I’m wondering if anyone can provide any insight as to why this happens. I’ll use this morning as an example. I woke up and was 109. I knew this meant trouble. If my sugar is, usually, over 90 and certainly 100 when I get up, my sugar will (95% of the time at least) spike into the high 100s or 200s (depending on how soon again I check it). If I wake up below 90, it typically remains stable. Why would what my sugar is upon waking make such a huge difference in where it is going to go within the hour (it happens very fast)?? I haven’t eaten anything, by the way. It drives me crazy. When I got up and was 109, I was quite sure it would be high (it was 183 within an hour) but I can’t exactly take insulin at 109, no matter how sure I am it is rising. Why would my sugar stay stable waking at 70, but rise 100+ if I’m over 100?? Anyone wager a guess or idea? I’m thinking dawn phenomenon, but I’m not entirely sure that is it. It’s as though I get out of bed and my liver thinks I’m about to run a marathon and goes nuts pumping out glucose (but again, only if, roughly, over 90)?
If it isn’t dawn phenomenon, maybe you are going low shortly before you wake up and what you experience is your sugar bouncing back, because your liver is pumping out glucose like crazy. You could try to see if reducing your basal makes any difference.
I actually did reduce the basal rate in the couple hours prior to waking up, then increased the basal rates in the few hours after waking up. This seemed to decrease the number of times this happened to me, but I still have these issues from time to time. My typical pattern is to wake up in the high 60s or 70s. Then about four hours later when I test again, I’m in the 80s or 90s. This is my usual pattern. Just trying to understand why being over 90 would cause such a massive spike (I’ll go into the mid 200s if I don’t test within 1.5 hours of the last reading).
I suppose I could try testing an hour or so before I get up (I wake up a lot, so this probably won’t be a problem) to see if indeed I’m getting really low, but my gut says no. During the 5 days I tried the CGM, my sugars were pretty darn good throughout the night.
I think I’m doing the best I can with the situation. If I wake up over 90, I test within/around one hour later to see where I am and give a correction bolus, which is almost always what happens. I don’t know what else I can do… just know my body’s trends as best as possible and deal with it. My last A1C, I’m happy to say, was 5.4 so I guess I’m not doing too terribly bad : )
While I agree with Kat, your thoughts on dawn phenomenon could be a possibility as well. I have battled with DP throughout , nesessarily just at dawn). In the beginning it was nothing unusual for me to awake every morning between 420 and 450!! Not a good way to start ANY day! But after trying several different insulins and insulin regiments, I finally began pump theropy which fixed my problems quite quickly, partially because my body doesn’t seem to utilize long acting insulins at all…
Anyway, I also question exactly when you are testing. Do you test the minute your eyes open (my doctors words) or after you’ve been awake for a few minutes or maybe even after getting out of the shower… These little things can effect your results. I would bet your basal changes just about the time you normally get up anyway, so it’s possible that tweaking the time that rate changes may fix your problem as well… (ie. if your basal decreases at that time, make it decrease alittle later in the morning, if it increases however, maybe make that increase alittle sooner)
I still agree with Kat tho… the most likely candidate is that you maybe coming out of a low…
Sounds like DP…I experience almost the same thing(and like you, the lower I am when I wake up, the less significant the rise). The issue I have, since it happens right after I wake up, is that I can’t set a higher basal rate to catch it, as I don’t wake up the same time everyday. If I raise my basal rate, I will go low with it while sleeping. So, for me personally, I have gotten in the habit of bolusing about .6u the minute I get up(even if I am not eating, and even if my BG is in range) to counter the rise. It works for me.
I test my sugar as soon as I get out of bed (so, within a minute). And you’re absolutely right about the basal rate changing as soon as I get up. Quick review - at midnight rate is 0.5, at 2:30 a.m. rate is 0.3, at 5:00 a.m. is .35, at 7:30 a.m. it jumps up to 0.9. So I go from .35 to .9 after getting out of bed. It used to be 0.7 but bumping it up to 0.9 seemed to keep these spiking problems from happening as often. I’ve kind of thought… “well, maybe I do have problems with DP, but I’ve learned to get the insulin rates right, so I’m okay”. I’ve hesitated with increasing the rate earlier than when I get up, due to the fact that what is typical for me is the 60s and 70s. It’s a very, very fine line for me in the mornings.
A side note - on weekends when I get up much later than during the week, I never have problems with my sugar spiking. If anything, I have problems with lows, since my liver sees I’m crashed out in bed, and doesn’t bother with pumping out extra glucose… who knows… But it is nice to know that the ones reading this completely understand what a challenge this disease is to keep in control! Many thanks to all of you for your comments. Food for thought from the experts, those living with this : )
I’ve thought about doing that (dosing a little despite a good BG range) but I’ve been fearful of running too low, since I don’t always spike (most of the time I do, but not always). That’s basically why I just increased the basal rate an additional 0.2 units for a few hours after getting up. But though I don’t want anyone dealing with this, it is still reassuring to know others can relate to this problem! This morning would have been a perfect time to give a little dose when I got up. I knew in my gut my sugar was rising (because I didn’t feel 109, I felt higher… always a giveaway of things to come!) so I just might give your tactic a try when this happens again. Thanks sooo much for the advice!
