How to Treat Foot to Floor Phenomenon

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.

  1. I am on Control IQ and still do take a small bolus upon rising because otherwise my BS goes up without eating a thing. This can occur immediately or an hour or two later. I find the added basal from Control IQ doesn’t start early enough or is not sufficient to avoid the incease in BS. Occasionally my small bolus isn’t enough! So a second small bolus is needed to cover the increase. This is unpredictable and requires a degree ov vigilance to avoid this peak.

  2. Thanks! I also have bg go up when I get up. I assumed it was from my 1 cup of coffee, and since I am not hungry for a while, didnt worry abt it. This makes more sense!😊

  3. How would one treat this if they’re not on insulin? I’m on metformin and notice 90 in bed, and then 120+ when I test in the kitchen.

    • Hi Ashley, good question. Talk to your doctor and see if you can take most or all of your metformin at bedtime, i.e. 300 in the morning and 1500 at bedtime. This sometimes helps. Also, if you are on a sulfonylurea you could also shift that to bedtime. If your A1c is good, then it really does not matter that much. Do not change your medication without talking with your doctor first. Good luck!

  4. I also have a high blood glucose when I first get up in the mornings. I walk a few steps to my desk to test my blood sugar, but not far. My blood sugar will be 107 or so when I take it in bed, but 125 or 130 if I get up & go to my desk to check it. Should I be worried about the difference?

    • No you should not be worried about the difference. These are normal differences as the meters we use can vary a bit.

  5. Thank you for all of your comments! After I get up in the morning, my blood sugars rise too. I thought is was the vitaminsI took in the morning, but they are gluten free. Still wonder??? I up my insulin dose in the AM on my pump and recheck hours later to see if I need more. Sometimes I do need more insulin depending on what I eat. I currently don’t use a CGM, but am waiting for insurance approval. I have used CGM in the past, but finances don’t allow me most the time.

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