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Harvard Medical School
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General Medical Questions
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Question : I have type 2 diabetes. My blood sugar runs high in the morning, especially if I am in pain. I have arthritis and neuropathy in my feet and lower legs. Why is my sugar running high in the morning, especially when my pain is worse?
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The Trusted Source
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Howard LeWine, M.D.

Howard LeWine, M.D., is chief editor of Internet Publishing, Harvard Health Publications. He is a clinical instructor of medicine at Harvard Medical School and Brigham and Women's Hospital. Dr. LeWine has been a primary care internist and teacher of internal medicine since 1978.

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August 30, 2011
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A:

If you have diabetes, it’s common to have high blood sugar in the morning. Our liver creates blood sugar when we don’t eat to keep our blood sugar from getting too low. This happens in all of us, whether or not we have diabetes. It’s 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 don’t 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.

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