Morning blood sugars high

I am new to diabetes since April.  I always have trouble with my morning blood sugars.  They want them under 120 but they are always 130s to 140s and higher sometimes no matter what I do or don't eat at night.  Anyone have a similar problem and if so any tips on how to get them lower.

Jano

I am taking 500 mg at breakfast and 1000 mg at dinner of Metformin.  I have cut way down on carbs.  I have an appointment with a nutricianist next month to get a better hold on what I should be eating. I tried last night to have a high protein snack before going to bed and my blood sugar this morning was 126 which is good for me, so I am wondering if I have hit on something with this.  I can go without a snack and still wake up with too high of a blood sugar in the morning.  I am wondering if your body fights to keep blood sugars up while you are sleeping so they don't go down too low.  I have read that this can happen to insulin dependant diabetics.

Jano

Hi there,

            Since you did not say that you use insulin, i will focus on the "Dawn Phenomenon".

 The "Dawn Phenomenon" commonly occurs between 3am and 8am. In most people, glucose levels rise just enough to provide the body with enough energy needed to wake up and start the day. Any excess glucose is handled by a burst of insulin. People with type 2 diabetes cannot properly use available insulin to respond to this rise in blood glucose. Therefore, blood glucose levels will rise to abnormally high levels and cause hyperglycemia (high sugar levels).

 It is also possible that your blood sugar may be dropping too low during the night causing a compensatory increase in glucose (rebound hyperglycemia). This could also cause your morning reading to be high. You may want to get up in the middle of the night around 2-3am to check your blood glucose level to determine if it is going too low.

 If it is low, you may want to try eating a snack containing carbohydrates before bedtime to see if this helps keep your level from dropping too low and rebounding high. 

The"Somogyi"effect occurs most often in diabetics on insulin.

Your question is partly perplexing because you mentioned you are on Metformin.Metformin is one of the best drugs to counter-act the"Dawn Phenomenon"So there you are!

Same thing happens to me, this "rebound", I noticed. When I skip lunch my bg is normal but then raises all on it's own without me eating anything.

Hi Jano,

Those are some pretty hefty doses of Metformin.  You should talk to your doctor about adding a sulfonylurea (a type of pill that stimulates your insulin production) to your meds.  Not only will it get your numbers lower, but it may prolong the time you can take metformin before it becomes ineffective.  The combination may get you into the sub 100's for your numbers which is a nice place to be.

 Warren

HI spooky,

2000mg of metformin in its XR form is the max dose you can take. Or let me put it this way, it is the maximum dose that most Endo's will prescribe or that the manufacturer recommends.  If you are taking this much metformin and your blood sugar is still rising, the med has become ineffective.  Unfortunately, metformin has a long and noted history of being a drug that eventually fails to be effective; and in many people that have been prescribed ONLY metformin (monotherapy), this happens sooner rather than later (clinical trials have shown a nearly 80% failure rate over a 7 year period).  I know you like to quote websites, so perhaps you can do some research and give us a quote on failure rates for metformin, because it is usually the first drug prescribed to a type 2 and the first one to fail.

As patients progress along the natural history of diabetes, multidrug combinations are usually required to achieve glycemic goals. When monotherapy with metformin is inadequate, addition and not substitution of another oral agent or exogenous insulin typically achieves tighter control. For example, the combination of a sulfonylurea and metformin can be effective when patients are failing maximum doses of either medication used alone. Trials using metformin in combination with glyburide (marketed as DiaBeta, Glynase, and Micronase) have also shown that this treatment strategy of adding to and not substituting for metformin can be extremely effective. 

Now, knowing this, and taking 1500mg of metformin and still running fasting blood sugars in the 130's and 140's, would you still advocate using it as a monotherapy; or perhaps increasing the dosage?  I think that is probably irresponsible.

 Warren

Hi there,

               Diabetes is a progressive disease.Medical treatment at the time of diagnosis depends on many factors.In a newly diagnosed overweight diabetic the usual drug of choice in normal circumstances would be Metformin.You start with a low dose and gradually increase to acheive optimum results.The rule in PHARMACOTHERAPY is to start with a low dose and go up to as high an amount as safely possible,assess and then add a second drug.

               In Jano's case too, similar should have been the circumstances because SHE HAS BEEN A DIABETIC ONLY SINCE 3 MONTHS AND WARREN ALREADY WANTS TO ADD A SECOND DRUG. THEORETICAL RHETORIC AND TRYING TO PROVE A POINT ARE FAR DIFFERENT FROM REALITY CHECK .The endo has to factor in so many things,most importantly her apprehensions,anxities and the stress of being told that she is a diabetic,self-monitoring her blood glucose and the amount of time taken by her to come to grips with the fact"YES!IAM A DIABETIC AND I HAVE TO MAKE SACRIFICES EVERY STEP OF THE WAY IN MY LIFE FROM NOW ON"

               

               It takes time for proper counselling,diet adjustments,exercise and medications to exert their influence on Jano,and i would surely would'nt mind 3 months of slightly higher fasting values.She's touching 120's now and that's only 10 to 20 mgs away from control IN A NEWLY DIAGNOSED DIABETIC!Have a heart,man!Give her some breathing space!

              Warren has neatly side-tracked me into the above when my simple contention was that 1500 mgs of metformin is a perfectly safe and therapeutically acceptable dose.

Post Edited (spooky) : 7/28/2006 6:33:58 AM (GMT-6)

mjr,
The best evening snack that I use is a one by one inch block of motzarella cheese plus 18 peanuts. This has lots of fat (to slow stomach emptying) and protein to take care of hunger. Not many carbs present to prevent rebound insulin secretion. Hope this helps.

Hi Jano- Just wanted to throw my 2 cents in the bucket. This may be part of the "Dawn Phenomenon" that was previously mentioned, but I had something simular to the high morning sugar when I was diagnosed and started metformin.

After researching and talking to my Dr this was the answer I was given. I found out that high amounts of sugar that are stored in the liver are released at night when the body is at rest and can make for a high morning reading, which happened with me. The morning readings did eventually normal out, but in the beginning they were all over place, generally being in the 200+'s.

Anywho, I don't know if that will help, but I am a layman term gal. Too many medical terms leave me boggled. ;)
Take care,
~Jen