Spiking from 1030pm til4am

[Andywidd]

Hi,
Looking for advice on how to stop my bg spiking after 10pm. Most of the time I’m averaging under 6m mol during day but at about 10pm ish it increases to high 7,s and 8’s. A few times I’ve injected some fast insulin before bed as well as my slow as it’s due then which usually helps. However this means an extra injection! It doesn’t matter if I eat at 6pm or 8pm I still get this increase and ideally would like to keep it at 6 or under when asleep. Up until a month ago it was pretty level all night. Any advice greatly accepted. Thanks, Andy

 

[helli]

If an extra bolus injection when you go to bed works, why not?
It sounds as if your basal needs are not the same 24 hours a day which is completely normal. You could try splitting your basal (I would discuss this with your diabetes team) but, again that means an extra injection.
Without a pump it is not possible to adjust your basal intake to match your body’s needs. And, even with a pump, you find no two days are alike.

 

[SB2015]

Hi,
Looking for advice on how to stop my bg spiking after 10pm. Most of the time I’m averaging under 6m mol during day but at about 10pm ish it increases to high 7,s and 8’s. A few times I’ve injected some fast insulin before bed as well as my slow as it’s due then which usually helps. However this means an extra injection! It doesn’t matter if I eat at 6pm or 8pm I still get this increase and ideally would like to keep it at 6 or under when asleep. Up until a month ago it was pretty level all night. Any advice greatly accepted. Thanks, Andy

Hi Andy

Your levels sound pretty tightly controlled. If you are concerned about the variation overnight you couod talk to your team about whether you can get a pump. This allows you to alter your basal insulin hour by hour, which can then match your needs a lot more closely.

I tend to eat at 6:30 to give my body to process the food and the bolus. I can then do adjustments at night knowing that (in general) my bolus has finished Which makes it easier to decide whether to make a corrections.

Let us know how you get on.

 

[Andywidd]

If an extra bolus injection when you go to bed works, why not?
It sounds as if your basal needs are not the same 24 hours a day which is completely normal. You could try splitting your basal (I would discuss this with your diabetes team) but, again that means an extra injection.
Without a pump it is not possible to adjust your basal intake to match your body’s needs. And, even with a pump, you find no two days are alike.

Thanks Helli, Always have good advice. I don’t mind the ‘extra’ injection but not sure if it’s okay to do this regularly. But guessing it is. Thank you

 

[Andywidd]

Hi Andy

Your levels sound pretty tightly controlled. If you are concerned about the variation overnight you couod talk to your team about whether you can get a pump. This allows you to alter your basal insulin hour by hour, which can then match your needs a lot more closely.

I tend to eat at 6:30 to give my body to process the food and the bolus. I can then do adjustments at night knowing that (in general) my bolus has finished Which makes it easier to decide whether to make a corrections.

Let us know how you get on.

Hi, thanks for the reply. I’ll keep doing an ‘extra’ injection and see if I can keep in the range I’ve set myself (3.9-7.8). Was doing this a month after diagnosis (june2021) til recently then suddenly starting spiking a bit. May be the honey moon coming to an end!? Thanks again for your insight.

 

[trophywench]

Er, I think the parameters you have set yourself are more than a bit unrealistic, for any length of time I'm afraid.

 

[Andywidd]

Er, I think the parameters you have set yourself are more than a bit unrealistic, for any length of time I'm afraid.

Probably right Jenny! Since I’ve been diagnosed in June I’ve done a lot of reading. I’ve come to the conclusion rightly or wrongly that a low carb approach seems to be the best way to increase time in range. From August 1st til beginning of October I managed 100% TIR (3.9-7.8). Then just last couple of weeks started increasing to over 7.8 occasionally over night though so far highest is 8.2. I’m trying the Bernstein approach although allowing more carbs- keeping to <4 breakfast, <25lunch and <40 dinner. I’m still 94% TIR and this includes when I just started with libra late July so had to rapidly change diet and dosage. . Was Hoping for a simple solution(!!) but learning this is diabetes so not going to happen! Hopefully my overnight will lower. Sounds like I’m trying too hard and just need to relax about numbers. Thanks, Andy

 

[Inka]

I agree with @trophywench That target range will burn you out very quickly! Relax it a bit @Andywidd

 

[trophywench]

