Updated: Aug 14, 2019
It‘s going to be another beautiful day tomorrow. You run through your usual nighttime routine then relax in bed, waiting for the impending slumber.
Then, as the sun rises, so does your blood sugar. For some, it’s a gentle increase starting in the middle of the night. For others, it’s a rapid incline from the moment they wake.
Non-diabetics also succumb to this daily event, but due to the fact that they have a wonderful fully-functioning pancreas which fires up and combats the rising blood sugars with insulin, they don’t need to take any action (not jealous at all).
For diabetics, this isn’t so much as a phenomenon but rather a consistent pain in the bum.
Our inability to create, or resistance of, insulin now means that we must manually combat rising blood sugars at a time of the day whereby most people are asleep.
But before we look into these 2 events, we must first identify whether they are the real cause of the rise in blood sugars.
Now, as a diabetic, we’re used to testing on ourselves so this shouldn’t be much of an issue. The downside is it’s in the middle of the night.
If you have a flash or continuous glucose monitor you can simply check it in the morning to see when or if there is a rise. If you don’t, you’ll need to set an alarm at 3am and check. Yes, we get it. It’s annoying, but without this info we’re not treating it correctly.
The same principle goes for feet on the floor; check at 3am, then when you wake up, then every 15 mins until you see a rise or don’t.
If there’s no rise, you’re one of the lucky ones. Go back to sleep and dream of a cure.
If there is a rise, then we need to identify the following;
a) When is it starting
b) If there’s another cause
Outside of dawn phenomenon and feet on the floor, there could still be other causes. So you’ll need to check the following;
a) Is your basal running out
b) When did you last eat and what was it
c) Are you sick or getting sick
a = If your basal is running out, you’ll need to look at splitting the dose (most popular) to twice or three times a day. Check with your medical team on how to do this.
b = Your evening meal could still be contributing to higher blood sugars. Particularly if it‘s high in carbs and protein. Protein increases bloods as well, but over a longer period and to less of a degree than carbs. Have a low carb meal the next evening and check overnight again.
c = Frequently, your blood sugars will rise before you start to feel the symptoms of sickness, so check your ketones as well. However, you’re likely to see an all-round increase in blood sugars, not just overnight.
If by now you’re convinced it‘s DP or FOTF, then let’s move on.
Why is this occurring and how do we stop it from impacting our much needed sleep?
Oh, we do like to consider ourselves all individuals and that we’re very different from one another, but in the case of dawn phenomenon it’s a pretty standard approach. However, before we look at how to fix it, we need to know what it is.
Overnight, our bodies undergo a plethora of important natural processes (it’s why sleep is key to good health). One of these is to release hormones (growth hormone, cortisol, glucogon and epinephrine), and researchers believe that it’s these hormones that result in rising blood sugars. It also accounts for why many of us are more resistant to insulin in the morning and require higher doses to cover food. For diabetics, it’s a pain as we struggle to stop this rise without the assistance of our pancreas.
Many diabetics will split their basal insulin so that they will inject half or part in the evening. The exact amount depends greatly on your own needs and some may require a 50/50 split, whereas some may need a 75/25 split. If you’re comfortable with doing this yourself then give it a go, but if not, make sure you consult your medical team.
If you’re on an insulin pump, then you won’t have any basal on-board, so you’ll need to adjust/increase your bolus insulin dose amounts to reflect the rise in overnight blood sugars.
Feet on the floor syndrome
Like the dawn phenomenon, feet on the floor has it’s roots in the release of hormones like cortisol, which is released to provide energy as we begin our day. However, this time we’re faced by a balanced blood sugar overnight and then a sharp rise as we start to get up, There is only one way to combat this rise and that’s to inject rapid-acting insulin before you get up.
If you want to be very disciplined with your blood sugar levels then you’ll need to test with very small doses (.05 - 1.0u), and roughly 30 - 60mins before getting up. Otherwise, you can inject as you’re getting up, but you then run the risk of rising bloods - potentially out of your target range.
Factors to consider:
a) Quality of sleep.
Having a poor nights sleep will impact your blood sugars for the following day. You may find yourself requiring more insulin to stay in target range or be more resistant the following morning. A good nights sleep is integral to proper management of your blood sugars.
b) Exercise the day before.
Exercise helps your body process insulin quicker. It also helps by feeding your muscles with glucose so there’s less running around in your blood stream. This can have a blood sugar lowering effect many hours following exercise and even into the next day. If you’re planning on doing medium to long-term intensity exercise in the morning, you may not need to inject rapid acting insulin to cover feet on the floor. As you won’t want to increase your chance of a hypo during your morning work out.
c) Food - Dinner the night before and breakfast the following day.
As mentioned above, your evening meal can have a big impact on your bloods overnight. You may need a correction as well as a small dose of rapid to counteract feet on the floor the next morning.
We now know that breakfast is not the most important meal of the day, so skipping it won’t result in severe weight gain or death, but it’s important to remember that if you experience feet on the floor and extra insulin resistance in the morning your dose will be considerably higher than lunch and dinner (even for the same food).
Alcohol has a blood sugar lowering effect and this can run into the next day. So, if you’ve had a few drinks the night before, you may not need your morning dose to counteract feet on the floor. As this could increase your chance of a hypo. Perhaps, try a smaller dose if you can still see a small rise and as you’re getting up, not before.
Stress causes blood sugars to rise. Be aware that if you’re coming off the back of a stressful few days or have an impending interview or stressful situation pending, it may well have an impact on your morning bloods. You may have to inject a bit more bolus and basal if you’re comfortable with this.
We already have a lot on our plate, so if you’re just learning about dawn phenomenon and feet on the floor, I’m sure you’re rolling your eyes and screaming “what! another thing for me to think about”. We get it. But once you get your head around these things, they fall into daily life and become a routine.
If you’re not across them and they‘re not part of your routine, that‘s when stress occurs and we already have enough of that.
Perhaps stay in bed a bit longer.
Believe the hypo