A “Wake Up” Bolus?

Is there something more than Dawn Phenomenon?

The dawn phenomenon is typically described as the body releasing a handful of hormones overnight that cause some insulin resistance.  You see this as higher blood sugars in the morning, even though you went to bed with a great blood sugar.

I do experience the dawn phenomenon, and have been able to adjust my pump to deliver a bit more basal, or background, insulin during the early morning hours.

wakeupBut I’ve also got something else going on.  When I get up for the day, no matter what time it is, my blood sugar goes up.  If I wake up at 4:00 AM, it goes up.  If I wake up at noon, it goes up.  If I wake up anywhere in-between there, it goes up.  I’ve come to think that my body just hates waking up and squirts out some extra dawn phenomenon hormones to get me moving.

This is not something I can program my pump around because I wake up at different times almost every day (the “joys” of being self (partially) employed?).

Once last week I woke up with a low blood sugar.  I didn’t treat it because I knew that just waking up would make it rise.  I went from a 71 mg/dl on waking to a 92 mg/dl less than an hour later.  It didn’t stop there though.  It was on a fast road to hyperglycemia if I didn’t do something.

I’ve not gone as far as to track and measure the rise, which would be the smart thing to do.  But I have made a habit of taking a couple units of insulin when I get up, trying to keep my blood sugar level.  Sometimes it works, sometimes I’ve given too much, sometimes too little (a popular problem when living with diabetes!).

This wake up rise complicates a handful of things for me though.  My insulin needs are different for both meal and correction doses in the morning, and it really exaggerates the troubles I have with my infusion site changes in the morning.

One thing I learned in writing this, is that breakfast is critical.  According to this article from Theresa Garnero at dLife.com, eating breakfast signals the bodies counter-regulatory hormones to turn off.  Since I think those are the hormones messing with me, turning them off would be good.  I know that I am often guilty of skipping breakfast, so this is one thing for me to work on.

I would love to know, does this happen to anyone else?

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23 thoughts on “A “Wake Up” Bolus?

  1. Thanks for referencing this post in your tweet to me today. Glad I’m not the only one dealing with this weird high-upon-waking. It totally sucks.

  2. My endo and I have adjusted my basal rates through the night and on the days I have the dawn phenomenon it works perfectly but the days I don’t, which can be 3-4 nights a week, I’m waking up at 3:30am with low blood sugars…..so frustrating. I can’t remember the last time I slept through the night.
    J.B is right…adjustments are never ending.

  3. Yes, Scott. I’ve been dealing with this same issue for about a year. I have set my basals to try to accomodate it, but even then I need to do a correction on some mornings.
    It just sort of popped up one day as a new issue – no gradual onset or anything like that. It’s like so many things with diabetes – something new that you just have to keep figuring out and making adjustments for. Seems like the adjustments never end.

  4. I’d wager this happens to me too.
    I notice it pretty regularly, but not enough to document (hello! logbook?! where are you?!) or do anything about. My problem is that most days I wake up at 7:30am, I bike into work from 8-8:30 or 8:30-9, test when I get into work, and I’m a usually a full 50mg/dl higher even though I did a little bit of exercise (my ride into work is mostly down hill). I take my bolus and have waited well over an hour on some mornings before I notice (either with testing or my Dex) that my BG is even Starting to fall. So I wait a L O N G time between my bolus and eating at breakfast. I can do this rather safely, ’cause I’m just sitting at my desk.
    I used to think my BG just spiked after breakfast because I was dumping carbs into an empty, receptive stomach, but I now think it’s more about insulin timing, or it could be the exercise, or site changes on Monday, Wednesday, or Friday mornings, or… (Logbook? Are you here somewhere? Can you help me figure this out?)
    I think you get the picture.

  5. I wonder how much to bolus for a couple of eggs, fried in butter? I have been giving no bolus for such a breakfast, thinking no carbs, no bolus. But I get really high from such a routine. I think this may be partially DP. What do you all think?

  6. Hi Scott
    The way I explain this 2nd phenomenon to people I mentor is the body thinks it needs energy so the liver spits it out. It’s just trying to help. Little does it know we need to fix the mess it makes.
    Personally, I can have a 10 point increase or I can have a 100 point increase. What I have noticed is that the more carbs I eat the day before the worse it tends to be (I’m normally a

  7. As a chemist I’ve treated my body as a walking, living, breathing science experiment for the past 5 years (has become both rewarding and frustrating at the same time). I experienced this for a while in college and found that there are a few triggers for this and a few fixes that worked for me:
    Waking up at the same time every day drastically regulated my morning BG.
    Eating a small, lower-carb breakfast (just about anything) daily helps cut down the extreme jump. Inconsistency in eating breakfast lead to serious inconsistencies in insulin sensitivity.
    Changing an exercise routine confuses my body’s metabolism and can help increase insulin sensitivity in the morning.
    I’ve always found that if I lose routine, I lose control. Every person is different, but hopefully one of these ideas helps!

