bolus administered between 3-3:30am. Depending on BG between 4-4:30am, I take another 0.5-1.5 unit bolus. (If you’re wondering, many of us wear CGM’s and always know where our blood sugars are).

If on MDI, consider upping your basal and bolus’ing as soon as you get out of bed. Please Note I eat nothing until late in the day so I’m not dealing with any influences other than dawn effect.

Here’s how it looked before I used CGM & pump technology to work thru to a solution

Here’s a link to an article on How to Avoid High Morning Blood Sugars

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I almost always give a shot, usually one unit, during the early morning or my glucose level will rise to 120 or higher. So, if it is 80 or over at 5:00 am, I know I am guaranteed to be high when I get up without the extra insulin. Since I like to eat breakfast right after I get up, I like waking up in the 65 to 75 range.

I remember Dr. Bernstein saying that he injects in the early morning too.

With the CGM I honed in on the rise starting to occur around 4am even if I’m fast asleep. I now take 1.8mg injection of Victoza at 8pm as the peak effect is 8-12 hours which covers me from 4am-8am. My fasting BGs have dropped from 120-130 to 95-105 without any lows.

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Don’t eat fatty foods in the evening or for supper even if that is prior to 5PM.

Thanks guys, lots of interesting info here. I have been making some observations, also based on suggestions from this thread.

I am now not sure if this is really the waking-up phenomenon. I woke up today at 4 AM because of a hypo alert (threshold is at 70 mg/dL). I could actually feel a small rush of stress hormones due to being woken up like this. BG rose immediately to 80 mg/dL, but remained there, and began to fall again, so I ate a few grams of carbs. After about an hour, I fell asleep again. I woke up at ~9:30 AM, with a BG at about 83 mg/dL. After half an hour, it had risen to 104 mg/dL, and continued to climb to 116 mg/dL. But at that point I was already on my feet getting ready for the day. So, either this is actually a feet-on-floor phenomenon, or a delayed dawn phenomenon (so, the release at ~9 AM is that automatic liver dump in the morning, but happens at ~3-4 AM for most people instead).

Next thing I’ll try is to stay lying in bed for an hour or more after waking up. If the BG doesn’t climb until I get out of bed, then it is a feet-on-floor phenomenon.

Oh, also, how do you factor in such a phenomenon generally? I mean, if you aren’t aware of it, it can distort your morning I:C ratio. My impression is that you need to separately factor in units for countering that phenomenon. So, if you make breakfast right after you stood up, showered etc. , then you need to calculate: total_units = morning_rise_units + carbs / IC_ratio … right?

My morning I:C ratio is 1:2 :frowning: I just try to eat minimal carbs in the morning otherwise it’s a giant bolus which I hate.

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My nightime and early morning (breakfast time) I:C ratio is lower than the rest of the day.

:+1: I have this too in its many variations. The problem for me is I’m on Tresiba for basal, and not a pump, so if I make a change it takes 3 days to register. I’m also on a low dose. So at 5 units I was dropping to 40 overnight, but when I increased to 6 units I started going up to 128 fasting (after several days).

As with others of you, it depends a lot on when I get up, which is often very early. I also tend to dip low at midnight and then keep climbing until I get up.

Right now I’m trying to manage by staying at 5 units and having a snack at night before bed.

I typically take 1 unit soon as I wake up unless I am low. If I am eating breakfast right away, which I usually do during the week, I just take 1 unit + the breakfast dose. If not, I would take the 1 unit and then dose normally when eating breakfast. It’s not always consistent as so many things affect how much morning insulin you need and how rapid/high the rise will be including stress, quality of sleep, activity level, the weather, how well the insulin absorbs, etc. All you can do is try and correct when you fail.

I have dawn phenomenon plus. 50% of the time, I will drop up to 30-50 points usually after 4 am but as early as 2 am and I will start climbing usually right before 6 am, with no adjustments I will climb to over 300 plus points. So I have my pump set from .5 an hour at night raising to 2.2 per hour from 6 am to 9 am. Then I drop down to around 1 unit per hour the rest of the day. A CGM and the pump has been hugely helpful in handling this.

If I haven’t climbed before I wake up, I will after I am awake, although usually not as bad, but I will still climb to over 200. The adjustments I’ve made on my pump stop most of the obnoxious highs.

But it is problematic as I usually will still be too high, the problem is that “usual”, I can’t give more insulin because then a third of the time I’d be too low. I also can’t give the full correction dose as 2 hours later I will be too low, I give about half of what it says, because I already have a programmed basal rate in the pump to help make up for it, without that programmed amount I would wake up too high. So I keep tabs pretty constantly in the morning to make adjustments.

And then a third of the time I have a very slow escalation or once in a rare time hardly any escalation at all. I tried eating the night before to not eating after 6:00 pm, I’ve tried only carbs or only protein and none of it has seemed to work. I don’t eat anything above 10 carbs in the am as I can’t control my BG’s if I do.

Does this help you? Probably not lol! Except to tell you a CGM helped identify the extent of my problem and a pump helped to control it!

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I had severe insomnia for 6 months and tried every sleep medicine possible with no luck. I was finally prescribed Trazadone and it worked! I’ve recommended it to many people. The drug is actually one that my holistic doctor even recommends, he says it doesn’t stop REM sleep like many sleep aids do. It’s been around forever, it’s an older anti-depressant and given a lot to patients in the hospital to help them sleep. I take 50 mg. Good luck!

That’s a new one on me. I’ll check it out. Interesting that you say that Trazadone doesn’t interfere with REM sleep. My preference, however, is to sleep without taking any meds for it.

Some more observations. It is possible that this is a combination of phenomena. Waking up, just remaining in bed, I noticed a slight BG increase. I stayed in bed for about an hour. Then I got up, and the BG increased again, more pronounced this time.

Furthermore, I wonder if carbs can “linger” in your stomach if you eat them late at night, for example for correcting a low. So, is it possible that only part of the carbs were absorbed (and pushed the BG away from the low), and the rest remained for hours somehow in the stomach, and only get digested after you wake up?

Not linger in the stomach, but in the intestinal tract and if one has gastroparesis there’s even more issues with food causing bg raising for many many hours. When I used to eat large Mexican meals, my bg’s would be elevated for more than 10 hours (unless I carefully bolused using an extended bolus, but it’s really hard to predict how each similar meal will react with me because of other factors on any given day). I avoid eating like that 99.9% of the time. :slight_smile: