Unexplained High Blood Sugar: Is It High Cortisol While You Sleep

What causes high blood sugar?

Most of the time we know what causes high blood sugar. Eating too much food. Especially simple carbohydrates and junk food. But there are other factors which can elevated blood sugar independent of diet.

Other causes of high blood sugar include:

Stress and cortisol
Nutritional deficiencies

The adrenal glands, cortisol and the stress response

The adrenals are two small glands which sit on top of the kidneys. Their job is to make numerous hormones which regulate stress response including cortisol, epinephrine and aldosterone. For the purpose of keeping things simple, I’m just going to focus on cortisol.

Cortisol is out "Fight or Flight" hormone. Normally it follows a diurnal, rising to it’s highest point in the morning, and then slowly decreasing during the day. Ideally it is lowest at night when we go to sleep.

Chronic stress can deregulate this pattern. Stress is simply the body’s adaptation to any extra demand. This can be psychological stress, or physical stress from an injury. The body's physiological response is the same. The adrenals release cortisol. It’s job is to get more blood and nutrients to the heart, lungs and brain to help you survive an emergency.

Short term elevations of cortisol are essential for survival. But when stress in our daily lives does not go away, cortisol levels get thrown off.

Cortisol may be high, or in some cases the adrenals became exhausted and cortisol is too low. Neither is good. It is also possible for cortisol to be normal for some parts of the day, but deregulated at other times.

Lab tests for blood sugar

Since cortisol raises blood sugar, that means even if you eat a good diet, stress by itself may cause a blood sugar issue. Blood test can help figure this out.

Blood glucose: This is your blood sugar levels at any one moment. This test helps diabetics regulate their medications, supplements or diet. A single reading should never be used to determine if someone is a diabetic or has a blood sugar problem. It's possible for blood sugar to be ok during part of the day, and very much off at other times.

HgA1c: Used to test blood sugar over time. Hemoglobin is in our red blood cells. Its job is to bind oxygen. Over time blood sugar will glycosylated hemoglobin. The higher the blood sugar over time, the higher HgA1c will be. This test can not be used for short term rises in blood sugar. Instead if shows if blood sugar has been elevated over several months.

Mysteriously high blood sugar and cortisol

If you follow the following pattern, you may be experiencing a spike in cortisol while you sleep, causing high blood sugar:

Elevated HgA1c
Normal blood glucose levels on blood tests
You are not eating a high carbohydrate, or high sugar diet
You wake up in the middle of the night for no reason (not all the time, but common)

How to test for middle of the night spikes in blood sugar and cortisol

Go to any drug store and buy a glucometer. I recommend getting a cheap one, as you probably are not going to be using it that often. Take your blood sugar at night and in the morning. If you wake up in the middle of the night, take your blood sugar then as well. It's normal to see some increase in blood sugar as your sleep. This is part of your body getting ready to wake up. However a very large spike can indicate that cortisol is too high. In some people cortisol is normal during most of the day, but goes up way to high at night.

The other test is a saliva cortisol. Theses are commonly used by naturopathic doctors, or other functional medicine practitioners. One of the advantages in using a saliva cortisol tests is that samples can be taken multiple times during the day and even in the middle of the night. If I have a client who is waking up in the middle of the night, I have them take a cortisol sample then, so we can see exactly what is happening.

If blood sugar is spiking in the middle of the night, there is a good chance it is cortisol. The glucometer blood sugar test is therefore a way to infer if cortisol is going up to much at night. The saliva cortisol is a direct measurement.

The advantage to testing blood sugar is you get immediate results. Taking a saliva sample, sending it off to the lab and waiting for results takes about two weeks. You also need to either order a kit from a company that sells it, or get one from a practitioner you are working with. Neither test is that difficult to do, so doing both is really the best option for difficult cases.

How to fix elevated cortisol

The real answer is going to be different for everyone. When working with clients I often use herbs or homeopathics which are best individualized. There are also many different way to lower stress response with lifestyle modifications such as meditation and exercise. Each person needs to find what works for them. In the office I also use a system called Neuro Emotional Technique to help the body release emotional triggers it is holding onto.

Some common supplements for stress, cortisol and blood sugar

These are some supplements that often work. Since everyone is different I can't guanantee these will work for everyone. But, without knowing anything more about a case, other than there is a stress response at night, these are the supplements that come to mind to try first.

Seriphos or phosphatidyle serine. Both of these are similiar. Seriphos will actually get converted into phosphatidyle serine in the body. For some people one may work better than the other. Phosphaidyle serine blunts the adrenals from being signaled into making too much cortisol. Doses can vary a lot. My last year in naturopathic school I developed middle of the nigh insomnia. I woke up about 3AM every night, for 8 months in a row. I didn't discover the cause until finally getting a cortisol test from my schools clinic. My cortisol was more than double what it should have been in the morning. One of my teachers told me to try 200 mg of phosphatidyle serine. It did nothing until I took 800 mg before bed.

Chromium: this is the most commonly used supplement for elevated blood sugar. Without chromium insulin can not function properly. It's very simply, but does work.

Ashwagandah: A very common herb for the adrenals. Some herbs which are used for the adrenals such as rhodiola, American ginseng or licorice can be very stimulating. Ashwagandah is more gentle and over time helps to repair the nervous system. Not a quick fix but generally very good. There are other options, but I can only recommended the bests helps I know if going over a case one one one.

As a side notes, some people may wake up in the middle of the night because cortisol and blood sugar are too low. In those cases eating a snack at night, or taking the herb licorice may help. The herb valarian is also generally for good for sleep. For those those with too much heat (Pitta in Ayurvedic terms) it can actually make their sleep worse. This is why going over a case properly and treating the person is much better than trying various supplements based only on their symptoms or disease.

Other pages on the adrenals and cortisol:

Adrenal supplements and adaptogens

Naturopathic treatment of adrenal fatigue

Saliva cortisol testing and adrenal fatigue

Saul Marcus, ND
New York City
Naturopathic Doctor

Adrenal Supplements And Adaptogens

Adrenal Supplements and Cortisol

The hormone cortisol plays a major role in regulating our stress response and energy production. Too little cortisol results in fatigue and often blood sugar problems.Adrenal supplements can be used to help boost cortisol production. Many of these actually have a balancing effect, raising cortisol when it is too low, and calming it down when it is too high. Herbs with those properties are called adaptogens.

This article reviews different types of adrenal supplements. For a more general discussion about adrenal fatigue follow this link.

DHEA and Pregnenolone.

In order to make cortisol and other hormones such as testosterone the body must first make them from cholesterol. The most difficult step is the first one, converting cholesterol into pregnenolone. It is still common for people to think that cholesterol is “bad.” However, without cholesterol you can’t make your hormones. In fact, low cholesterol may be associated with fatigue.

Both DHEA and pregnenolone are used as adrenal supplements. Pregnenolone may be converted into either cortisol or DHEA and other sex hormones. If DHEA is taken as a supplement, it will only be converted into the sex hormones.

DHEA and pregnenolone is not appropriate for everyone.

These supplements can aggressively push hormone production. Hormones should be tested before starting supplementation. DHEA in particular can have many side effects, especially those related to high androgens (male hormones) and estrogens, as it can be covered downstream to both. Acne and hair loss can easily result from taking too much DHEA.

These only raise hormones. Since they don’t help to balance out elevated hormones these are not adaptogens.

DHEA and pregnenolone are usually taken together. Taking a lot of one and none of the other may simply deregulate the overall hormonal picture even more. Pregnenolone will feed the cortisol pathway. DHEA can be converted into testosterone.

You may see these adrenal supplements are commonly sold in doses far higher than needed. For women who will benefit from DHEA, typically doses such as 5mg a day or less are sufficient. However, DHEA is often sold in doses of 25mg per pill or higher.

Supplementing with pregnenolone and DHEA for most people is best done with a health care professional. Lab tests should be run to monitor hormone levels.

This is typically not the first option I would try, but can be helpful in certain cases with lab tests.

Adaptogens

Adaptogens help if cortisol is is too high or too low. When taking in the morning it improves energy. At night it is calming and improves sleep.

For most people adrenal adaptogens are the best adrenal supplement to use. Their adaptogenic function makes then helpful for a wide range of people and low chance of side effects. Since they will not force hormone production in the way that DHEA and pregnenolone does, hormone lab tests are not needed.

When adrenal adaptogens work best

To help with the stresses of over day life. Long work hours, emotion stress and toxic exposure are some common examples of such stress.
For people with more severe/chronic fatigue – as an adjunct to a more comprehensive plan that is correcting their problem at a more causal level. For example, someone with chronic Candida, may take adaptogens for brain fog and fatigue – but it will not work that well unless the candida is also addressed.

When adrenal adaptogens will not work well

In complex cases such as Chronic Fatigue Syndrome more is needed than adenal support. Go to the page on chronic fatigue for more information. Adaptogens may be useful in these cases. However, they won’t work well just by themselves. Sometime a more holistic approach is needed. The adrenals need support, but so does the immune system and detoxification.

Cases of more severe fatigue, chronic fatigue syndrome, fibromyalgia, chronic viral infections. In these situations the cause of symptoms needs to be more directly treated, then simply covering up fatigue with an energy supplement. Typically this means working more directly on the immune system and/or detoxification.
Multiple chemical sensitivity. Some people are so sensitive to different stimuli that even tiny amounts of supplements that are safe for most people make them work. Adrenal supplements may make some people feel “speedy”.

Paradoxical symptoms are common in such cases. This is when a supplement that is supposed to do one thing, causes the complete opposite reaction. In such cases, patients may bounce around from doctor to doctor (and not just MD’s, this include people in natural health) just to be given one treatment plan after another that makes then worse and surprising the practitioner each time with extreme symptoms.

In these cases slow careful detoxification is important. The correct homeopathic remedy may do wonders as well.

People with multiple chemical sensitivities and paradoxical reactions much be treated accordingly. Most advice about what supplements to take for energy will rarely work in these cases.

Adaptogenic herbs for the adrenals.

This is a list of some herbs I most often for adrenals and poor energy. There are many other good herbs available. This list is not meant to be exhaustive.

All of these are good herbs. None are the best, nor are any of these good for everyone. For more information on a holistic herbal medicine intake see this page.

Licorice (glycyrrhiza glabra). Licorice has an extremely wide range of action. In terms of adrenal function, it acts like a weak steroid hormone (cortisol is the body’s primary steroid it makes on it’s own) which is one reason why it helps with energy. It is also a strong anti-viral. Often it is added to herbal formulas to help drive the action of other herbs. Another common function is to help soothe the digestive system. Regular licorice is used for energy, and “deglycyrrhizinated” or DGL licorice is sold for digestion. DGL has one of the active ingredients, glycyrrhizic acid removed. Therefore it will not have the stimulating effect of regular licorice.
Ashwagandah (Withania somnifera). Primarily used for fatigue and sleep. It is a strong anti-oxidant and can be used for other conditions such as to increase immunity, arthritis, hypertension, and hypothyroidism.
Rhodiola. A traditional Chinese medicine herb. Long used for, (and studied by Russians) increased physical stamina.
Kirin ginseng (Panax notoginseng) and American ginseng (Panax quinquefolius). These are similar. American ginseng is slightly cooling and sweat. Kirin ginseng is more warming. Both help with stress and energy. In Chinese medicine Ginseng was considered calming, and not stimulating at all. However, it helps the body handle stress, improving overall energy.
Siberian ginseng (Eleutherococcus senticosus). This is not a true ginseng. The name was simply applied to Eleuthrerococcus my marketers. Useful from people under prolonged stress from modern life style. People who are tired, with dark circles under eyes. Can help with sleep as well, but if not needed may be stimulating.
Rhemannia. A traditional Chinese herb. Helps adrenal and kidney function. At times it can be helpful when signs of weakness in the kidneys (needs to pee all the time, fear, sometimes heart palpitations.)

Glandulars

An adrenal glandular supplements is essentially the dried adrenal gland of and animal turned into a pill. This is not a form a hormone replacement therapy. Adrenal glandulars do not have large amounts of hormones in them. They work much more by giving nutritional support.

Often glandulars are more stimulating than herbs or other adrenal supplements. Some people feel much better on them. However others report feeling “speedy.” Since glandulars are only stimulating these would not be considered adaptogens.

Some people may with to avoid these products because they go against vegan beliefs. That is fine as we have many other ways to support adrenal function. Consider this information for the sake of completeness. No one should ever be told they have to take something that goes against their beliefs, unless there simply is no other option.

Vitamins and minerals

Vitamin C and most of the B vitamins are needed for proper adrenal function. Without these vitamins the adrenals can not convert cholesterol into cortisol. Like other supplements, some people feel much better on adrenal supplements high in B vitamins. Others may feel “speedy,” especially if they are the type who is often sensitive to supplements. Others may feel nothing at all.

In my office I’ll typically do kinesiology muscle testing against different B vitamins. The ones I see needed most often are vitamins B1, B12 and folate. An organic acid functional lab test can also pick up need for B vitamins. I wouldn’t normally run that tests just for B vitamins as it’s usually just as good to figure things out through in office testing and trying the supplement.

Other than cortisol one of the other major adrenal hormones is aldosterone. Aldosterone controls mineral balance. Without enough aldosterone people urinate more frequently, and this also means they are constantly peeing out their minerals. Magnesium may thus be low (often causes muscle cramping) but also sodium.

Sodium is often maligned for causing high blood pressure. Nonetheless many people with adrenal fatigue actually have low blood pressure. They are not able to maintain minerals. Having adequate intake of salt is essential to help the adrenals. Just make sure to get real sea salt, or eat vegetables that contain sodium like celery.

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