Q: I've been in the Zone proper for two weeks now and have noticed my morning blood glucose levels decreasing from before starting the program. However, I still have elevated blood glucose levels in the morning. I suspect Dawn Phenomenon versus Somogyi Effect. Testing at between 2 and 3 a.m., levels are also high. I've read this elevated glucose is due to counter-regulatory hormone release of HGH, cortisol and catecholamines caused by the wearing out of bedtime insulin resulting in increases of blood glucose levels. I do eat a bedtime snack of one block. Should I split my evening meal to two, two-block snacks to increase my insulin before bedtime?
A: Since your blood sugar levels are high between 2 and 3 a.m., it is indicative of the Somogyi Effect due to the lowering of the nocturnal blood sugar levels caused by long-lasting insulin injections. When nocturnal blood sugar gets too low, hormones, such as cortisol, are secreted to cause neoglycogenesis. Unfortunately, the increased cortisol also causes increased insulin resistance, which is the cause of high morning glucose levels. I would keep your evening meal constant and increase your evening snack to two blocks. Alternatively, you can discuss with your physician the potential of lowering the amount of long-acting insulin at bedtime. Keep in mind, your best indication of the success of the program will come from the lowering of your glycosylated hemoglobin levels, the best marker for long-term glycemic control.