I often hear my patients ask, “why is my blood sugar high in the morning when I didn’t eat anything overnight?” Or they say, “nothing has changed. I eat and exercise the same as I always have, but my readings are rising.” So how can this be?
As you probably already know, there are several things that can affect your blood sugar readings: your diet, exercise pattern, stress level management and whether you have taken your medications. But there are two other possible culprits responsible for raising blood sugar: aging and hormones.
Diabetes and Aging
As we age, our body does not use insulin as well as it may have in earlier years. And there’s a shift in hormones. We all make less human growth hormone, women produce less estrogen and progesterone, and men often produce less testosterone.
In addition to the hormones effecting your readings, there are side effects to hormonal changes that also can play a role in blood sugar management. For example, changes associated with menopause — weight gain, increased risk of infections and sleep problems — all have a direct effect on blood sugars typically rising.
How it effects your blood sugar levels depends on which part of the hormone cycle you are experiencing.
For instance, during pre-menopause, women may see lower blood sugar readings due to the reduction of hormones at that time, and adjustments to diabetes medication to avoid hypoglycemia (low blood sugar) may be necessary. But there’s also a potential side effect of weight gain from hormonal changes slowing down your metabolism that occurs during menopause. Increases in body weight increases insulin resistance with an outcome of above target blood sugar levels.
For men with diabetes, low levels of the hormone testosterone can cause insulin resistance. Again, when there is insulin resistance, you will see above-target blood sugar readings.
Aside from hormones related to life cycle changes, there are also hormones that are secreted overnight — anywhere from 2 to 8 a.m. — as part of our normal sleep process. These hormones include cortisol, epinephrine and growth hormone, and they can also raise blood sugar.
This happens for people with or without diabetes — it’s called the “dawn effect.” The difference is that people without diabetes can compensate and secrete more insulin automatically to help lower the morning blood sugar. In one respect, this process is a good thing. Our body is preparing us for the day by assuring we have enough energy via glucose to start our day.
There are some especially important hormones to help with blood sugar stability. Insulin, glucagon and amylin are helpful hormones. Insulin allows the body to use glucose for energy and helps with the stabilization of our blood sugar. Glucagon which is also produced in our pancreas, helps manage glucose and ketone production. It is secreted in between meals and overnight.
How to Counteract Hormone Disruption on Blood Sugar
So, what can you do with your diabetes management to help counteract hormone disruption?
1. Check your blood sugar more often. Knowledge is power in the fact that if you see your blood sugar rising or falling, you can adjust your lifestyle behaviors to get your reading closer to target range. If you have a continuous glucose monitor or a blood glucose meter, you have the power to literally tap into your body to find out how your blood sugar is trending.
2. Make healthy eating choices. Healthy eating is part of the treatment plan for managing diabetes. If your blood sugar is trending above target (our target is 80 to 130 before meals and 80 to 180 two hours after eating), then try eating lower carbs at that time. If your blood sugar readings are below target, this may indicate the need to have a between-meal snack, add more carbs to your mealtime or make a medication adjustment. Or you may need to change the timing of your meals.
If you are seeing above target in the morning, try eating dinner earlier or try a bedtime snack containing protein and carbohydrate. Don’t skip breakfast, we want our body to be out of the “fasting state” so hormones and blood sugar levels will smooth out.
3. Increase or add a physical movement. Follow an exercise routine at least five days per week. This will help balance the blood sugar rise by adding more physical activity into your day. If you see above target readings in the morning, try to add exercise after dinner.
4. Adjust diabetes medications. With doctor’s order, you may need to adjust your medications during this hormonal change time of life. Share your blood sugar readings log with your doctor so they have more “data” to make informed decisions on how your readings can be in target range.
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