Diabetes Forecast

How Can I Fight Morning Highs?

My morning blood glucose is quite elevated (190 to 260 mg/dl). Is there a certain time before bed that I should eat to help lower my blood sugar? Are there certain foods I should eat after dinner? Nancy Lipschutz

Belinda Childs, MN, ARNP, BC-ADM, CDE, responds:

The rise in your blood glucose in the morning may not just be about when you snack at bedtime or what you eat. It may also mean that you need an adjustment in your medications, physical activity, or some combination of all three factors.

What to Know: The dawn effect or phenomenon occurs in people with both type 1 and type 2 diabetes. Early in the morning, the body releases wake-up hormones that can make your body's insulin less effective. Meanwhile, the liver releases too much glucose overnight. The result is a rise in blood glucose, usually between 3 and 6 a.m.

Find Out More: Recording three or four consecutive days of blood glucose levels three or four hours after supper or at bedtime and before eating in the morning will allow you and your health care provider to review how much your blood glucose levels are increasing overnight. A 3 a.m. check can also be helpful, as that is when the dawn effect often sets in. This information will help show whether you need a medication change to alter the glucose release or control the rise in blood glucose. It will also provide feedback about any evening snack you may have.

Possible Solutions: Although research does not prove the benefit of a bedtime snack for controlling morning (fasting) blood glucose, many providers still recommend one. The theory is that the food in your system tells your liver to hang on to extra glucose instead of releasing it and raising blood glucose levels. Use your glucose monitoring as a tool to determine the value of a snack for you. A low-fat, high-fiber snack such as air-popped popcorn or reduced-fat string cheese and whole wheat crackers may be a good choice. Avoid high-fat foods, because they can promote insulin resistance and may contribute to morning highs.

Physical activity makes the insulin you make or take work better, and the benefit lasts up to 36 hours. So an afternoon or evening walk is likely to lower your fasting blood glucose the next morning. Finally, talk with your health care provider to see if you need a change in medication to help control morning highs.

Takeaway: A reminder: The goal for most people is fasting blood glucose between 70 and 130 mg/dl.



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