The Overnight Blood Sugar Conundrum

I agree 100%. I didn’t have an insulin pump when I was first diagnosed (because they didn’t exist!), but if someone took it away now, I don’t know how I’d survive! It may not be impossible to survive without them, but it would be like taking away our computers. We survived without them a long time ago, but when you have become as accustomed to using them, it’s one of those things where it’s hard to go back, especially if you like the new way better. Necessary? No. Preferred, better, more efficient? Yes.


It’s all part of DP, but they are somewhat distinct phases of it. For example, I get a slight rise starting at 3-4am, but it’s not usually large enough that it can’t be handled by the peak of Levemir or a slight basal increase when using a pump. When I wake up and get out of bed, I will get a significant rise that starts within 10 minutes of walking around and continues for the next hour or two. This is feet on the floor, and can be easily handled by MDI since it is tied to when I get out of bed, not a specific time. If I were to sleep in or wake up but just lay in bed, my BG usually stays constant until I get out of bed. Again, this is easy to deal with on MDI since even a pump user couldn’t program for this unless they wake up at the same time every day.

Or how about the DP that is not all the time! I can have five days in a row with no problems, than the next morning I do. There is no rhyme or reason to it, just sometimes I do and sometimes I don’t. Some days the climb happens before I get up and sometimes a few hours later. I did way back in 1990, go on the pump to help with this very problem, so I could get the ok to try for a baby. And a pump was the only way to make it happen. And here I am 27 years later still pumping, never taken a vacation and so enjoy the flexibility it has given me.
And that pesky DP, I just deal with it on the days it decides to read its ugly head and move on. It would be much easier if it was an everyday phenomenon but for me it’s not so I fix it and move on. A quick walk with a small correction and I’m good to go!

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Scott_Eric, my glucose level rises while I am in bed. If I didn’t give a shot in the early morning hours, my morning glucose level would be through the roof upon rising.

Is it Dawn Phenomenon? Or is it Feet on the Floor Syndrome? Or perhaps is it a bit of both?

Everyone is different. Some of us have far more trouble with spiking BG in the morning than others. And some of us don’t have this issue to the same extent every morning.

When I was younger, I didn’t experience this type of glycemic syndrome like I do now. I suspect many of us experience both of these issues to some degree.

Dawn Phenomenon - which usually occurs between 2-6AM - is the result of hormones releasing in the body in the early morning, predominantly growth hormone, cortisol, epinephrine, and glucagon – which in turn increase insulin resistance for 5 or 6 hours.

Feet on the Floor Phenomenon - which affects everyone in varying degrees - occurs as soon as you get out of bed. Your body signals your liver to release (dump) glycogen, which raises your BG. In combination with the DP adrenal release hours earlier, insulin resistance is significantly higher, especially if your BG goes high (very difficult to start the day with a high BG).

In addition to increasing my pump’s basal dose 5x’s at 3:30AM, I awaken myself at 3:45 every morning to decide what size bolus I need (anywhere between 1.75-3.75 Units), even if my BG at that time is 4-5mmol/L (72-90mg/dl)