  8. Yes, this happens to me, too! If I correct a low, I’ll spike really high, as well. For example, the other day I woke up at 45. I drank a juice box that was exactly 15g of carbs and 20 minutes later when I ate breakfast I was at 179. How does that make sense?

  9. Wow, cool post. I’d never heard about the eating breakfast counteracts the morning hormones thing before. On Sunday’s, Justin and I lead worship at a local church and I often skip breakfast and don’t eat much until about noon…. I know, stupid, but I NEVER GET LOW and often find myself in the upper 100s to lower 200s before lunch. It always boggled me that I hadn’t eaten anything and was still high! I figured it was from the stress of leading in front of many people, trouble shooting issues throughout the morning, etc, but this makes more sense. I would rather run just a little high on stage, since a hypo would cause major problems….. but I will try to make an effort to eat!

  10. Yes for me too. Doesn’t matter when I wake up. No DP for me. I go low around 4-5am, so have basals adjusted for then and then back up at 9am at nearly double.
    I can wake many hours later (eg sleep-in Sunday). It’s actually worse for me when I have to be somewhere in the morning, then I can go higher than usual. Have put this down to stress. Like you, I can’t set my basal for when I wake up ’cause I don’t know when that’ll be. The 9am basal increase doesn’t cover the wake-up rise that could be anytime.
    I can’t remember when I haven’t taken a morning correction, even though that rise is usually in range, it’s at the wrong end of my target range. I almost always have a protein-only breakfast but usually well after I wake.
    I think it’s the stress of getting my day going – even a laid-back day. And on a busy day that rise is worse. Got to be a connection.

  11. Scott.
    Yep. Same thing for me. Doesn’t matter what time of the day I wake. I also try waking up a bit lower to correct for the impending rise. (wake up at 78, 1/2 hour later I’m 100.) I also have to bolus differently for breakfast, which is why I try to limit my carb intake to 15 grams in the a.m. Dam diabetes. Wish I had a good answer. Just keep experimenting. 🙂

  12. Yup, lately I’ve been noticing a rise when I wake up too. Nothing too drastic, but I do see a 10 – 20 point jump with a rapid up arrow on my CGM. Luckily, it levels back off quickly and I don’t need to bolus for it or anything. Well, I suppose if I woke up high I would bolus to correct it – but I’ve been waking up on the low side lately so the jump is just what I need to get me back to 100.

  13. I have the same problem! That’s two posts in a row of wonky trends that we share. Being a grad student on a variable sleep and work schedule probably means we share similar lifestyles. I have taken to going to the gym first thing in the morning to deal with the inevitable wake-up rise. The rare occasion that I don’t means I have to do a temp basal of +50% for 1.5 hours and a small bolus (size depending on some weird guesstimath) to keep me somewhat in range. But, this all gets complicated when it’s a site change morning (see your previous post). All of this has taught me to eat next to no carbs within the first 3 hours I am awake and hope that I can get some exercise in first thing. Oh, diabetes, how I work to please your finicky needs!

  14. Yep, this resonates. I typically take an extra unit of insulin when I wake up and have been recently been bolusing for breakfast (which I am religious about) a good 15 minutes before eating it. It’s been helping.

  15. It makes sense for bg to rise at/after waking: your body is telling your liver it’s awake and so has higher bg demands. Same reason waking bp is usually the highest of the day.
    I’m wondering if something in the “diabetes” trigger also turns off the “I have enough free glucose running through my veins” trigger to cause a stacking of DP, wakeup rise, and postprandial rise… Actually, there should be: in the absence of (sufficient usable) insulin, the “turn-off trigger cells” are likely just as glucose-starved as every other cell in the body…
    Definitely hard to calculate a “wake-up bolus” in advance of waking when your schedule is not consistent and your wake-up time is not planned in advance. (If it is planned in advance, can you schedule your pump to slightly increase the feed to start at wake-up time?)

  16. Same thing happens to me, although I don’t really suffer from Dawn Phenomenon effects, and I almost never skip breakfast.
    The rise on waking works out for me as it allows me to exercise right away in the morning without having (much of) a snack 🙂

  17. This exact thing happens to me every day! I have the dreaded DP and my basal handles it. BUT, waking causes a rise and it matters not what time I wake. I don’t like to eat breakfast so I enjoy a cup of coffee and hit the trails. If I don’t hit those trails, I’m in for a correction bolus I don’t want to waste. I purposely let my bg go into the lower range in the mornings so I can enjoy that stoopid cuppa joe before I head out. You have some very similar issues to mine Scott – it’s freaking me out a little bit 🙂

  18. No high bg’s when I wake but recently no matter what I ate for breakfast, post bg’s were off the charts. I discussed with my Endo, a basal rate change did the trick.
    Breakfast is very important. I have not skipped breakfast on purpose, probably, since ever.
    I haven’t experienced the Dawn Phenonenon in a very long time. Wish I could help more.
    Dang D. Keep at it man. Hope it works out soon!

  19. YES! I hate it. No matter how big the bolus, I seem to rise anyway.
    I’m also guilty of not eating breakfast…but I think I better start doing it.