BG Spikes through the night, any ideas?

[HassleHall]

Good morning,

Recently I've had a bit of a scare resulting in me taking better care of my BG levels. Gone from 20% time in range to 62-68 TIR with a huge drop in being in the higher zone. My body has started to adapt to this and now I'm a lot more sensitive to high BG episodes (brain fog, aching etc).

The issue I've got is that even with good control, through the night my BG is spiking from in range up to high teens around 3-4am without consuming any carbs and the last meal being accounted for with insulin. Whether or not my last meal is just before bed or a few hours before it still happens. I've read something around the liver dumping glucose into your system not too long before you're due to wake up but this is still well before I'm usually waking up. Does anyone have any ideas about the what's happening or why? And any ideas on countermeasures to take without having a high alarm wake me up every night (man neeeeeeds his sleep )?

(Type 1 Insulin Dependant, Libre2, Tresiba base and Humalog fast acting, no pump).

TIA
Mike

 

[everydayupsanddowns]

If it’s regular and doesn’t seem related to the tail end of carbs from a late meal it does sound like it might be Dawn Phenomenon or something similar?

Some people definitely seem to have a more definite ‘bump’ in their BGs than others - though for many 3am (graveyard shift) is when cortisol production drops to its lowest and BG tends to bottom out.

But since when did T1 know how to play by the rules!?

If it’s a liver dump / DP, some people find a protein/fat snack before bed (say a chunk of cheese, olives, or some cold meat) can help the liver feel fuelled and be less panicky in the small hours?

Another possibility might be turning somene else‘s problem into your solution - lots of people who take Lantus find they have a difficulty with low BG at about 3am, because lantus has a little boost of activity about 5hrs after injecting (so if you take it at 10pm that often coincides with the 3am dip).

But in your case the rising BGs at 3am may welcome that little extra Lantus oomph at that time?

Of course… you are then relying on the fact that your BGs will rise - otherwise you risk dipping low at that point! So I guess part of it would be working out whether this is a permanent thing, or just something your body is doing for a month or two and then will stop.

Another option might be Levemir, which is often taken 2x a day, allowing a different amount of circulating basal during the daytime, and during the nighttime.So you could have more active at night to counter the BG rise?

The other (slightly more complicated) possibility, of course, is to switch to an insulin pump. Not being able to get my basal right was one of my main motivations for shifting to a pump - because I can now tailor my basal profile however my body seems to need it at any point in the year. And for me that changes a LOT. Some seasons I seem to need a completely different ‘shape’ of basal. Which a single or double injection of something flattish profile is never going to manage!

Hope you find a method that works for you 🙂

 

[helli]

I wondered if this was Dawn Phenomenon or just needing more basal: if there is a definite rise at 3/4am, I would assume DP. However, if your BG is rising all night and then the rise is accelerated at 3/4am, this could also suggest a need for increasing basal dose.

Regarding DP, I find it is seriously reduced when I exercise the day before. For me this needs to be intensive exercise which is not a walk around the park but more like a spin class or a few hours at the climbing wall.

 

[rebrascora]

Can you post a screen shot of a typical Libre graph showing this rise?

Does it happen after a particular meal, like pizza or pasta (known as the pizza effect) or is it occurring every night regardless of what you eat?
Have you done a basal test and skipped your evening meal one night to see what happens to your levels in the absence of food?

 

[rebrascora]

If it is DP I too find that intensive exercise in the evening will knock it on the head. For me it is as simple as spending 10 mins running up stairs and back down about 20 times. Really gets the heart and lungs working and the thigh muscles burning and those muscles will suck that glucose out of your blood stream to replenish their stores whilst you sleep. They do for me anyway. I have stopped using evening basal since I made this a regular routine.

 

[trophywench]

Argue all you like - the effects of exercise last up to 48 hours. Full stop. Of course the biggest noticeable effect is next day. So I'm not feeling tired today because someone suddenly decided we'd get the Xmas decorations up yesterday afternoon - so you know how it is - you vacuum immediately before the Xmas tree is erected and decorated - then you need to do it again because of all the glitter, plastic pine needles et al deposited during this annual event! Carpet wonders what the hell hit it - doesn't get vac'd for ages and then twice in a few hours!

 

[nonethewiser]

Sounds like DP at play, ask to switch over to a insulin pump which will deal with varying basal needs, meaning you can set a seperate basal rate prior to DP taking place each morning, job done.

 

[SimonP]

Argue all you like - the effects of exercise last up to 48 hours. Full stop. Of course the biggest noticeable effect is next day. So I'm not feeling tired today because someone suddenly decided we'd get the Xmas decorations up yesterday afternoon - so you know how it is - you vacuum immediately before the Xmas tree is erected and decorated - then you need to do it again because of all the glitter, plastic pine needles et al deposited during this annual event! Carpet wonders what the hell hit it - doesn't get vac'd for ages and then twice in a few hours!

However, the amount of exercise you need to do to get a response changes - your body adapts if you are doing lots of exercise (I believe the liver is less prone to emptying its glycogen stores during exercise, so there's less that needs to be replenished afterwards).

There is probably an optimal amount of exercise to ensure you can still hit the DP on the head with a quick run/ride in the evening - for me that lies below riding 750km/month but above 250km/month.

More experimentation to be done!

 

[trophywench]

True - typical example of how it always depends on the individual.

NB I very deliberately did not use the phrase YMMV here!