In our diabetes practice, we frequently get asked this question.  It is frustrating to go to bed with a glucose level in a good range but awaken to an elevated glucose. Following the American Diabetes Association guidelines, good glucose control is awakening between 80-130 mg/dl and keeping glucose less than 180 mg/dl after meals.

If something did not change in your body, you would continue sleeping. So, waking up is a good thing and glucose control needs to be maintained.  Elevated morning or fasting glucose can be termed ‘Dawn phenomenon’ and is described as the abnormal early-morning increase in blood glucose levels in persons with diabetes.  This is caused by the release of many counter-regulatory hormones including growth hormone, cortisol, glucagon and epinephrine. This can cause a dysregulation of hormone patterns leading to an increase of glucose release from the liver.  There may be insufficient insulin production and/or insulin resistance which is typical of diabetes. Thus, elevated fasting glucose.

Other things that can contribute to elevated fasting glucose can be poor sleep from pain, anxiety, or sleep apnea. Poor sleep from any cause is stressful to the body and is reflected in glucose values. Those that are overweight or obese have a high risk of sleep apnea. 

Ways you can help avoid elevated fasting glucose is:

  • Avoid snacking at bedtime.  There are many reasons to NOT eat at bedtime including heartburn and added calories.
  • Medications may need to be added such as basal or long-acting insulin. Another class of medication called GLP-1 can be very effective and has other benefits including lowering appetite, weight loss and heart protection.  The GLP-1 is a once WEEKLY injection compared to basal insulin which is once daily. The GLP-1 medications can only be used in Type 2 diabetes or obesity.
  • Current medication doses may need to be adjusted or timing may need to be changed.
  • If you are already on insulins, an insulin pump may be an option. Rates can be customized.
  • Low glucose….yes that is correct!  A low glucose sets the body in motion to FIX IT which in a diabetic can be exaggerated and cause elevated glucose later.  This is the opposite of Dawn phenomenon and is called the Somogyi effect.

To get an accurate view of your glucose levels during the night, wear a continuous glucose monitor (CGM), such as Dexcom or Libre.  These devices wear for 10-14 days and are then disposed of so cost is low. Knowledge is power and having complete glucose values gives you the power to better control your diabetes.

Most insurance companies cover the cost of CGMs if you are on one or more insulin injections daily.  If paying out-of-pocket for the CGM, I recommend periodic wearing:

  • Prior to visits with health care provider
  • Any change in medications, not just anti-diabetic meds
  • Any change in health
  • During sickness

Live Long, Live Healthy!

Dr. Julie Wood is a Nurse Practitioner and has been serving the Middle Tennessee area for more than 30 years, specializing in adults with obesity, prediabetes and diabetes. Office is located at 401 First Avenue, Mt. Pleasant, TN and statewide with telehealth. Dr. Wood can be reached at 931-325-5560,,  

Articles are meant to be informative and should never replace the advice of your health care provider.