What the F is Foot to Floor Phenomenon?

Woman with 2 feet on the floor, getting out of bed

My morning alarm goes off, and I check my blood sugar while I’m still in bed. 100mg/dL – great, right where I want to be. I get out of bed, grind my coffee beans, and take a quick shower. I check my blood sugar again before breakfast, and it’s now up to 160mg/dL – even though I didn’t eat or drink ANYTHING…what the F?!

This phenomenon is called Foot to Floor, and is an annoyance for some people with diabetes. Foot to Floor is your body’s natural stress response to the get-up-and-go mentality. It is your body saying “hey, you need some energy to get your day started,” and then releases certain hormones that cue your liver to dump extra glucose into your bloodstream. Gee, thanks, Liver. I think my coffee would have sufficed. 

Foot to Floor is similar to, but not the same thing as Dawn Phenomenon, and can be a little trickier to manage. Keep reading for more info on how to identify Foot to Floor, and ways to deal with it.

Dawn Phenomenon vs. Foot to Floor

You may be familiar with Dawn Phenomenon, an early morning rise in blood sugars, affecting approximately 50% of people with diabetes (both type 1 and 2). Similarly to Foot to Floor, it is the body’s way of helping you wake up – hormones like cortisol, glucagon, and growth hormone tell your liver to dump glucose into your bloodstream hours before you wake up. Dawn Phenomenon is fairly predictable in people who experience it, causing the same rise in blood sugars day after day. Many people with insulin pumps control for Dawn Phenomenon by having a higher basal insulin rate, starting around 3-4am. 

Foot to Floor seems to be less predictable. It may only happen on mornings when you are rushing to get to work or school on time, or mentally preparing for a busy day. Remember, Foot to Floor is a stress response, so the more stress you experience, the more likely you are to see a rise in blood sugars. As an example, I rarely experience Foot to Floor on weekends, or days that I work from home. 

Why do My Blood Sugars go up in the Morning?

To determine if Foot to Floor is to blame for your high post-wake up blood sugars, you should first rule out Dawn Phenomenon. You can do this with early morning blood sugar checks or a continuous glucose monitor. If you see the same pattern day after day, it is likely Dawn Phenomenon. Talk to your healthcare provider about strategies to manage Dawn Phenomenon. 

If you’ve already ruled out Dawn Phenomenon, ask yourself these questions:

  • Is my blood sugar in a good range when I wake up, but high an hour later, without eating or drinking?
  • Am I particularly stressed or hurried on mornings when I see a post-wake up rise in blood sugars?
  • Does my blood sugar rise at the same time every day? Or just on mornings when I’m in a rush? (think weekend vs. workday)

If your patterns indicate a stress response, it’s probably Foot to Floor, and not Dawn Phenomenon.

Managing Foot to Floor Blood Sugars

The advice I can offer for managing Foot to Floor is largely anecdotal. There isn’t a ton of research on it. Here are some strategies that I’ve found helpful:

  • Allow yourself more time to get up and ready in the morning. A leisurely wake-up is less likely to cue a stress response in your body. 
  • Check your blood sugar 10-15 minutes after you get up and start moving around. If it is already headed in an upward direction, consider pre-bolusing for breakfast, a correction insulin dose, or both. 

With T1D, sometimes our bodies work against us. Our liver thinks it’s being helpful by giving us a load of sugar when we get out of bed. But understanding how your body works, and responds to things like a stressful morning, is the key to better blood sugars.

If you suspect you’re experiencing Foot to Floor, talk to your healthcare providers about your unique situation and strategies to manage it.

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