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Fasting blood sugar too high despite drugs, low carb diet & discipline: What was driving it up in my patient?

Find out how your numbers just need a bit of small moves to get aligned with your body’s natural rhythm

The body’s blood sugar levels spike between 4 am and 8 am because the body releases hormones like cortisol, which sets your body up for a new day. (File)

One of my patients, Ganesh, is what we would call a very disciplined patient, doing everything to keep his blood sugar levels in range. “My morning readings are not coming down at all. I eat protein and vegetables. Have less than 70 gm carbs a day (70 gm of carbohydrates contain 280 calories). I drink a lot of water. I take all my medicines on time and track my blood sugar levels regularly. But my fasting blood sugar level does not come down below 140 mg/dL (normal is less than 100 mg/dL),” he told me.

Sometimes your fasting sugar levels can spiral out of control even with a strict diet, routine and medicines. What triggers such spikes?

The dawn phenomenon

This condition is called the dawn phenomenon. The body’s blood sugar levels spike between 4 am and 8 am because the body releases hormones like cortisol, which sets your body up for a new day. As a result, the liver releases glucose early in the morning. But in people with diabetes, the pancreas may not produce enough insulin to counteract the increased glucose production by the liver, leading to high blood sugar. So fasting sugar goes high.

Did my patient do anything wrong?

Not at all, his body was just responding strongly to early morning glucose response. Now this is affected by many factors like stress, poor quality of sleep or even minor changes in medication timing. For example, the type and timing of your long-acting insulin or tablets can be adjusted to counteract the dawn phenomenon.

Why a post-meal walk matters

Continuous glucose monitoring (CGM) can be helpful in managing this situation. It gives you a complete picture of your glucose trends in real time over 24 hours. So your medication, meals and exercises can be adjusted based on your CGM report. You can also try taking a post-meal walk for 15 minutes. This helps your body use glucose more efficiently and improve insulin sensitivity. In the long run, this helps reduce your fasting sugars as well.

Check your fasting sugar

If it is very high or too low, check your 3 am blood sugar. If 3 am blood sugar is lower than 70mg/dl, your fasting blood sugar may rise in response to the low levels. Low sugar might have occurred because of overdose of night time insulin or tablet. It might also be due to low food intake at dinner. Your body reacts in response by releasing stress hormones like adrenaline and cortisol, elevating sugar in the morning. In this scenario, a night dose of insulin or tablet can be reduced after getting a consent from your doctor.

In order to prevent the dawn phenomenon, you could have a light protein snack like protein bar, half-a-cup of legume salad or two egg whites before bed time. Dawn phenomenon is just your body’s natural response. Your numbers need a bit of small moves to get aligned with your body’s natural rhythm.

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(Dr Mohan is Chairman, Dr Mohan’s Diabetes Specialities Centre, Chennai)