How to Lower Morning Blood Sugar
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Waking Up to High Fasting Blood Glucose Numbers
Many people believe that what you eat in the evening affects your blood glucose levels the next morning. But often the real culprit of these high numbers are hormones that work to control your blood sugar levels when you have type 2 diabetes. Find out about the four hormones that affect your blood sugar levels.
Learning More About Hormones and Diabetes
During the years when type 2 diabetes slowly develops (which can be up to 10 years through developing metabolic syndrome and continuing on to prediabetes), hormonal control of blood glucose breaks down. To understand how your body responds, it's important to understand the essential hormones involved in blood glucose control.
Four hormones are involved in blood glucose control:
1) Insulin, made in the beta cells of the pancreas, helps the body use glucose from food by enabling glucose to move into the body's cells for energy. People diagnosed with type 2 diabetes have typically already lost at least 50 percent of their beta cell number and/or function, and their insulin reserves are slowly dwindling further.
2) Amylin, secreted from the beta cells, slows the release of glucose into the bloodstream after eating by slowing stomach-emptying and increasing the feeling of fullness. People with type 1 and type 2 diabetes are amylin-deficient.
3) Incretins, hormones secreted from the intestines that include glucagon-like peptide 1 (GLP-1), normally enhance the body's release of insulin after eating. This in turn slows stomach-emptying, promotes fullness, delays the release of glucose into the bloodstream, and prevents the pancreas from releasing glucagon, putting less glucose into the blood.
4) Glucagon, made in the alpha cells of the pancreas, breaks down glucose stored in the liver and muscles and releases it to provide energy when glucose from food isn't available.
Out-of-Control Blood Sugar During Sleep
For people in the early years of type 2 diabetes, the hormones that control blood sugar can particularly be unbalanced. Here's what happens during sleep to a person with type 2 diabetes:
"Overnight, the liver and muscles get the message from excess glucagon to ramp up the glucose supply because the person is sleeping, not eating, and needs glucose from stored sources like the liver," says Marty Irons, R.Ph., CDE. "There is not enough of the incretins, insulin, or amylin hormones to stem the tide of excess glucose from the liver and muscles, essentially throwing this feedback loop out of whack."
High fasting blood sugar levels, particularly in the earlier years of type 2 diabetes, result from this hormonal imbalance that drives the production of glucose from the liver and less so from the muscles. Evening meals and snacks often get the blame for morning highs, but hormones are the likely cause.
Is Type 2 Reversal Possible?
You can't completely reverse the hormonal imbalance of type 2 diabetes, but a combination of actions can solve the high fasting blood glucose problem. "With your health care provider's guidance, experiment to find what works for you," says Arlene Monk, RD, CDE, a dietitian and diabetes educator at the International Diabetes Center at Park Nicollet in Minneapolis.
Start, Change, or Add Medication
As guidelines from the American Diabetes Association and American Association of Clinical Endocrinologists suggest, "Most people need to start a blood glucose-lowering drug at diagnosis to fight the insulin resistance and resulting hormonal imbalance," says Marty Irons, R.Ph., CDE. The most common medication recommended, metformin, cuts down on glucose overproduction in the liver overnight.
One or more of the newer blood glucose-lowering medications are prescribed as starting or add-on medication when you aren’t meeting your blood sugar goals.
The oral dipeptidyl peptidase-4 (DPP-4) inhibitors—sitagliptin (Januvia), saxagliptin (Onglyza), or linaglilptin (Trajenta)—work to keep more of the GLP-1 hormone circulating.
The more potent injectable GLP-1 agonists—exenatide (Byetta) (twice daily), liraglutide (Victoza) (once daily), or exenatide extended-release (Bydureon)—increase the amount of GLP-1 available.
These three medications are in the class of incretin mimetics, also called GLP-1 analogs. Some people also experience weight loss while using GLP-1 analogs.
"As type 2 progresses, especially beyond 10 years, many people need to add insulin to control fasting and other blood glucose levels through the day," Irons says. "When starting insulin, most providers use long-acting Lantus or Levemir."
Lose Weight to Lower Blood Sugar
Weight loss, especially soon after diagnosis of type 2 diabetes, can help the hormonal disturbances, increase insulin sensitivity, and lower blood sugar levels. The best approach: "Make lifestyle changes, choose more healthy foods, trim the portions of less-healthy foods, and crank up your physical activity," says Arlene Monk, RD, CDE.
You'll often see blood glucose drop before the pounds do. For people who have had type 2 diabetes for many years, losing weight alone is unlikely to correct fasting highs or other blood sugar highs throughout the day—medication, possibly in more than one category, is likely needed.
A Snack Before Bed Might Help
A small bedtime snack containing some carbohydrate, but no more than 20 grams, can help you wake up with better fasting blood glucose, says Monk. A bedtime snack shortens the time span that the liver is in overdrive producing glucose while you sleep.
Our community on Facebook suggested these carb-friendly snack options:
-- Low-fat yogurt
-- One serving of bite-size tortilla chips and fresh salsa
-- Hummus and edamame (soybeans)
-- Small piece of fruit
-- Frozen grapes
Lower Blood Sugar with Regular Activity
No matter what kind of aerobic activity you do or what time of day you do it, moving more enhances the body's response to insulin and helps your cells be more insulin-sensitive. "Being inactive is simply unhealthy in many ways. Some is better than none; more is better than less," says Monk.
Easy ways to get more exercise:
-- Do 10 minutes of stretching after you get out of bed.
-- Park your car in the back of the parking lot to get in more walking.
-- Take the stairs when, and if, you can.
-- Grab your spouse or a friend to go on an early morning walk with you.
-- Sit on an exercise ball and bounce or stretch side to side while on the computer or watching TV.
Mix and Match Solutions with the Help of Your Provider
Before you act on a solution to lower your morning fasting blood sugar, consider the blood sugar numbers on your meter, your A1C results, your lifestyle, your schedule, the medications your health plan covers, and what you can afford. Use meter checks and regular A1C results to assess the solutions you try.
Remember that your fasting blood sugar numbers tell you how you made it through the night. Checks midway through your sleep cycle can cast light on what's happening overnight. Be ready to change solutions if you don't hit your targets quickly and as your years with diabetes add up.
Hope Warshaw, RD, CDE, is the author of several best-selling books published by the American Diabetes Association, including Diabetes Meal Planning Made Easy and The Guide to Healthy Restaurant Eating. She is also contributing editor to Diabetic Living magazine.