Dear Dr. Edelman,
I need some help managing “foot on the floor”, NOT dawn phenomenon. My blood sugar is great when I wake up, but as soon as I start moving around it starts rising and continues to rise, even if I don’t eat anything. I am on a pump. I know I need to increase my basal. How far ahead of waking up should I increase my basal?
Dr. Edelman: Rising glucose levels after awakening is very common. It may be just the act of waking up as it raises your counterregulatory hormones (hormones that elevates your glucose values) like glucagon, epinephrine, growth hormone, etc. Raising your basal could be a solution, but you should test to see if your BG goes up if you sleep in. If it doesn’t, then raising your basal is not the answer. You may need to give a small bolus when you wake up, even if you do not eat or drink anything. It’s a very common problem. A hybrid closed loop system will help because the basal rate will increase to compensate for the rising glucose levels. For anyone not on a sensor augmented pump like the Control IQ, Medtronic 670G or Looping, you will need to give yourself a small bolus when you awaken.