I’m with other folks - this sounds like the dawn phenomenon, although not observing ANY effect if you wake up on the lower side would be unusual I think. The extent of mine can be quite variable, though I haven’t managed to find any causality with respect to when it’s severe and when it isn’t. It’s something I have wrestled with the entire time I’ve had diabetes (25+ years).
Be very careful in trying to adjust your morning and night time basal rates, or long term insulin if you’re using that, to compensate, and work closely with your endo - trying to adjust insulin levels in your sleep can cause nocturnal hypo and all the attendant problems with that, up to and including seizures, etc.
I know, that’s what bugs me. No serious raise in sugar at all if I stay below 90-100 when I get out of bed. And I’m happy to say seizures are very much a thing of the past since going on the pump a little over five years ago (spent 23 years giving shots…hard to imagine now!). No problems with lows requiring assistance with the pump : )
Thanks everyone so much! An odd form of Dawn Phenomenon it is!
Do you eat breakfast soon after waking up? I’ve found that eating almost immediately keeps my BG from going higher. So, I test, inject, eat right away even if I’m high.
Could stress in the morning when you’re rushed be a factor, or not getting enough sleep on the days this happens? You mentioned that you don’t experience this on weekends.
No, I don’t eat breakfast at all and I’m not stressed or rushed and get enough sleep (I do horribly without it, so definitely get to bed at a decent hour).
My theory as to why I don’t experience this on the weekend is because simply getting up and about can (again, only if over 90 or so) in itself raise my sugar. I’m thinking my liver assumes I’m about to run a marathon and so goes to town raising my sugar once I’ve gotten up. If I stay in bed until 10 or 11 am, no raise in sugar at all. In fact, I will tend to get low since the basal rates are at their highest for the day. I really should create weekday and weekend basal rates for my morning, but haven’t. Do many of you have weekday and weekend rates that differ?
Might be worth experimenting by eating when you’re above 100 to see if this tames the spikes. This should tell your liver there’s enough glucose for the marathon.
You mean eating something and giving insulin for it? I’m afraid I’d really complicate things then. Even when I’m low enough to warrant some orange juice, I literally have to count the sips or I’ll end up too high. Three small sips of typically enough. Five might be too much. I just have a crazy sensitive body in the mornings. Tiny things make a huge difference. Then again, I’m really pretty sensitive all the time. I have to consider every single tenth of a unit. My room for error is maybe, maybe two-tenths of a unit. It sucks, but keeps me on my toes if nothing else!
I have to say again, you guys are all wonderful for writing with your thoughts!
Yes, eating & taking a bolus, like you would for any meal. It’s worth a try to see if it stops the spike. What stops the liver from dumping more glucose is food, if glucagon release isn’t due to stress hormones.
I never was a morning person ; )
Me either! Having to eat in the morning was a chore for me. But, it was either that or watch BG climb. I don’t eat much for breakfast, just some protein to keep it in check. Carbs in the morning would send me sky high.
I would try testing on other areas of my body such as the forearm, fingers, thumb, right side and left side first. I am wondering if it is a circulation thing and your BS is actually higher but because your fingertips may not be circulating the blood well they may report lower until the blood gets circulating better.
Try doing four or six tests first thing when you get up. Right finger, left finger, Right forearm left forearm and maybe even upper leg not quite at the groin level to see if they report different numbers.
Testing using other sites will show different readings because arms & legs will be about 15 minutes behind. If Tiffany is consistently using her fingers for testing, she’s getting consistent results in knowing that BG spikes from over 90 to high 100’s & 200’s.
Gerri - I agree with the breakfast chore. I just raised the basal rates in the morning hours to avoid the rises and it did help. And me as well, a few sips too many of OJ and sugar goes crazy high. And I always use my fingers to test. But, you know, I actually was stressed this morning (extremely rare) in that I forgot to set my alarm, so panicked when I woke up to realize that (I only got up 2 minutes late though, wooohoo!), but still, maybe that played a factor this time. I think I’ve decided on this plan. The next time I wake up with a sugar over, let’s say 100 and I feel higher than that, I’m going to go ahead and give 0.5 units. Start with that and hopefully put the brakes on things. Or, Gerri, maybe eat a piece of cheese and see if that helps. I’ll try a number of everyone’s suggestions and let you know how it goes. These instances have become rarer for me since making changes to my basal rates, but they do still occur.
I never ate breakfast before being diagnosed. Now–ugh, have to. The times when I’ve been high & not eaten anything for fear I’d be soaring, taught me to eat right away. I have to be careful not to oversleep because my dawn phenonmenon hits hard then. I’m not on a pump, so it’s harder to make the adjustments you can.
I’m glucose sensitive also & have to be super careful when correcting lows. Doesn’t take much to overdo it for me.
Sounds like a great plan! Please let me know how it goes.