why the spike in the moring when i don't eat

[styime]

I have had JD for 30 years and I have always gotten the answer of 'i'm not sure why' from Dr's so I pose this to you.  In the moring my BS is 157 at 6am i get ready for work go and retest at 8:30 am my BS is 276!  How can this be I have not eaten and my last meal was say 9 hours ago from 6 am?  I have been taking lanuts and that works great as will the humilog at leas in keeping my BS in control.

I am assuming alll my food is gone that i ate and since I do not eat anything where is this extra sugar comming from?  urine is negative in sugar and no ketones?

Always been a mystery without a really good logical answer.  I have had from 'liver might leak' to 'body movement releases sugar'.

thanks for the help

[JDRF-Team-sgg]

While both of the comments posted on this question COULD be the reason you are finding that your glucose rises in the morning, there is another possibility also. Let me address the first two comments first.

Dr. Johnson's comment is one possibility. But I would personally not make the assumption that you are dropping low at night and lower the long-lasting insulin (NPH or Lantus) just based on that assumption. You may want to set your alarm clock for some time in the middle of the night (maybe at around 3 a.m. if you are taking NPH before bedtime, for that would be when it would be peaking) and just do a blood test a few nights in a row to see for sure if you are dropping low while you sleep. This can be verified or negated as the reason for the morning glucose rising fairly easily by doing this a few times to see what those middle of the night sugars really are. You can then drink some juice if you ARE low or just roll over and go back to sleep if you aren't. But I would do this before making any assumptions that night lows are the problem and lowering your insulin dose. You don't want to change your insulin dose if you are not dropping low.

The other comment by imediject is another possibility. If you are injecting Lantus as your long-lasting insulin, and are injecting it in the morning, the Lantus will probably wear off between 20-24 hours after injection, causing glucose levels to rise in the morning until that morning's dose can kick in and cover it. You need insulin whether you eat or not, for a normal body produces and uses small amounts of insulin all day long, not just when we eat. That's why we take the long-lasting insulins -- to cover a base need for insulin. And the 24-hour insulin (Lantus) doesn't work full force for 24 hours and then just quit all at once, but it slowly peters out in 20-24 hours, depending on the person. So imediject has a valid point if you are taking Lantus in the morning. Many diabetics split their doses of Lantus and take some at night and some first thing in the morning so that peaking is minimal (for some of us, there IS a slight peak about 4 hours after injection) and the petering out of it as it wears off is also minimal. If this sounds like a possible solution for you, please work closely with your doctor to change your dose from a morning injection to either a night injection or a split dose that covers your base needs better.

BUT WAIT! There is yet another possible answer for you. Some people notice what is called a "Dawn Phenomenon", and the symptoms are exactly what you describe. There is a good explanation of what causes this on the following web site:
http://www.webmd.com/content/article/81/96985
This site also has a more detailed explanation of the Somogyi effect mentioned by the responder named Dr. Johnson.

Another website that has an even better explanation and some suggestions on how to minimize the Dawn Phenomenon (and this site also mentions the Somogyl effect) is below:
http://www.diabetic-talk.org/dp.htm

Some diabetics seem to notice more of this glucose rise in the morning than others. You may be one whose Dawn Phenomenon is more noticeable than some others. I am not a doctor, but a very knowledgable long-time type 1 diabetic whose volunteering with the Juvenile Diabetes Research Foundation puts me in contact with MANY type 1 diabetics, and this Dawn Phenomenon is widely written about.

Finally, hopefully one of these suggestions will fit your situation. Please do discuss anything you discover with your own endocrinologist. If you find that your problem is not due to night lows or to timing of Lantus injections, but is a Dawn Phenomenon evidencing itself, then please tell your doctor what you have read about (do a Google search on "Dawn Phenomenon and print out some articles for him or her). That way you can discuss it with your doctor and maybe help some of his or her other patients as well.

[B_Johnson]

The phenomenon is referred to as the Somogyi effect.  It means that your blood glucose drops too low at night and your body secretes cortisol (a stress hormone) in response.  Cortisol is a catabolic steriod and increases the amount glucose in the blood from energy stores in the body.

If you are on an NPH regimen before bedtime i would ask your doctor about lowering it so you do not drop so low at night.

If you are taking a lantus (which has no peak and should not suddenly drop you at night)type regimen you need to lower your last dose of QAC (dinner) regular insulin or possibly have a snack at night before you go to sleep.

The main problem here to remember is that you are dropping too low while you are sleeping and your body responds to this.  You should definately not increase the amount of insulin you take at night to compensate for the spike.

Please see your doctor about this.  Mention the Somogyi effect and tell him you might need to change your insulin dosing.

[Imediject]

I've had Diabetes for 42 years, and something came to mind when I read that you're taking Lantus -- do you take it once a day, and is it in the AM or PM?  I went through the Very same thing you're talking about when I was taking it once a day in the morning.  The Lantus plus the humalog for carb coverage at meals worked great through the day, evening, and most of the night.  But the problem was that the Lantus wasn't covering me for 24 hours.  My BG at 4AM was always excellent - somewhere between 80 - 130, but when I did a finger stick at 8AM right before taking my Lantus, it was anywhere from 200 - 300.  No food in between - just this huge jump.  Keeping good records showed me that I got 18-20 hours of coverage At Most from the Lantus, and when I hit that blank spot between 4 and 8 AM, there was just nothing left.  I ended up splitting the Lantus to a 2/3 dose in the AM, and 1/3 in the evening.  That covered the 'no Lantus left' spot that was causing the mystery highs. I've found through experience that Lantus works differently for just about everyone, so maybe you might want to talk to your doctor about the less than 24 hour coverage possibility and what changes might be made.

Bonnie

[styime]

Thanks for the great tips.   i have had reactions at night so it may be too much humilog, but then again my last meal is around 7 and i go to sleep at 11 pm.

I take lantus roughly at 10 pm and I have foiund out that when I take a snack (1 carb) and do not that the humilog for that I have a great spike in the morning that without say taking the 1-2 ccs for the snack.

I will speak to my dr. about all of this soon.

thanks again for your help