Does your morning blood sugar rise if you have diabetes? (Dawn Phenomenon and Somogyi Effect)

As a person with diabetes, you probably check your blood sugar level as soon as you wake up in the morning. If you think about it, even if you have controlled your diet and taken your medication at night, you must also feel worried when you see that your sugar level is high in the morning, right? "I did everything right, why does my sugar only increase in the morning?" You may also think. There are two main reasons for this. One is the Dawn Phenomenon, and the other is the Somogyi Effect. Although the two names are a bit strange, don't be afraid. Let's talk about this simply.

The Relationship Between Insulin, Blood Sugar, and Sleep

First, let's get to know the main characters in this story. Our body's main source of energy is a type of sugar called glucose. It's like gasoline for a car. The hormone that helps take this glucose from our blood into our cells and make energy is insulin. Simply put, insulin is like the key that opens the doors of our cells and lets glucose in.

When we are sleeping, our body does not need much energy. It is like a car that has just been started. However, when it is time to get up in the morning, our body is preparing for the day's work. Then the body sends a signal to our liver, saying, "Okay, now is the time to start working, release some more glucose into the blood." In this way, when glucose accumulates in the blood in the morning, a healthy person's body produces more insulin to control sugar levels.

However, in the body of a person with diabetes, this process does not happen properly. Since the required amount of insulin is not produced, the blood sugar level increases in the morning. We call this hyperglycemia. If this continues, it can be harmful to health.

What is this Dawn Phenomenon?

Simply put, the Dawn Phenomenon is a natural hormonal process that causes blood sugar levels to rise in the early morning, usually between 3 a.m. and 8 a.m. This is different for everyone. But if you have diabetes, your body doesn't have enough insulin to control the rising sugar, so you wake up with high blood sugar levels. This is common in about half of people with Type 1 and Type 2 diabetes.

But you can talk to your doctor and do some things to control this.

• Avoid eating foods high in carbohydrates before bed.
• Changing the dose and time of your insulin or diabetes medication (for example, taking it before bed instead of in the evening). Never make these changes on your own. Always consult your doctor.
• If you use an insulin pump, change its settings.

So, what is the Somogyi Effect?

The Somogyi Effect is the same thing that happens when your blood sugar levels rise in the morning. But the cause is completely different. It happens because you take too much insulin at night, take too little, or skip a meal at night .

Imagine this. You took a little too much insulin at night. Then in the middle of the night, your blood sugar level drops very low. We call this hypoglycemia. The body reacts to this drop by panicking. Thinking, "Oh, my sugar is running low, I need to raise my sugar level quickly," the body suddenly releases a lot of hormones that work against insulin (e.g., cortisol, growth hormone). As a result, the low sugar level suddenly rises. That is, the sugar level drops very low, and then rises very high again. This is called 'Rebound Hyperglycemia'. This condition is more common in people with Type 1 diabetes.

But new research, especially studies using Continuous Glucose Monitors (CGMs) , has found that the Somogyi Effect is not as common as previously thought. Some experts now believe that the Dawn Phenomenon, or insulin dose instability, may be the cause of many morning spikes rather than the Somogyi Effect.

How do you know exactly the difference between these two?

Both of these conditions cause high blood sugar in the morning, but the treatments are different because the causes are different. So your doctor will need to determine which of the two you have. To help with that, your doctor may ask you to check your blood sugar levels in the middle of the night (around 2-3 a.m.) for a few days. If you use a CGM, it will automatically get this data.

The table below further explains the main differences between the two.

What are the symptoms of both of these conditions?

The main symptom is high blood sugar levels when you wake up in the morning. In addition, depending on how high your blood sugar levels are, you may also experience symptoms such as:

• Feeling more thirsty than usual
• Feeling hungrier than usual
• Frequent need to urinate
• Headache
• Feeling uncomfortable and angry

Regardless of any of these symptoms, it's best to keep a record of your sugar levels and see your doctor.

Diabetes, Morning Sugar Increase, Dawn Phenomenon, Somogyi Effect, Insulin, Hyperglycemia, Blood Sugar