49 years in - my D clinic wants me between 3.9 and 10.0 for 70% of the time. Nothing wrong with being above 70% nor below it as long as the 'aboves and belows' don't go on for ages - though I strongly more than suspect years ago (when Adam was a lad, old fashioned regimes) we would mostly have been so. Not wanting to go back there, just saying, sometimes not knowing or even suspecting is a much easier thing to live with. By all means, lower the carb if you want to - but just don't get stressed about it - so when you just fancy a great big bowl of trifle at Xmas or a big jacket spud - let it be guilt free! (as long as you jab for it of course)

 

[PattiEvans]

Hi Andy

Just wondering what basal you are on? Some basals are meant to be split e.g. Levemir but some HCPs don't always tell people to do that. Also be aware that basal needs change from time to time. A lot of people find theirs change when the weather changes i.e. it gets cooler in Autumn. Do you know how to do a basal test?

 

[rebrascora]

I have started doing an extra jab in the evening to deal with a similar rise. I brought my evening basal forward a bit and injected at 7-8pm instead of bedtime but then I hypoed just before the alarm went off several times so I have gone back to basal at bedtime and that extra jab of quick acting insulin to deal with the increase on an evening. As long as you find a strategy that works for you and isn't causing hypos then that is fine but I would agree with others that you may be being a bit too tight with your target range and if your honeymoon period is coming to an end, it may become less realistic to maintain that. The honeymoon period is funny because it seems to cause some people's levels to be erratic and get sudden nasty hypos and for others, the pancreas seems to just nicely buffer the insulin they inject and make their levels less volatile. Or as @Pattidevans mentioned, it could be the change of season causing your basal needs to change and your current basal insulin may not have the right profile to cover your new needs or the dose or time of day you take it may need tweaking.

 

[Andywidd]

49 years in - my D clinic wants me between 3.9 and 10.0 for 70% of the time. Nothing wrong with being above 70% nor below it as long as the 'aboves and belows' don't go on for ages - though I strongly more than suspect years ago (when Adam was a lad, old fashioned regimes) we would mostly have been so. Not wanting to go back there, just saying, sometimes not knowing or even suspecting is a much easier thing to live with. By all means, lower the carb if you want to - but just don't get stressed about it - so when you just fancy a great big bowl of trifle at Xmas or a big jacket spud - let it be guilt free! (as long as you jab for it of course)

Thanks Jenny. Useful to know what other people are doing

Hi Andy

Just wondering what basal you are on? Some basals are meant to be split e.g. Levemir but some HCPs don't always tell people to do that. Also be aware that basal needs change from time to time. A lot of people find theirs change when the weather changes i.e. it gets cooler in Autumn. Do you know how to do a basal test?

Hi Andy

Just wondering what basal you are on? Some basals are meant to be split e.g. Levemir but some HCPs don't always tell people to do that. Also be aware that basal needs change from time to time. A lot of people find theirs change when the weather changes i.e. it gets cooler in Autumn. Do you know how to do a basal test?

Hi Pattidevans, I’m taking abasaglar at 10pm. I’ve recently increased it from 5->6 and now to 8 for last couple of weeks. I don’t know how to do a basal test- never even heard of it!? I can’t always take a bolus of novarapid pre bed as the case last night was my level was 4.9 when I went to bed but looking at my libra this morning it steadily increased to 6.7 and stayed there til about 6 then returned to 4.4. Then when I got up it was 6.9 5 mins later.

 

[Andywidd]

I have started doing an extra jab in the evening to deal with a similar rise. I brought my evening basal forward a bit and injected at 7-8pm instead of bedtime but then I hypoed just before the alarm went off several times so I have gone back to basal at bedtime and that extra jab of quick acting insulin to deal with the increase on an evening. As long as you find a strategy that works for you and isn't causing hypos then that is fine but I would agree with others that you may be being a bit too tight with your target range and if your honeymoon period is coming to an end, it may become less realistic to maintain that. The honeymoon period is funny because it seems to cause some people's levels to be erratic and get sudden nasty hypos and for others, the pancreas seems to just nicely buffer the insulin they inject and make their levels less volatile. Or as @Pattidevans mentioned, it could be the change of season causing your basal needs to change and your current basal insulin may not have the right profile to cover your new needs or the dose or time of day you take it may need tweaking.

