Why is blood sugar high in the morning?

Many people are surprised to experience high blood sugar levels in the morning and understandably wonder why. Rest assured, researchers have been asking this question for over 50 years.

There are several reasons for this, and here I will explain three main ones.

Mr. Michael Somogyi was a biochemist and professor at the University of Washington.

In the 1950s, he hypothesized that "hypoglycemia leads to hyperglycemia."

In essence, to compensate for nighttime hypoglycemia, the body secretes counter-regulatory hormones like glucagon and adrenaline, which increase morning blood sugar levels. This is known as a rebound hyperglycemia.

This phenomenon is documented in type 1 insulin-dependent diabetes. However, in my practice, I have also encountered it in type 2 diabetics whose evening hypoglycemic therapy was too intense.

Today, the advent of continuous glucose monitors has made it easier to understand morning hyperglycemia.

In the past, to document and confirm this effect, patients were woken up during the night for a blood glucose test. In some countries where patients don't have access to continuous glucose monitors, they are still asked to wake up in the middle of the night to measure their blood sugar, just as Somogyi did.

This is a natural process that occurs toward the end of the night.

A natural process means it exists in everyone, both diabetics and non-diabetics.

As dawn approaches, the body releases hormones like cortisol, adrenaline, and growth hormone to prepare for waking up. These hormones stimulate the liver to release glucose. If this release is excessive, it can raise blood sugar levels.

Thus, a patient may find their blood sugar elevated in the morning, even though it was within target range before bed or before eating.

As one patient said, "The brain doesn't command the right amount of glucose to be released!"

Well, no it would be too simple!

In a healthy individual, the interplay between these glucose-releasing hormones and insulin maintains stable blood sugar levels.

But in a diabetic, this balance is disrupted. Therefore, it is crucial to study and understand what is happening.

The third reason I often encounter is improper carbohydrate consumption relative to therapy.

The evening meal is important and should not be neglected when you have diabetes.

I often hear, "I didn't eat anything, and my blood sugar is high.

" You're all very surprised when I respond, "Yes, that's normal."

Explaining the metabolic and hormonal reasons here would be quite lengthy, but know that it's always a balance between insulin and glucagon.

The body strives to find its fuel. The primary source is the liver's glycogen. Glycogen is mobilized, glucose is released, and blood sugar rises.

Therefore, you must eat in the evening.

Conversely, if you consume too many carbohydrates, your morning blood sugar will also be high. You don't have enough insulin to store the excess sugar in tissues and the liver. Your therapy is insufficient at this stage.

I have outlined the main reasons for morning hyperglycemia, but there are many others. None should be overlooked, as they all play a significant role.

• Worry, insomnia, poor sleep

• Anxiety, commonly known as stress

• Heat

• Fever

• Surgical stress

• Medication use, such as anti-inflammatory drugs or corticosteroids

• Too high an insulin dose at bedtime

• Issues related to your insulin injection technique

• Consumption of alcohol on an empty stomach or excessive intake

• Unusual physical activity during the day

If, despite all attempts, morning hyperglycemia persists, it is essential to consult your healthcare provider to adjust your treatment plan accordingly.

I would like to conclude on a positive note.

"Every problem has a solution; if there is no solution, then it is not a problem, or it has been wrongly posed." Albert Einstein.

From my practice, I unfortunately realize that the problem has often been wrongly posed, because the problem undeniably exists.

The solution lies in conversation, questioning, followed by careful analysis and study of the patient.

Today, we are capable of finding and providing answers.

Few practitioners take the time to truly reflect on and study their patients. Without blaming them, I understand why. The healthcare system is running in circles, like a dog trying to bite its own tail but unable to do so.

To understand, time is needed, time that practitioners do not have, and follow-up they are not allowed to provide.

Dietitians do not receive adequate training to fully understand all this. This is not a criticism, but a reality. One module on diabetes is not enough to grasp everything. Some dietitians take the initiative to continue training, which is fortunate for patients.

Personally, during my medical studies, I had only one course on diabetes.

It is impossible to teach us everything. My knowledge comes from a personal, multi-year learning process alongside my specialties.

Therapy and diet taken in isolation cannot solve the problem.