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THE MORNING SUGAR: A Window into your Type One Management

I lie in bed with one eye open, ears still ringing from my poorly selected, overplayed alarm tone. I sit half hunched over my glucose monitor attempting the first blood-drop-to-test-strip co-ordination of the day. Its 05h30, I have fasted for 6 to 8 hours, it’s time to dive into diabetes. My test strip sucks up the drop of blood and counts down to my first glucose reading of the day:

BEEP: 4.6mmol/l (84)

OR

BEEP: 9.6mmol/l (173)

OR

BEEP 16.6mmol/l (299)

The good, the average and the ugly.
These are the 3 general ranges of readings that might greet me at the first finger prick of the day. It’s only one of the many sugar readings that lie ahead, but it is a special one to pay attention to, as your morning glucose reading can provide important insight into your diabetes control.

A fasted reading has a myriad of information which you can choose to ignore, or preferably dissect and investigate for optimum diabetes control. I believe it is vital to ask myself why? Why is my blood glucose this level and what were my preceding actions?

I will take you through my 3 ranges and my general approach to morning sugar readings and how I personally troubleshoot these readings. We each tackle diabetes differently, but hopefully the following brings some insight into your morning sugars or encourages you think critically of those interesting rise and shine numbers!

The “Gem”
My personal values are 3.8-5.6mmol/l

Oh this is a sweet, gem of a reading. It’s the real “roll out of bed on the right side” number.
Perfectly in range, it is still important to acknowledge the formula that achieved this number. We could all do with a little positive reinforcement and mindfully recognize and enjoy our diabetes successes! I always ask myself, “What did I do well?”

This sugar reading generally informs me that I have correctly dosed my long acting insulin as it did not bring me into the clutch of hypoglycaemia when fasting during my sleep. It was also sufficient to meet the cascade of morning hormones such as cortisol and hyperglycaemia it brings along with it. This sugar happily greets me when I don’t snack after dinner and I eat around 3 hours before bed-time. This plan allows for an honest, stable blood sugar reading before bed where my injected insulin has already peaked in activity, and I can expect predictable glucose readings as I sleep.

The “Meh”
My personal values are 6-9mmol/l

It’s a sugar range that is higher than I would like for a fasting blood glucose level, but it’s not remotely the end of the world. To solve this morning glucose and to prevent it creeping higher, I have my insulin dosage for my breakfast plus a dash more insulin to correct. I wait 20-30 minutes for my insulin to start working and bring my glucose down before having my breakfast. I ask my “why?” and make a mental note of how I could improve and act accordingly. If went to bed with a great blood glucose level and I woke up high, it could be various things:

1. Insufficient long-acting insulin: The Dawn phenomenon

When I have my continuous glucose monitor (CGM), the Dexcom, attached, this will be displayed as a nice steady graph with readings in glucose range for the first 2/3rds of sleep, only to find in the few hours before waking my blood glucose slowly and steadily increases. This is due to the get-up-and-go hormones that pump through your body to prepare you for waking and tackling the day. These sneaky buggers include growth hormones, cortisol, glucagon and epinephrine and they increase your insulin resistance, causing blood sugar to rise.

2. Too much insulin: The Somogyi effect

This is an interesting stress response of your body, a rebound effect of low blood glucose while sleeping. If you have too much insulin, long acting or short acting, and you experience a low while sleeping your body mounts a survival response and encourages your body to release sugar back into your blood via adrenaline and cortisol. This low may not be rapid or severe enough to cause a seizure, but sufficient to mount a physiological survival response from your body.

3. Not enough short-acting insulin

This is usually prompted by snacking before bed and eating late. My stomach is still full and has not emptied. My blood sugar will be in range when I get to sleep, but as my tummy works to digest my food, sugar trickles into my blood which I thought I had sufficiently covered by my short-acting. This especially occurs if I eat meals that have a carbohydrate, protein and high fat content. It has even been dubbed “The Pizza Effect”, where fats and protein delay the absorption of carbohydrates from a meal. The most challenging part is that you don’t know when the carbohydrates are going to be dumped into your bloodstream as sugar. It could be more than 5 hours until you feel the true effect of your meal. This could also be a reason for a really high morning blood glucose reading, the one where you would rather turn over and head back to sleep, which brings me to my final morning range, which I like to call the “Lie in Bed for a Few Minutes in Denial”.

The “Lie in Bed for a Few Minutes in Denial”
My personal values are anything double digit

The “Man, I messed up” feels. I most likely did not give myself enough insulin for the previous night’s meal, or I ate complete rubbish, did a massive carbohydrate count guestimate (that’s right folks- guess and estimate can really be combined into one perfect word), it could be “the pizza effect”, or I forgot my long acting insulin.

The alternative explanation is that I woke up with low in the middle of the night and quite passionately, dove into my bedside glucose stash, bathed myself in sugar before falling back asleep in a pile a sweet wrappers. (Yes, I have awoken with gummy sweets melted into my back and bed sheet).

If my sugars are really bad in the morning, there is usually a pretty grand, blatantly obvious reason as to why they are absolutely deranged. I find myself glancing in the mirror, at my poor, hard-done-by face to ask myself why? My expression smirks, “Oh girl, you know why. You know.”

This is where the power of the mind can transform your day. You can switch to victim. You can choose guilt and actively bring yourself down. You can choose to let a number on a plastic monitor define your day or you can free yourself from mental binds, for you are capable, you are strong and you are going to tackle the day.

My go-to plan of action:

1. Massive bottle of water with loads of top ups
2. Small simple, low sugar breakfast (I find waiting for my sugars to come down before eating leaves me more frantic and stressed)
3. More water
4. Add Insulin
Tip: Don’t give yourself 70000 units because you are panicking and desperately want your sugar to go down as quickly as possible (TRACY SANDERS I am talking to you girl). A resultant severe hypoglycaemia does not make it easier to improve the day.
5. Forgive yourself, give thanks to your body for all the other goodness it brings to you and power forward.

Transform your WHY’s into WISE, pay attention to each nugget of information your body and glucometer communicates to you. By building up an understanding of your sugars, you build a stronger relationship with your body and mind. Work closely with your support network, endocrinologist and diabetes educator to make the correct adjustments to suite your body, always ask questions and challenge your knowledge and experience of type one.

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