I started having this issue a few years ago and did some research and found in my case it was in fact the "Dawn Phenomenon" that people have mentioned, where your body basically is starting to get you ready for the day. I have had experiences when going low and it has "rebounded" and ive woke up in the morning rather high, but I'll focus on the "Dawn Phenomenon" here because it can be a bit more difficult and to me sounds like what you might be experiencing (Im not an expert though)
Im on Novorapid / Levemir for short / long acting respectively (sorry i never really use basal / bolus terminology). I found that no matter how Basal (long lasting) I had, the rise would just keep on going up and would be slowed by a Bolus injection. But that was only temporary, it seems quite counter productive but I HAD to eat something, like cereal or a slice of toast, to stop the dawn phenomenon from continuing.
I know that everyone is different, I have always managed my diabetes in a slightly different way (which it took any new doctors a while to realise) but it works really well for me! So some of the tips i mention may not apply.
Sorry if you are already doing some of this stuff and Im telling you to do what you are already doing, but I'll just mention everything you might find helps.
Ill start out with some non-diabetes related solutions you could try that I have found helped:
- Regular routine in meals and sleeping pattern, this will get your body used to when to start giving you energy for the mornings.
- Comfortable surroundings - Now this is gonna sound rather weird, but when I was living away for a year, my Dawn Phenomenon was worse and more severe. AS SOON as I went home it was INSTANTLY back to normal. I put this down to it being more comfortable spaces that I was more at ease in and this had some sort of underlying effect on it. (Diabetes for ya!)
- Food types to avoid. I could eat any food and with the right adjustment of insulin, quantities of food and exercise I would be fine. In the past few years this has had to change. I've found that foods that are high in carbs and fats (that you might have for treats) are stuff i no longer touch with barge pole. They outlast my bolus by a good few hours and at night time can cause me to spike high the middle of the night with no prior warning. Rice can also cause this, it seems to kick in after my bolus has passed its prime and then requires a 2nd injection, same as above about the middle of the night. So now i just stick to lower quantities of rice. If diet could be an issue, try eating maybe lower carb meals and then when you get a handle on it look at expanding your foods. Again sorry if you already eating low carb meals and everything!
Some diabetes related things:
- The libre! A few people have already mentioned it, but even if you look at getting it / self funding it for a month or so it will let you see trends. I started out self funding on it and it was like night and day! I could see exactly when i would start to rise, my trend in the night and how different things I tried had different effects.
- Monitor sugars before bed, I know you said your sugars are spot on before bed, but do you know the trend, are they level? Are they dropping (could be you going low in the night and "Rebounding"? Are they already rising and then going even worse?
- Pump, if you can maybe a pump will work since it can help you when you sleep. Im not on a pump, I know... I need to look at getting one and I'm behind the times on it!
Personally, I have always adjusted my insulin as I see and need fit and its always worked well for me. I know some people don't like to do this or aren't confident with it, so ONLY TRY THESE STEPS IF YOU ARE CONFIDENT CHANGING YOUR INSULIN AMOUNTS! Otherwise speak to your diabetic nurses / doctors:
- If you are on a basal / bolus regime (like me) try looking at when you take your Basal (long lasting). If it has a "peak" time you could try timing that for during the spike you experience. (I take mine at 11-12pm, just before i go to bed)
- Maybe look at increasing your basal (long lasting), even though i said mine rose though anything, yours might not or it might atleast lessen the effects. But be careful with this, because during the day you might start to have lower blood sugars or earlier in the night before the rise happens (which can be even more dangerous)!
- When it got bad and i would rise from 5am and it would just nuts until i woke at 8, I started having a small amount of bolus (short acting) at around 5:30 to stop it from going out of control until i woke up. This can be quite risky if you aren't used to doing this so please only try this if you have no other options that are helping and are VERY confident in changing dosages and injecting as and when you need!
- Splitting your basal. I don't personally, but i know a lot of people do and it has helped them. Maybe try looking into that, I don't know about it so definitely speak to people before doing this.
Sorry for the essay! Sorry if some things don't apply, I couldn't get a full understanding of your situation from what i saw, but i hope some things help.
Anything can effect sugars like stress or even the weather, so try a few things out lifestyle wise and see if they help.
TL;DR version:
Sounds like the "Dawn Phenomenon". Everyone is different but above are some lifestyle tips / monitoring tips / insulin changes (BE CAREFUL WITH THESE) that might help.
Good luck!