When things go bump in the night

One of the interesting things that I deal with is a rise in blood glucose overnight. I go to bed with a BG of 84 mg/dL (last night), and wake up with a BG of 104 (this morning)! My last meal was about 12 hours ago so what happened?!

This can be the results of two different processes: Dawn Phenomenon and Somogyi Effect.

The dawn phenomenon is a natural part of our bodies circadian rhythm. The evolutionary process developed this so that our ancestors could get up in the morning after a night of fasting and have enough energy to find food. This is great ability to have when your food can run away ( think woolly mammoth ) but not so great when you just need enough energy to open the refrigerator.

The Somogyi Effect is caused by the bodies response to night time hypoglycemia. When BG drops overnight the body reacts by secreting a hormone, glucagon, which signals the liver to start converting stored glucose (glycogen) into glucose. This of course raises your BG.

I notice that my before breakfast morning BG is always higher (about 20 points higher) than my bedtime BG. I believe it’s the dawn phenomenon at work. Have you experienced either the dawn phenomenon or the Somogyi Effect and how have you controlled it?

Absolutely. Both.
But I think I mostly have dawn p. I can go to bed with a reading of 100, be at 100 at 2 a.m., and wake up at 200. And, more frustrating, this doesn’t happen every night.
The way I deal with it is to test during the night. Since I do not like alarms, I drink 12 ounces of water at bedtime and am naturally awakend at about 2 to pee. I then test. By that time, I can tell if I’m headed up or not.
If, at 2 a.m, I’m much above 100, I take a correction dose which I’ve pretty much got nailed. This works about 75% of the time.
I always have significant Som. Effects to a hypo, no matter what time of day they occur. If I wake up at night with a hypo, I treat it, set the alarm for an hourt later, retest and correct.
Just call me “the night prowler”…
Hope you get some solutions, however, 20 pts higher doesn’t seem like a big deal to me.

It’s also possible that you’re taking slightly too little long-acting insulin. Testing in the middle of the night will let you know if it’s a slow, all-night rise or if it’s one of the two things you mentioned.

Does anyone else have good advice for getting up in the middle of the night to test? I’ve been having to do it off and on for a few months, and it’s getting harder and harder to make myself wake up.

The water thing really works for me. But, I’ve been doing it for 5+ years so it’s a pretty steadfast habit.

I’m not regularly using insulin yet but one thing I noticed is that if I don’t eat when I get up in the morning, and particularly if I exercise, my BG goes up. I’m still in the honeymoon phase and my fasting BG is around 85 most mornings. However, if I don’t eat right away, my BG is usually up at 105 or so. That’s just 20 points but it annoys me to go up without even the pleasure of a bite of food. I think it’s the Somogyi Effect because my BG was dropping. I do the night time wake up routine to take my Synthroid since it has to be taken at least 2 hours after eating, or one hour before. I always wake up at least once to pee, so I occasionally test my BG and it is pretty stable all night so far.

I always eat breakfast first thing in the morning. I don’t skip meals and I have been doing the “right” things. I eat whole grains, low sugar foods, (actually did that before diabetes), test before each meal, between meals, and before going to bed.

How does one determine the “right” amount of basal insulin?

The water thing worked for a day or two, but everything I try ends up not working eventually.

It seems to be a lot of trial and error - keep good records, try shifting things just little bits at a time. Talk to your endo, or maybe a CDE nurse who can spend some time going over everything.
That’s the biggest frustration of sb - just when you think you’ve cracked the code, something changes and then you have to start all over.

I’ve totally have the dawn phenomenon. I’ll go to bed at 110 and wind up at 200+ in the morning. The wierd thing is as soon as I start moving around and getting ready for work it drops a good 70+ points. I’m not sure if the temporary high is harmful, but considering how fast I drop, I’m not sure how or if you should correct it.

It is my opinon that going from 84 - 104 is hardly anything for concern - i would be delighted with such results - you could take another meter read and get 84 - meter reads vary greatly back to back -with the DEXCOM double meter read calibration - i often get back to back readings that vary 15% -20%—sometimes more.

