Question concerning morning highs

T1D for 37 years plus here.
I recently have been having high morning blood sugars. I am on Novolog and Lantus pens.
My last H1Ac was 6.0, but my sugars start to elevate around 5am. By the time I get up around 645, they are in the 200s.
I have heard of the “boots on the ground” syndrome, but I do not know what to do to correct. I have tried increasing my Lantus(currently at 10 units) but to no avail.
Any help will be greatly appreciated.

hi @cc12345 welcome to T1N!

fixing mornings highs can be tough. fixing it on shots is even more tough. If you are taking more insulin and it’s not helping, then it’s time to do something different.

I get high blood sugar in the morning. It goes away a little when I vary my wake up time. I travel for work and so when I am not in my home time zone I notice I don’t have as much of a rise in teh morning.

If I shoot for a little higher overnight blood sugar overnight, often times my bs wont rise as much in the morning.

Varying what I eat at nigh makes a big difference in morning blood sugar as well. Maybe try varying proteins and see what happens.

I have a pump so its easier to increase my insulin by program when I see a pattern. this may not be an option for you, unless you set an alarm and get up test or watch your cgm and take a correction shot.

not entirely helpful… l know… good luck. though


@cc12345 , Do you take your Lantus at night or in the morning? I’m on a pump now, but when I was MDI my Endo recommended that I take half my long acting insulin in the morning and half at night, due to it running low by morning time. He also switched me to Levemir for some reason. It’s been a long time and I don’t recall the details, but it did help. You might ask your doctor if dividing it might help. I hope you can find a solution.

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My endo also switched me to half in the morning/half at night when I was still on Lantus and humalog. She switched me because I was getting a lot of overnight lows but I can see it working both ways, if you go high or low at night. Like many others, I’m now on a pump and fine tuned basal rates have mostly fixed the issue for me.
This is me coming up with ideas but could you possibly go for a walk right before bed? If your body responds to the exercise 5-12 hours late, could the exercise help counteract the highs in the early morning??? Of course you don’t want to go low in the middle of the night so that might not work.

I am not a doctor but I did have a similar problem when I was on MDI. The solution I used back then was to take a little less levimir and have a small snack at bedtime. Unless it was extreme I would sleep through the low and my body would generate sugar to counter it… It would probably be useful if you could get a cgm to see what happens when you sleep…

at night, usually at bedtime.

May I ask why you want to correct it? Are you trying to lower your A1c below 6? Are the morning highs making you feel ill? I’m curious because I’m in a similar boat (T1D for 30 years, using MDI Lantus twice a day and Humalog, most recent A1c’s ~8) and I’ve just decided to live with it and do my best to correct the highs with my breakfast insulin dose. I feel that getting my afternoon and evening doses more consistently on target will be both easier and more impactful.

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My problem is you may know is that high morning blood sugars, mean I am tired. If I over correct, then I go low. My job is very strenuous. Just trying to get levels below 150 would be great.
Thanks for your help

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I’ve had a similar issue that comes and goes. When it comes I increase my Lantus 20% (10u to 12u) and have seen improved BG values in the morning. However, when my morning BG feels too low I switch back to 10u to avoid night lows.

That’s a good idea. I will try that.
Thank you!!

I had the exact problem when I was taking lantus. My doctor changed me to take half of my dose in the morning and half at night and it helped but I still had some issues with morning highs. I switched to tresiba after my doctor recommended it, and he said some of his patients had trouble with lantus lasting the full 24 hours. If you have access to tresiba, I definitely recommend trying it as it seemed to fix my morning high problem. It does advertise that it lasts longer than other long acting insulins like lantus.

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The day after I posted above I had a morning that showed what I was trying to describe, so I saved a screenshot. I’d had a roller-coaster night but you can see from the graph how getting my evening/overnight blood sugar in a good place means the morning high won’t be so bad. It did take some trial and error to figure out appropriate Lantus and Humalog doses for this to work, though. (My target’s 150 from evening to early morning and 120 all the rest of the time, FYI.)

My job is also physically demanding, so I understand about not wanting to feel tired. When I get into the 300’s or higher my mornings at work are rough. But if I’m too aggressive with the mornings I wind up going low before lunch, which is even worse. Personally, I feel most comfortable with a moderately high BG at breakfast that comes back down slowly. What worked best for me in the end was being both more aggressive with my carb ratio and less aggressive with my correction factor than at any other point in my day. So - weird as this sounds - I treat my breakfast, not the high.

One thing I found, being so much more active at work than on my days off, is that I need more Lantus on my weekends and also on my first day back at work.

Like @Bbodkin said, I tried Tressiba because I’m one of those people for whom Lantus only works about 22 hours, but I didn’t think it helped much. Then I tried the Omnipod and my A1c rose (it used to be 6 or 7, but it’s been 7 or 8 since the pod). So after a year on the pod I went back to MDI and that’s when I started using Lantus twice daily. It seems to help a little with stability. :woman_shrugging: I never found my perfect solution, but all that to say there are options that might work better for you than they did for me.

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For me it hits around 3am. Dunno why my body thinks I need energy before sunrise. I tried splitting my lantus dose for a couple of weeks but didn’t see a change. So my doc and I cranked up my lantus to deal with it. Lantus now accounts for 40-50% of my daily insulin.

Diet affects how much of a rise. Slow release carbs like a yam with dinner mean I’m going to wake up at 180 instead of 100.

When I go to my endo she wants to see ~40% of my insulin dosage coming from basal/background/long acting insulin and ~60% from bolus/short acting insulin given for corrections/food. I thought that was interesting :slight_smile:

Source for @6yGodsGr endo’s recomendation
9. Pharmacologic Approaches to Glycemic Treatment: Standards of Care in Diabetes—2023 | Diabetes Care | American Diabetes Association.

I had same problem and using minimed pump with fast insulin. Dr made some adjustments but I remember her telling me to have a snack before bedtime. I would go low 5-7am and high after 8am before breakfast :flushed:

I use MDI and Lantus (Semglee) myself. I have this issue every morning and really was never aware of the severity of it until I started using a CGM. My doctor told me it is “morning syndrome”, and is due to your body dumping hormones into your bloodstream when you initially get up. I have found it fascinating how it does not matter what time I wake up, as soon as I get up out of bed and start my day, my BG starts going up. I have changed my morning routine to now take my Humalog bolus and wait a half hour to a full hour to let it get onboard and start bringing my BG down before I eat breakfast.
I also take 2 separate doses of Lantus (Semglee) everyday; morning and evening, as it does not work for 24 hours in my body.