The 3 AM Blood Sugar Phenomenon | Zyla Health
We all want a good night sleep of 8 hours to wake up fresh and energetic in the morning. If you’re a diabetic, sometimes you just wake up at 3:00 am not because of some noise but because your body wakes you up suddenly.
You wake up with some uneasiness or excessive sweating and might not be able to go back to sleep. You check your blood sugar levels and it is <100 mg/ dL. As per your doctor’s advice, you eat something sweet and after some time, everything’s normal.
Now that it’s solved, you go back to completing your sleep but when you wake up, your fasting blood sugar is high which might surprise you.
Sometimes, you might just wake up at 3:00 am with no or very few symptoms. Since there are no symptoms, you won’t check blood sugar and won’t eat anything but still get high fasting blood sugar.
When such things happen, you have a lot of questions… “Why does blood sugar drop at night?” or “why is my blood sugar high in the morning” or “how can I prevent low blood sugar at night” etc…
With the ongoing diabetes treatment, no doubt that prevention is very important to maintain blood sugar within the normal range. Let me tell you the science behind it.
Somogyi Effect
Usually, a low blood sugar level is considered when it’s less than 70 mg/ dL or if you experience symptoms like shaking, increased heartbeat, weakness etc at less than 100 mg/ dL.
Generally, in people who are on insulin, the blood sugar level drops very late at night or early in the morning, that is, between 2:00 am- 3:00 am. This is called nocturnal hypoglycemia i.e. drop in blood sugar levels at night.
The 3:00 am blood sugar level at this time plays an important role in deciding the levels of fasting blood sugar.
Whenever there is nocturnal hypoglycemia, around 2:00 am- 3:00 am, our body as a defence mechanism makes the liver release a large amount of sugar in the bloodstream which results in high blood sugar levels after waking up the next morning (High Fasting Blood Sugar). This is known as the Somogyi effect.
3:00 am blood sugar depends on blood sugar before eating dinner, blood sugar after eating dinner and units of insulin taken.
People with diabetes generally take 2 types of insulin:
- Short-acting insulin and
- Long-acting insulin.
Short-acting insulin such as APIDRA or NOVORAPID or HUMALOG reaches the bloodstream within 30 minutes after injection and peaks (shows its maximum effect) anywhere from 2–3 hours.
However, long-acting insulin such as LANTUS is peakless insulin that works in the background and lasts more than 24 hours.
The effect of these two insulins gets combined and the peak of short-acting insulin shifts to early morning hours. This increases the risk of hypoglycemia (low blood sugar) around 3:00 am.
Who’s at risk of low blood sugar at night?
The Somogyi effect is a common phenomenon that happens in people taking insulin injections and sometimes due to intake of heavy doses of anti-diabetes medicines like sulphonylureas (eg: glimepiride, glipizide etc).
Other factors can include:
- Skipping dinner or bedtime meal
- Insufficient quantity of dinner or bedtime meal
- Intense physical activity at late night
- Alcohol intake
Wondering how alcohol intake can cause a Somogyi effect? Know all about the science behind alcohol intake and diabetes here.
What are the warning signs of early morning hypoglycemia?
Whenever you experience low blood sugar levels at 3:00 am, your body will show symptoms that are not always the same for everyone. These symptoms include:
- Feeling uneasy during early morning hours
- Unable to fall asleep after waking
- Feeling weak or excessive sweating while asleep
- Increased heartbeat or shaking of hands and legs on waking
- High fasting blood sugar level
What should you do if this happens?
If you experience any of the symptoms mentioned above at late night around 3:00 am, you have to be quick and follow these steps:
- Measure your blood sugar level immediately.
- As low blood sugar levels need instant treatment, mix 1 tbsp (15 grams) glucose powder in 1 glass of water and drink. You can also have fruit if the symptoms are mild.
- Wait for 15 minutes and measure your sugar again.
- If the blood sugar is still below 100 mg/ dL then repeat the 2nd and 3rd points. And if blood sugar is above 100 mg/ dL that means you are out of hypoglycemia.
What should blood sugar be at 3:00 am and how to maintain it?
It is important to maintain a 3:00 am blood sugar level between 100–180 mg/ dL and prevent it from dropping. Make sure that you are following these guidelines:
- Correct your eating pattern: Instead of having 3 heavy meals eat a small portion of meals every 2–3 hours throughout the day.
- Balanced dinner: Include chapatis (2–3)/ rice (1 medium bowl) with dal/ curd (1 small bowl) and sabzi (1 medium bowl) in your dinner.
- Bedtime meal: Before sleeping, drink 1 glass of milk with a pinch of turmeric and black pepper. This will help in managing sugar levels while you’re sleeping.
