You can feel, almost touch, the anticipation that a new day brings. The glorious early morning orange glow signaling a new beginning. As an early bird I’m somewhat biased but I feel that dawn is the most beautiful time of the day. It will beat out dusk for me any day of the week. At the end of the day there is little to look forward to leaving only the reflections of what went well, or not so well during the prior hours. The early morning marks another opportunity, a new chance to do something meaningful. In our home most of us are early risers. Now that her honeymoon period (a period of time shortly after diagnosis when blood sugars remain fairly level) is over we’ve noticed that A’s blood sugar is an early riser as well.
We usually notice this rise in BG (blood glucose) levels around breakfast. After some research and discussion I thought it might be the product of what is known as the Dawn Phenomenon. My understanding of this phenomenon is that there are often hormone surges early in the morning that lead to increases in BGs. These surges then impact the insulin required to counter the highs and, in A, may be showing up as highs following breakfast. She typically does not have BG spikes after lunch or dinner, just breakfast. After doing some reading, speaking with medical care providers and other parents of children with T1D it seems that this is common. However, this is not due to the Dawn Phenomenon at all because when she immediately wakes up her blood sugar is not elevated.
There is some psychology involved in these early morning blood glucose rises, like most other things. A doesn’t want to manage highs first thing in the morning (or at any other time of the day I guess). I can’t blame her. Who wants to start their day like that? The other part of the psychology here, she’s got other things that she would like to keep their attention on as she starts the day like her upcoming birthday, having lunch with a friend or what to look forward to in school that day. We’ve started to consider her routine that may impact these early morning spikes. Here are some things we’ve found that sometimes work to counter the early morning high:
- Exercising before breakfast — This is not one we typically turn to. Given that A is still fairly new in her diagnosis we don’t want her to feel like to eat she needs to do 20 jump and jacks.
- Bolus 15-20 minutes before eating (this is called pre-bolus)- Normally when we give her a bolus before a meal it is as she is sitting down at the table. For breakfast we start a little bit earlier.
- Bring on the dairy — I’ve heard that adding dairy in the morning can counter the effects by increasing absorption.
- Lower carbs in the a.m.- I don’t like the idea of limiting what my daughter can eat. When she wants pancakes she should have them. We are fortunate, however, that she loves hard-boiled eggs and other lower carb options to eat for breakfast. We go for that win!
The blog ‘A Sweet Life’ does a nice job of breaking down some of the other reasons for highs BGs in their post ‘High Blood Sugars After Meals and What To Do About Them’ https://asweetlife.org/high-blood-sugar-after-meals-and-what-to-do-about-them/.