Living with diabetes can be difficult, but it’s not impossible. With help, you can learn to control and manage your diabetes so you are able to live a more fulfilled life.

A large part of managing diabetes is simply being educated on topics and issues that diabetics encounter on a daily basis. Registered diabetes educators Susan Jepkema, RN, CDE; Lauren Carlson RD, CDE; and Nicole Morrissey, RD, CDE, answer three common questions they receive while educating patients on diabetes.  

What causes high blood sugar in the morning?

“There are a number of things that may cause high blood sugar in the morning. While you are asleep, your liver is producing sugar called hepatic glucose output, or “HGO.” This function of your liver is what allows anyone to sleep through the night without their blood sugar dropping. Some people have what is called “dawn phenomenon” which means the liver goes into over drive and produces too much sugar and it can cause your blood sugar to rise significantly while sleeping. Another possibility is your blood sugar has dropped low enough that your liver produces the extra sugar to save you from that low.

One way to manage this is to keep your blood sugar meter in your bathroom. As you get up in the middle of the night to use the restroom, check your levels at different times of the night and make sure your blood sugar is where it should be at. That will allow us to discern if the high numbers in the morning are because of dawn phenomenon or because your blood sugar is dropping and then rebounding up. Knowing the answer to that question helps us to know how to adjust medication. If it becomes a more serious and frequent concern you can wear a continuous glucose monitor so it can read numbers throughout the entire night as you sleep. Having that data will allow your diabetes care providers to know if a change in medication is needed.”

-Susan Jepkema, RN, CDE

What is sugar alcohol?

“Sugar alcohol is not actual sugar. It’s often found in items labeled “low sugar” or “sugar free.” Your body doesn’t fully absorb or digest them, but they can impact blood glucose levels slightly and therefore it’s important to understand how to calculate them into your diet. On a food label you will generally see it listed under the carbohydrates section and we tell people with diabetes to count half of the dosage of sugar alcohol towards your total count for the day. For example, if there are 10 grams of sugar alcohol, five of them will count as “carbohydrates.” One thing to keep in mind while eating items with sugar alcohol, is that it can have a laxative effect if eating in excess and can cause stomachaches.”

- Lauren Carlson RD, CDE

What are the ranges of hemoglobin A1c to determine difference between pre-diabetic and diabetic?

“Hemoglobin A1c is a lab test that shows glucose control over a period of two to three months. It is used in conjunction with finger sticks to help providers and patients gain information on how well-controlled their diabetes is. For many people, they may check their glucose every morning and be stumped when their A1c comes back elevated. Because A1c values calculate an average of two to three months, it gives a more complete picture of what your glucose levels are doing day in and day out. A person with a hemoglobin A1c of 5.6 or below is considered non-diabetic. A1c levels of 5.7 to 6.4 are considered pre-diabetic, and anyone with A1c of 6.5 or higher is considered diabetic.”

- Nicole Morrissey, RD, CDE

For more information on how Lakeland Health can help you manage your diabetes, click here.