- Monitor your blood sugar levels: Keep a check on the low blood sugar trend. This will help you and your doctor in planning future actions.
- Keep your Doctor in the loop: Low blood sugar levels must not be taken lightly so always consult your doctor for insulin and medicines changes.
- Be ready: Always keep multiple glucose powder sachets and water on your bedside. This will help in preventing any delay to treat low blood sugar.
- Avoid alcohol intake: Alcohol is known to cause low blood sugar episodes at night. Start by limiting alcohol and then gradually stop it for a healthier lifestyle.
How to manage low blood sugar? Know it all from our expert Dr Arpit.
Now that you know why you are waking up in the middle of the night with low blood sugar, let’s discuss another phenomenon that diabetics experiences, called high fasting blood sugar.
The Dawn Effect
Most of the patients have questions like, “Why is blood sugar high in the morning?”
Nothing to worry about, it is a common phenomenon observed in patients with diabetes.
When you wake up from sleep in the morning, your body prepares itself by making the liver release a large amount of sugar in the bloodstream for energy. This increases blood sugar levels in the morning and is called the “Dawn effect”.
And insulin is the hormone released from the pancreas which controls the rise in blood sugar levels. If the body doesn’t produce enough insulin or there is insulin resistance, this may cause a rise in blood glucose levels (High Fasting Blood Sugar).
Who’s at risk of high blood sugar in the morning?
- Overweight and obesity
- Physical inactivity
- Sedentary lifestyle i.e. sitting most of the time
- Irregular meal timings
- Intake of high carbohydrates, unhealthy fats, processed and packaged foods
- High-stress levels.
What should you do if this happens?
High fasting blood sugar levels cannot be managed instantly like low blood sugar levels as they tend to normalise with regular improvement in lifestyle. But you can follow these tips for some relief.
- Drink 1 cup of fennel (saunf) ginger tea by boiling 1 tsp fennel seeds and 1-inch ginger. Drink the water and chew the seeds.
- Involve yourself in physical activity for 15–30 minutes daily.
How to prevent the Dawn effect?
- Discuss your blood sugar trend and medicines with your doctor.
- Manage body weight within the normal BMI (Body Mass Index is weight in Kg divided by the square of height in metres).
- Eat small and frequent meals throughout the day. Learn here how to do it.
- Add fruits and salads to your mid meals.
- Maintain a gap of at least 30 minutes between dinner and bedtime.
- Try to walk for 10 minutes after having dinner.
- Avoid midnight or late-night snacking.
- Involve in regular exercise for at least 30 minutes.
- Manage stress by practising meditation and breathing exercises.
- Try to sleep early and have a sound sleep of at least 7–8 hours every night.
At this moment, I believe that you know a bit more about how your body works. Now you know why you have low blood sugar at 3:00 am and high blood sugar after waking up.
It is quite clear which action you have to take if you will have a Somogyi or a Dawn effect. But, both effects give high fasting blood sugar levels so how will you know which effect you are experiencing?
Just continue reading further because you are on the right track…
How to differentiate between the two effects, if you suspect high fasting blood sugar?
If your sugar level shoots up every morning after you wake up, then always check your 3:00 am sugar.
If sugar at that time comes low then this is a Somogyi effect. You should always consult your doctor as root cause analysis of hypoglycemia is required. There may be a need for drug dose reduction but it all depends on clinical judgment.
But if your 3:00 am sugar comes out to be normal or on the higher side, then it’s a dawn effect. It requires clinical judgment, your dose may need to be increased or changed.
Hypoglycemia or low blood sugar levels should be managed at priority since low sugar causes our body to get deprived of energy and causes symptoms such as tiredness, weakness, fatigue, lethargy, shivering, and extreme hunger.
If sugar levels are not managed at this stage, it can further lead to unconsciousness or coma. Unawareness of hypoglycemia phases could be dangerous due to the same reason and hence must be looked for!
On the other hand, hyperglycemia or high blood sugar levels are also important to be managed as it can further lead to complications. Constant high blood sugar levels can impact kidneys, eyes, nerves, heart and brain.
You must work on managing your blood sugar levels within the normal range in order to live a healthy and happy life. Do improve your lifestyle by eating timely, exercising daily, going for doctor follow-ups and taking insulin or medicines on time. For more information, read this blog.
All the best for managing your blood sugar not just by losing weight but by lifestyle modifications and proper guidance on medications under doctors and experienced healthcare professionals.
Zyla is one such platform where you can consult Doctors, their extended team of nutritionists, physiotherapists and get 24*7 chat support via a personal care manager. It helps you manage blood sugar levels through personalised health and exercise plans and Doctors guidance over lab tests and medicines as and when required.
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