What should I know about fasting blood glucose levels if I have diabetes?

One specific pattern of glucose fluctuations needs special consideration: high fasting blood glucose values. It seems perfectly logical for blood sugar levels to rise after eating, but many people are surprised to find that they have higher glucose levels when they get up than they do before other meals of the day, such as dinner. Higher blood sugar levels in the morning mean that you have less insulin action in your body overnight.

We often see this in people treated with medications such as the sulfonylureas, which are more effective at promoting insulin release following eating than during prolonged fasting.In addition, there are two special conditions that may raise fasting glucose levels. The first is called the dawn phenomenon, which results from an increase in certain hormones in the body, especially the stress hormone cortisol, beginning at three or four o'clock in the morning. Cortisol increases insulin resistance, often causing a rise in blood sugar values.

The other problem is called the Somogyi effect. This refers to a blood sugar level that rises in the early morning after the person experiences an unrecognized hypoglycemic event during the night. High morning glucose values should prompt some testing at bedtime and then a few tests at 2 or 3 A.M., just to rule out nocturnal hypoglycemia.

Clues to nighttime hypoglycemia include fitful sleep, nightmares, or awakening drenched in sweat.

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