Ask The Expert
August 30, 2011
If you have diabetes, itís common to have high blood sugar in the morning. Our liver creates blood sugar when we donít eat to keep our blood sugar from getting too low. This happens in all of us, whether or not we have diabetes. Itís called gluconeogenesis.
Normally, insulin controls how much gluconeogenesis happens. The pancreas releases just enough insulin to keep blood sugars in the normal range. If blood sugar starts to rise above normal, more insulin is released. And gluconeogenesis turns off.
People with diabetes donít have this control. With type 1 diabetes, the pancreas does not make insulin. With type 2 diabetes, there is usually plenty of insulin. But the insulin does not work effectively in the liver to hold back gluconeogenesis. This happens even if blood sugars get higher.
Pain can also raise your blood sugar. When you are in pain, your body makes extra amounts of stress hormones, such as cortisol and adrenalin. These hormones cause your blood sugar to rise.
If you are not taking any insulin now, a small dose of NPH insulin would work best. I usually recommend 10 units before bed. The insulin will hold back gluconeogenesis during the night and lower your morning blood sugar.
If you are already taking insulin, talk with your doctor. He or she can adjust your current doses and the times you take insulin.