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 Comments on "A “Wake Up” Bolus?"

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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.


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.


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.

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… Read more »
John Harnish

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?