Many people with diabetes observe that their numbers first thing in the morning are often higher than their target. This condition is called “dawn phenomenon” and it can occur in people with type 2 diabetes. It’s best described as a high fasting blood sugar (FBS) number after waking in the morning. This puzzles and even alarms many people, especially when their blood sugar number the night before was in the right range for them, they have been following the meal and exercise plan set out by their doctor or diabetes educator and are taking their medications as prescribed.

What’s your A1c?

Before we delve into the dawn phenomenon though, it’s really important to emphasize that if your A1c is at or below your target, individual glucose numbers that are higher than your target aren’t a big deal. Your diabetes is still doing fine. If your A1c is above your target though, that’s when you really need to work with your doctor to figure out when your blood glucose is high and what to do about it. Figuring out how to address high morning numbers can be an important part of this process.

Why does this happen?

The science behind a high fasting blood sugar number has to do with a group of hormones that are released by the body during the night. All people, with or without diabetes, experience this as a part of the natural body cycle, or circadian rhythm. The hormones (including growth hormones, cortisol, glucagon and epinephrine) that are released sometime between 2 a.m. and 8 a.m. increase insulin resistance and cause blood sugar to rise. As you near waking time, the liver begins to release stored glycogen to give you the energy you need to get up and start the day. For a person without diabetes, the pancreas then reacts to this glycogen by appropriately releasing the correct amount of insulin to keep blood sugar in the normal range and still give the body the energy it needs to start the day. But if you have type 2 diabetes and are already insulin-resistant, this is where the problem is – the amount of insulin produced is not enough to balance out the glycogen and so you get a high blood sugar number in the morning.

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