Differential Diagnosis for Glucose Spike at 2 am
- Single most likely diagnosis
- Corticosteroid induced hyperglycemia or exogenous insulin dosing error: This is likely due to the common use of corticosteroids and the potential for errors in insulin dosing, which can lead to glucose spikes, especially during the early morning hours when cortisol levels naturally rise.
- Other Likely diagnoses
- Dawn phenomenon: This is a normal, natural rise in blood glucose that occurs in the early morning hours, typically between 2 and 8 am, due to the release of certain hormones such as cortisol and growth hormone.
- Somogyi effect: This occurs when insulin doses are too high, causing hypoglycemia, which in turn triggers the release of stress hormones like cortisol and adrenaline, leading to a rebound hyperglycemia.
- Sleep-related eating disorder or nocturnal hypoglycemia: Consuming food during sleep or experiencing low blood sugar levels at night can lead to a glucose spike in the early morning hours.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- Infection or sepsis: Infections can cause significant stress to the body, leading to the release of stress hormones that increase blood glucose levels. Early detection and treatment are crucial to prevent severe outcomes.
- Pituitary or adrenal gland disorders (e.g., Cushing's syndrome): These conditions can lead to an overproduction of cortisol, causing hyperglycemia. Although rare, they are critical to diagnose due to their significant impact on health.
- Rare diagnoses
- Pheochromocytoma: A rare tumor of the adrenal gland that can cause episodes of high blood pressure, rapid heart rate, and hyperglycemia due to the excessive release of adrenaline and noradrenaline.
- Insulinoma: A rare tumor of the pancreas that produces excess insulin, leading to episodes of hypoglycemia, which can sometimes be followed by a rebound hyperglycemia.
- Glucagonoma: A rare tumor of the pancreas that produces excess glucagon, leading to hyperglycemia, among other symptoms.