By Howard LeWine, M.D.
Q: 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?
A: It’s common for people with type 2 diabetes to have high blood sugar levels in the morning. In type 2 diabetes, formerly known as adult onset diabetes, the body’s cells are resistant to the action of insulin, so sugar doesn’t move readily from the blood stream into cells.
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, the problem is insulin resistance. Similar to other cells, the liver cells also have insulin resistance. The pancreas might not release enough insulin to hold back gluconeogenesis, even if the blood sugar level is already high.
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 intermediate or long-acting insulin before bed often works well. 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.
(Howard LeWine, M.D. is an internist at Brigham and Women’s Hospital in Boston and assistant professor at Harvard Medical School. For additional consumer health information, please visit www.health.harvard.edu.)