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High readings.

Discussion in 'Type 2 Diabetes' started by ally1, Sep 23, 2015.

  1. fobbletops

    fobbletops Type 2 · Active Member

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    What Causes High Blood Sugar Levels in the Morning
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    There are two reasons why your blood sugar levels may be high in the morning – the dawn phenomenon and the Somogyi effect.

    Dawn phenomenon
    The dawn phenomenon is the end result of a combination of natural body changes that occur during the sleep cycle and can be explained as follows. Your body has little need for insulin between about midnight and about 3:00 a.m. (a time when your body is sleeping most soundly). Any insulin taken in the evening causes blood sugar levels to drop sharply during this time. Then, between 3:00 a.m. and 8:00 a.m., your body starts churning out stored glucose (sugar) to prepare for the upcoming day as well as releases hormones that reduce the body's sensitivity to insulin. All of these events happen as your bedtime insulin (or medication)dose is also wearing off. These events, taken together, cause your body's blood sugar levels to rise in the morning (at "dawn").

    Somogyi effect
    A second cause of high blood sugar levels in the morning might be due to the Somogyi effect (named after the doctor who first wrote about it). This condition is also called "rebound hyperglycemia." Although the cascade of events and end result – high blood sugar levels in the morning – is the same as in the dawn phenomenon, the cause is more "man-made" (a result of poor diabetes management) in the Somogyi effect. There are two potential causes. In one scenario, your blood sugar may drop too low in the middle of the night and then your body releases hormones to raise the sugar levels. This could happen if you took too much insulin(or oral medication) earlier or if you did not have enough of a bedtime snack. The other scenario is when your dose of long-acting insulin (or oral medication)at bedtime is not enough and you wake up with a high morning blood sugar.

    Because the cascade of events is the same with both scenarios, how is it determined if the dawn phenomenon or Somogyi effect is causing the high blood sugar levels?
    Your doctor will likely ask you to check your blood sugar levels between 2:00 a.m. and 3:00 a.m. for several nights in a row. If your blood sugar is consistently low during this time, the Somogyi effect is suspected. If the blood sugar is normal or high during this time period, the dawn phenomenon is more likely to be the cause.

    How can this situation be corrected?
    Once you and your doctor determine how your blood sugar levels are behaving at night, he or she can advise you about the changes you need to make to better control them.
    This article states if you are on insulin but the same natural body changes occurs with oral medication. Hope this helps.
     
  2. JenniferW

    JenniferW Type 2 · Well-Known Member

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    This is the first reference I've come across to there being different causes for high morning readings - thank you for posting.

    I've now got most of my day's readings down to within the target ranges, and some are even 'normal'. But the first one of the day remains high (above 7, as high as 9), and whatever I change seems to have no effect - supper / no supper, etc.

    Can I ask a question about the testing during the night? How does the time you test relate to the time you go to bed (and get up). I'm a late-night sort of person, so am often going to bed after midnight. Testing between 2:00 a.m. and 3:00 a.m would be testing sooner for me than for someone going to bed around 10 o'clock, for example.
     
  3. Indy51

    Indy51 Type 2 · Expert

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    @fobbletops - sorry, just noticed your post when quoted by Jennifer.

    According to Dr Bernstein, the Somogyi effect is a myth:

     
  4. phoenix

    phoenix Type 1 · Expert

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    I agree with Dr Bernstein about Somogyi being a myth! . When they have used continuous monitors they find that low glucose during the early hours ends up as low glucose in the morning (unless treated) and vice versa ; rising or high glucose levels at night ends up as high glucose in the morning. (the papers have to say the effect is 'rare' because they can never find it, but there might some rare exceptions)
     
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  5. JenniferW

    JenniferW Type 2 · Well-Known Member

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    Well, that's a sort of good news - there's not much point in me getting up in the middle of the night to check my levels!
     
  6. fobbletops

    fobbletops Type 2 · Active Member

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    As Type 2 Diabetes Develops

    During the years when type 2 diabetes slowly develops (which may be up to 10 years through developing metabolic syndrome and continuing on to prediabetes), hormonal control of blood glucose breaks down. To understand how your body responds, it's important to understand the essential hormones involved in blood glucose control.

    Four hormones are involved in blood glucose control:
    Insulin, made in the beta cells of the pancreas, helps the body use glucose from food by enabling glucose to move into the body's cells for energy. People with type 2 diabetes have slowly dwindling insulin reserves.

    Amylin, secreted from the beta cells, slows the release of glucose into the bloodstream after eating by slowing stomach-emptying and increasing the feeling of fullness. People with type 1 and type 2 diabetes are amylin-deficient.

    Incretins, hormones secreted from the intestines that include glucagon-like peptide 1 (GLP-1), enhance the body's release of insulin after eating. This in turn slows stomach-emptying, promotes fullness, delays the release of glucose into the bloodstream, and prevents the pancreas from releasing glucagon, putting less glucose into the blood.

    Glucagon, made in the alpha cells of the pancreas, breaks down glucose stored in the liver and muscles and releases it to provide energy when glucose from food isn't available

    Out-of-Control Blood Sugar During Sleep
    For people in the early years of type 2 diabetes, the hormones that control blood sugar can particularly go awry. Here's what happens during sleep to a person with type 2 diabetes:

    "Overnight, the liver and muscles get the message from excess glucagon to ramp up the glucose supply because the person is sleeping, not eating," says Marty Irons, R.Ph., CDE. "There is not enough GLP-1, insulin, or amylin hormones to stem the tide of excess glucose from the liver and muscles, essentially throwing this feedback loop out of whack."

    High fasting blood sugar levels, particularly in the earlier years of type 2 diabetes, result from this hormonal imbalance. Evening meals and snacks may get the blame for morning highs, but hormones are the likely cause.


    I have had the same problem with my blood sugars being 7.5 etc at night and then being 8.9.in the morning.
    I am taking my blood sugar before bed and if I wake up I take it again. I try to have a small snack just before going to bed as that stops your liver and muscles getting a message that you are not eating. My morning BSL 's have gone down and last night my bsl was 6.2 and this morning 6.8. Still up a bit.
     
  7. fobbletops

    fobbletops Type 2 · Active Member

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    I am finding repeatedly this happens with me. Low in the early hours and high in the morning so I do not think it is a furphy. also I am a nurse and have found this with a lot of patients who wake with lows in the night and then have highs. The other thing of course it could be that you are not getting enough insulin or oral medication the night before.Or your carbs are too high the night before.Have you seen a dietician. Good luck.
     
    #27 fobbletops, Sep 30, 2015 at 6:16 AM
    Last edited by a moderator: Sep 30, 2015
  8. Brunneria

    Brunneria Other · Moderator
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    I don't, of course, disagree with the quote, but my first reaction is 'Wouldn't it be nice if life were so simple?'

    My DP is largely governed by stress hormones.
     
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  9. Mike d

    Mike d Type 2 · Expert

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    I find the opposite. No, I'm not a nurse
     
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