Thanks Barbara, Useful to know it’s ok doing another dose of novorapid. I’ll monitor and see what happens and then ask dsn if anything needs adjusting.

 

[rebrascora]

I can’t always take a bolus of novarapid pre bed as the case last night was my level was 4.9 when I went to bed but looking at my libra this morning it steadily increased to 6.7 and stayed there til about 6 then returned to 4.4. Then when I got up it was 6.9 5 mins later.

You don't need to do a correction of insulin if you are on 4.9 at bedtime and in fact the majority of Type 1s would not think of going to bed with a reading that low and would eat a small carby snack without bolus to bring them up a bit.
Your graph following that 4.9 at bedtime is more than acceptable and in fact you should be extremely happy with it. It is also normal for levels to rise when you get up which is referred to as Dawn Phenomenon or Foot on the Floor Syndrome, where your liver dumps glucose into your blood stream to give you energy to start the day. I usually inject 1-2 units of bolus insulin to deal with this as my levels can easily rise from 5 to 9 just as a result of that alone.

You seem to be trying to get straight lines on your graph and that is not really possible most of the time. There are too many things other than food and exercise which affect BG levels.... approx 42 of them and many are not things you have control over, so you really need to loosen up a bit and not worry about these very minor deviations.

 

[PattiEvans]

Hi there @Andywidd

I’m not familiar with Abasaglar personally, but it is glargine which is similar to Lantus. As you are taking it at 10pm and that’s the time you normally get the rise I suspect that it’s running out a little by the 24 hour period, then you inject and it takes a little while for it to “ramp up” again. It can be common with long acting insulin to not quite last 24 hours when you are on very low doses as you are. Hence when you inject Novorapid it “props it up” over that period. I see you’ve increased the dose by 2u and that seems to have ameliorated the problem to some degree. The drop to 4.4 could be when Abasaglar has a small peak in action. I can’t be sure on that one as I only have Lantus profile of action (see https://www.diabetes-support.org.uk/info/?page_id=408).

Like the others, I think you are doing extremely well and trying to keep a tight profile which is a tad too restrictive.

I’m always surprised HCPs never tell people about basal testing as it’s one of the most useful tools we have to hand. If your basal is out then you stand little chance of getting your boluses right. It’s so much easier with a Libre than on finger pricking so I attach the instructions for your interest.

Since you are so invested in your management I’d recommend a book called “Think Like a Pancreas” by Gary Scheiner and I know members here recommend a book by Ragnar Hanas, I think it’s called something like T1in Children, adolescents and young people, but it covers adults as well.

 

[PattiEvans]

Oops, had to come and fire my laptop up to upload the file as it's on here and not my iPad.

 

[Andywidd]

Oops, had to come and fire my laptop up to upload the file as it's on here and not my iPad.

Hey, that’s really kind of you. Thank you. I’ll have a look at that just now. Kind regards, Andy

 

[PattiEvans]

@Andywidd did you see my post previous to the one with the uploaded file?

 

[Andywidd]

@Andywidd did you see my post previous to the one with the uploaded file?

Hi PattiDevans,
Thank you -yes I did and I’m going to have a look at those two books. I’ve read quite a bit since June but haven’t got round to those two yet. The basal testing sounds straight forward so I’ll give that a go- I’m on a week away at the moment and being very lazy in the morning so I’m noting that my libra is generally fluctuating between 4.4 and 5.3. (No food) (Usually my finger pricks are higher than my libra readings- although this last 10 days I’ve used the GlucoMen meter and the Abbott meter to compare and they regularly differ by a full unit eg 5.5 and 6.5 which is a bit of a concern). Any way I suppose the important thing is that I feel fine and am functioning!!
Thanks again for that info- I’ll work out my current basal requirements which I suspect are about correct at the moment but I did wonder if I’m not quite getting the full 24 hours from the 10pm dose.
Have a nice week, Andy

 

[PattiEvans]

although this last 10 days I’ve used the GlucoMen meter and the Abbott meter to compare and they regularly differ by a full unit eg 5.5 and 6.5 which is a bit of a concern). Any way I suppose the important thing is that I feel fine and am functioning!!

Hi Andy Meters are allowed a 15% tolerance anyway. So no meter is absolutely accurate, also blood taken from different fingers can vary quite a bit, so I wouldn't worry about the difference between 5.5 and 6.5 if blood was taken from a different finger.