Dr Mahesh Gupta - Diabetologist & Cardiologist (Non Invasive) I Obesity & Metabolism Consultant

Why a high fasting blood sugar reading at 7:00 AM might actually mean your blood sugar crashed at 3:00 AM! I've seen this pattern more times than I can count. A patient comes in. Fasting sugars running high. They've been careful with diet. They haven't missed a dose. So we increase the nighttime insulin. Sugars go higher. We increase again. Still higher. What's going on? We check a 3 AM reading. 47 mg/dL. The patient was crashing every night — and didn't know it. The body was triggering a hormonal alarm — glucagon, cortisol, adrenaline — dumping glucose into the bloodstream to survive. By morning, it looked like poor control. It was actually a rescue response. This is the Somogyi Effect. Rebound hyperglycemia after nocturnal hypoglycemia. The fix wasn't more insulin. It was less — plus a small bedtime snack. Within two weeks, fasting sugars normalized. A CGM would have caught this on night one. The lesson: a fasting number never tells the full story. The overnight journey matters just as much. If your sugars are stubbornly high in the morning despite doing everything right — ask your doctor about what's happening at 3 AM. The answer might surprise you. #Diabetes #BloodSugar #DiabetesAwareness #Somogyi #CGM #Diabetology #PatientCare Jun 19, 2026