BG management troubles while sleeping

[commit]

Hi everyone! Recently I've had an issue where my BG keeps rising on midnight around 4 am, rising up to 16 mmol/L when I wake up around 7 am. My current insulin plan is a basal/bolus approach, using Toujeo (i think gargline) as basal and Novorapid as bolus.

This rise happens regardless of what I ate, as I've had multiple days where I did not eat anything before going to bed, with a steady blood glucose of about 5-6 mmol/L. I'm confused as to what's going on. What are yall's opinions on this? Thankss ❤

 

[Inka]

I didn’t understand what you meant by “on midnight around 4 am” @commit If the rise starts around 4am, then that sounds like Dawn Phenomenon, where the body pumps out it’s own glucose ready to start the day. If the rise starts at midnight, maybe you just need a little more basal insulin (the Toujeo).

 

[commit]

Hmm.. but this is something that happened only recently, and I can't seem to pin down the reason why. How do I circumvent dawn phenomenon then? I've only experienced FOTF for the majority of my mornings, that I understand, but dawn phenomenon wasn't something for me to deal with up until recently. Are there any things that make dawn phenomenon more pronounced? I thought my basal insulin was enough to cover it..

 

[Wendal]

Hi Commit,
In terms of trying to understand what may be happening it is important to rule out things one by one and proceed from there.
I am assuming that you have not made any recent changes such as suddenly eating something just before going to bed or eating high carbs meals which are very slow release later in the evening.
Or you have taken less insulin.
Not sure how long you have been diagnosed but could you be coming out of the “honeymoon period” so that could explain a rise but yours does seem quite steep.
It does sound to me like you need to recheck your basal and adjust it upwards to try and get a better line overnight.
Once you hopefully achieve a more stable line then to me that is a big step forward.
Can be quite hard to manage DP but would look to do it with a small correction dose if it concerned me but again you need to get other variables stabilised as best you can and only do small adjustments and monitor accordingly.
Sorry can’t be more specific and things will vary according to individuals and of course there is always help available but imo best to try things yourself at least initially.
Good luck

 

[helli]

Basal needs can vary. Just because your dose was fine 2 months ago does not necessarily mean it is enough now.
You can look at your CGM graphs to understand if it is DP or insufficient basal. If DP, the graphs will be flattish until 3 or 4am. If you have insufficient basal, the graphs will show a constant rise which may become more pronounced in the early hours.
DP is a natural bodily response. Most people regardless whether they have diabetes or not, will get a glucose dump to give them energy for the day. Without diabetes, this is not an issue because their pancreas releases insulin.

 

[trophywench]

@commit - for 100% normal adult human beings so not having either diabetes or anything else wrong with their body or brain, the natural time that adult human bodies experience their lowest blood glucose is between 02.30 and 03.30 ish,* following which the BG begins to rise to provide the energy to stir, wake and deal with the day ahead. There is not that much you, me or anyone else can do to change this since we ARE human - and I for one still want to stay one of those!

(*sadly, trainee doctors in hospitals, doing their stint in A&E used to call this 'the suicide hour' (you can imagine why that would be) but thank heaven they've stopped that type of language being used even amongst medical students)

 

[everydayupsanddowns]

but this is something that happened only recently, and I can't seem to pin down the reason why. How do I circumvent dawn phenomenon then? I've only experienced FOTF for the majority of my mornings, that I understand, but dawn phenomenon wasn't something for me to deal with up until recently

I usually get FOTF too, but I find the level that I get isn't always consistent over time. Sometimes it's barely anything (and any precautions I've put into place massively over-reach and I'm dodging lows all morning). Other times it's much more marked and essentially the entire dose I've administered to take care of breakfast is soaked up with dealing with a much larger 'liver dump' than normal.

I've not really worked out any triggers for the variation, or any ways to successfully predict when a period of "this is mostly what happens" shifts to "ah... OK, now this is happening instead" for a bit.

I've just lobbed it onto the growing pile of "diabetes is very annoying" irritations. 🙄

 

[Inka]

My FOTF varies too. I find that it’s usually far less pronounced at weekends. I put this down to not working, not having to rush around, and so less stress.

 

[SimonP]

Hmm.. but this is something that happened only recently, and I can't seem to pin down the reason why. How do I circumvent dawn phenomenon then? I've only experienced FOTF for the majority of my mornings, that I understand, but dawn phenomenon wasn't something for me to deal with up until recently. Are there any things that make dawn phenomenon more pronounced? I thought my basal insulin was enough to cover it..

Both exercise the previous day and alcohol reduce both dawn phenomenon and FotF (running low overnight will also stop FotF and by definition you won't get DP either as you're low). It may just be one of those many things that changes though. I'd be tempted to either try more basal overnight (e.g. evening dose if you've got a non-flat type of insulin).

 

[SimonP]

My FOTF varies too. I find that it’s usually far less pronounced at weekends. I put this down to not working, not having to rush around, and so less stress.

That's interesting, mine is typically worse at the weekend and on days I WFH and don't do the school run - the one thing that does make it containable is taking FotF bolus, then driving the kids to school (walking used to be better, but 12miles now!), then having breakfast when I get back home.

I guess the problem on other days is that I don't otherwise tend to do much first thing, perhaps I should go for a quick run/indoor ride in place of my school run every day.

The wonders of diabetes 😉