03/12/2022
High sugar in the morning with diabetes: who has it? Why? What to do? The endocrinologist answers.
Who faced such a problem: before going to bed, sugar is good, and in the morning - high?
An increase in sugar in the early morning hours is called the "dawn" syndrome or phenomenon. Most often occurs in type 1 diabetes in adolescence, but can remain for life. May occasionally appear and disappear. With type 2 diabetes, this situation is also possible.
What is it connected with?
Around 4-6 o'clock in the morning we have a hormonal "splash". In the blood at this time, the maximum level of cortisol, prolactin, testosterone, somatotropin, thyroxine and many other hormones is determined. They are also called "contrinsular" because they suppress the action of insulin. A healthy pancreas at this time simply produces more insulin. In type 1 diabetes, there is no insulin in the body, hence the problems.
In type 2 diabetes, the cause may be slightly different - in the liver. If there is fatty hepatosis, she, the nurse, actively produces sugar all night, and by morning she can simply try her best.
How to identify the "dawn"?
Let's consider several options:
1. Sugar at bedtime 8 mmol / l, at 3 am (yes, you need to set an alarm) - 7 mmol / l, at 6-8 o'clock in the morning - 6.5 mmol / l: this is normal, excellent and healthy.
2. Before going to bed 8 mmol / l, at 3 o'clock in the morning 9 mmol / l, at 6-8 o'clock in the morning - 10 mmol / l: if there was no intake of a large amount of carbohydrates at night and this situation is repeated constantly -
not enough extended insulin for the night! If it is type 2 on tablets, it may be necessary to increase the dose of metformin in the evening. This, of course, needs to be discussed with your doctor.
3. Before going to bed, sugar is 8 mmol / l, at 3 am -5 mmol / l, and at 8 am - 11 mmol / l. If you set the alarm for 6 o'clock - the picture will be about the same-11! This is what "morning dawn" is. More often, sugar rises at 5-6 o'clock in the morning, but sometimes closer to 8 o'clock, everything is individual. Sometimes the patient notes: he got up at 7 in the morning, measured his sugar - it was normal, DID NOT EAT ANYTHING, measured it again before breakfast (for example, at 8.30), and the sugar is high. This can also be a manifestation of the "morning dawn"
And what to do then?
Nothing depends on the patient in this situation. I read from some "extremists" with type 2 diabetes about intermittent fasting, which seems to help them. But if you have diabetes, you can't starve. Let me remind you, for a moment, even on pills you can get hypo. Even on a single metformin. Dinner at 6 o'clock with fish and cucumber, hello hypo, in the middle of the night! Yes, not necessarily, yes, not for everyone, yes, there will be no hypo if the sugar is stable around 10. But we doctors are such bores, sorry.
The only way to deal with "morning dawn" is an additional injection of SHORT-acting insulin before the expected increase in sugar. Those who are on the pump are lucky here: they increased the rate of insulin delivery an hour before the X moment and sleep peacefully. What about the rest? Ideally, set an alarm for 6 in the morning (we don’t need to, we’re not animals at all) and make a joke. Sometimes a fairly large dose is required. The attending physician must prescribe insulin taking into account this feature!
Increasing the dose of prolonged insulin at night will not help, on the contrary, it will cause nocturnal hypoglycemia.
"Uh doc, I'm actually on pills, what are you talking about?"
In case of type 2 diabetes mellitus on tablets, a possible rescue may be the most late use of metformin and / or taking drugs such as Forsiga or Jardins (appointed, of course, by your doctor!). But, if it doesn’t help, a shot of short insulin is also prescribed. Yes, insulin. One injection per day. It can be experienced. But consistently high sugar for even 2-3 hours daily will lead to the development of complications of diabetes.
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