I suffer from the dawn phenomenon - my BS raises up to 80 mg within 20 minutes after i wake. if i wake at 120 - i will easily be 200 by the time i am considering eating(prior to getttin basals straight). I have my basal’s set to go from .4 (overnight) to 1.6 at 6:00am and that runs for 1.5 hours, then it falls off to 1.15 for another hour and then i drop to .70 for most of the day.

Mollie, I exhibit the same thing: b.g. rises 40 - 60 points in the first hour upon waking. But I was thinking it’s not actually dawn phenomenon. I thought dawn phenomenon was always before waking and always at a set time (like 5-7 am-ish).

For me, my b.g. will rise in that hour after getting up whether I wake up at 7 am or 10 am. But if I wake up, check my b.g. without getting out of bed and go back to sleep, my b.g. does not go up. Also, the rise is somewhat smaller on weekends than weekdays - so I was wondering if stress of getting up and going to work has an impact. Finally, if I manage to eat in the first 5-10 minutes, it seems to be diminished although it’s hard to tell because you have the added factors of food and bolus insulin. Since I don’t always wake up at the same time each day, now I just automatically take a bolus when I get out of bed, otherwise I would change my basals.

I agree that a 20 point rise overnight doesn’t bother me at all, it needs to be closer to 40-50 for me to think about it. I experienced Somogyi sometimes and reduced my basal to compensate and that helped - but also sometimes if I’ve eaten a late dinner with a good bit of protein, my b.g. rises through the night.


I don’t have D, but my 5 year old son does. I get up 2-3 times a night to test his sugar. I found that I was starting to sleep through the alarm or rather I was turning it off in my sleep. So, I put the clock on the other side of the room and set it. Now, I have to get up to turn off the annoying sound, and while I’m up, I check his sugar. I hope this helps.

I have a very similar deal, which I think is totally separate from dp or som. effect.
My theory is that when you get up, the body senses a shift and in an attempt to get ready for the day, dumps glucose in your bloodstream to give you energy.
If you already have dp going on, this really adds to the chaos.
On weekends, I sometimes go back to bed after my 6 a.m. test - if I sleep until much bast 10, I will easily have a severe hypo. If I get up at 8 or 9, my bg will immediately start shooting up, so I too take a correction as soon as I get up. Plus, morning exercise will easily send me over 300! (No early morning walks for me).

I’ve tried this too. :slight_smile: Also putting the alarm under my pillow. Setting two alarms. Putting the alarm in the bathroom. Rigging a light to go on when the alarm goes off. Putting it in a box with my testing supplies. I think I just need more will power. I can’t imagine getting up 2 or 3 times.

The question I am really asking is how do I know that it was the increase/decrease in basal insulin that affected my BG and not something else (stress, food etc)? Unless I can keep everything else fixed and adjust basal (scientific method) to see the effect then as you say “it is trial and error” and there really is no definitive system.

Wow! If I had such an erratic sleep cycle I would be one sleep deprived and cranky geek.

I have a dawn phenomenon that was extremely hard to deal with before I got the pump. I was regularly going to bed at 6, being 6 at 2 or 3am, and then waking up at 11 or 12. If I went to bed at 10 I would easily wake up at 17. The only way I could stop it was by waking up at 3am and giving myself 2 units of Humalog which I couldn’t do every night!

Now that I’ve gotten my pump my basal rate goes from 0.7 to 1.0 from 2-7am, and then goes back to 0.8 for the rest of the day until 10pm. I think it might need a bit of adjusting, because I’ve been waking up high a few mornings this past week.

I do the drink of water thing too! I’m glad I’m not alone in that! Alarms just don’t wake me anymore, I seem to be just toooooo tired every night.

I get the ‘wake phenomenon’ - Not sure if it has an official name, but that’s what I call it. My BG steadily rises from the time I get up to the time I eat. I don’t like to eat as soon as I get up, so instead I have a couple of units of NR to see me through until breakfast.

I get the bouncy Somogyi effect once in a while too, which always freaks me out. The only clues I have to let me know I’ve been low overnight is the high BG I wake up with and the fact I feel shattered for the day. Thankfully it doesn’t happen often, but it’s scary knowing I’ve slept through a low :frowning:

It sounds like the dawn p to me atleast that’s what happens to me on the other hand when things go bump in the night it’s usually me having a low! HA!