There is a specific kind of frustration that only a person with T1D can truly understand. It’s that moment when you wake up, check your CGM, and see a beautiful, steady line – perhaps a perfect 100 mg/dL. You feel successful, rested, and ready to take on the day. But the moment you actually swing your legs out of bed and stand up, that line starts to tilt upward. By the time you’ve brushed your teeth and started the coffee, you’re at 140 and climbing.
If this sounds familiar, you aren’t doing anything wrong. You are likely experiencing “Foot on the Floor” (FOTF) syndrome. While it can feel like your body is working against you, understanding the science behind this rise is the first step toward outsmarting it.
Please note, this post is not medical advice. Make sure to consult with your healthcare team before making any changes to your diabetes management routine.
What Is Foot on the Floor Syndrome?
Foot on the Floor syndrome is a phenomenon where blood sugar levels rise as soon as a person wakes up and physically gets out of bed. Unlike other blood sugar spikes that are tied to what we eat, FOTF is generally hormonal.
When you wake up and start moving, your body releases a surge of “get up and go” hormones, including cortisol, adrenaline, and glucagon. These hormones signal your liver to release stored glucose into the bloodstream to provide you with the energy needed to start your day. For someone without diabetes, the pancreas simply releases a small burst of insulin to counteract this. For those of us with T1D, we have to provide that “burst” ourselves.
How Is Foor on the Floor Syndrome Different From the Dawn Phenomenon?
It is very common to confuse Foot on the Floor with the Dawn Phenomenon, but they happen at different times. While Foot on the Floor is triggered by the physical act of getting out of bed, the Dawn Phenomenon is dictated by your body’s circadian rhythm. Here is a deeper look at what is happening while you are still fast asleep.
Around 3:00 a.m. or 4:00 a.m., your body begins to make sure you have enough energy to function when you wake up and prepare for the day ahead. To do this, the brain signals the endocrine system to release counter-regulatory hormones.
Several specific hormones rise during these early morning hours, including:
- Growth Hormone: This hormone is released overnight to repair tissues and stimulate growth. It also increases insulin resistance.
- Cortisol: Often called the “stress hormone,” cortisol levels begin to rise in the early morning to help the body transition from sleep to wakefulness.
- Glucagon and Epinephrine: These hormones act as signals to the liver to release glucose.
The primary result of this hormonal surge is that the liver is instructed to release its stored glucose (glycogen) into the bloodstream. In a person without diabetes, the pancreas senses this rise and automatically secretes just enough extra insulin to keep blood sugar stable.
For those of us with T1D, our bodies cannot produce that extra insulin. In addition, the presence of growth hormone and cortisol makes our basal insulin less effective. This creates a double whammy in which more sugar is entering the blood, and the body is more resistant to the insulin trying to manage it at the same time.
This is why many people find they may need a higher basal rate on their pump during those early morning hours compared to the rest of the night!
Foot on the Floor vs. the Somogyi Effect
FOTF is also differant than the Somogyi Effect, which is also known as rebound hyperglycemia. The Somogyi Effect occurs when your blood sugar drops too low during the middle of the night. In response to the life-threatening low, your body releases emergency hormones to dump glucose into your system, resulting in a high reading when you wake up.
While FOTF and Somogyi both result in morning highs, the cause is very different. FOTF is a result of natural morning hormones, whereas Somogyi is a defensive reaction to an overnight low. Checking your CGM data or testing in the middle of the night can help you determine which one you are dealing with.
What I Do to Help Prevent the Rise
Over the years, I have developed a few strategies to stay ahead of this morning rise. Because I know the hormones are coming, I try to get the insulin on board before the spike happens.
If I see my blood sugar start to trend upward upon waking, I generally choose one of three paths based on my plans for the morning:
- The Immediate Pre-bolus: If I know I am going to eat breakfast right away, I will pre-bolus for my meal the moment I wake up. By giving the insulin a 15- to 20-minute head start, it can work to counteract the hormonal rise and the breakfast carbs at the same time.
- The Loop “Pre-meal” Preset: Since I use the Loop app (an automated insulin delivery system), I have a “Pre-meal” preset configured. If I don’t plan on eating right away, I turn this on immediately. It temporarily lowers my target range to 75–90 mg/dL, which signals my pump to be more aggressive with basal insulin to catch the rise before it gets out of hand.
- The Manual Correction: Prior to using an automated system like Loop, I found success with a small manual correction. For my body, taking about 0.5 units of insulin immediately upon waking was usually enough to “blunt” the hormonal spike without causing a low later in the morning.
Final Thoughts
Managing Foot on the Floor syndrome is a perfect example of why diabetes management is so much more than just counting carbs. It’s about understanding your body and being proactive rather than reactive.
If you find yourself struggling with morning highs, I encourage you to look closely at your data to see if your rise starts before or after you get out of bed. Identifying that pattern is key to working with your medical team to determine the appropriate adjustments.
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