Blood sugar rising overnight

[digihat]

Good Morning Everyone 🙂

I've just started carb counting over the last few days slowly getting the hang of it. Doing the injections before and doing adjustments. I manage to get myself into range most days so far but I've noticed that overnight my blood sugar seems to double from where it was e.g 8mmol before to 16mmol by morning? I've done abit of reading up and feel confused.

Is this a natural thing to happen or am I potentially doing something wrong?

Recently joined the forum introduction what happened to me recently with DKA and possibly type1
https://forum.diabetes.org.uk/boards/threads/hello-and-recent-dka-experience.109985/#post-1318204 introduction to the events

 

[Inka]

If your blood sugar is rising overnight, it means you’re not having enough basal insulin @digihat What insulins do you take and when?

 

[digihat]

If your blood sugar is rising overnight, it means you’re not having enough basal insulin @digihat What insulins do you take and when?

I take 24 units of Toujeo long lasting insulin in the the morning and then take various amounts of NovoRapid during the day depending on how many carbohydrates I have before meals. I do occasional adjustments to bring it down if out of range

 

[Inka]

Ok, so what time do you eat your evening meal? Do you have a snack before bed?

 

[digihat]

Ok, so what time do you eat your evening meal? Do you have a snack before bed?

Normally have it around 8pm I don't normally have a snack before bed

 

[Inka]

That’s slightly later than ideal. I find eating around 6pm works best. So it could be partly that. Also, your Toujeo could be running out as you take it in the morning. You could consider moving your Toujeo to the evening, or you could swap to a twice daily basal insulin like Levemir or one of the isophanes. These give more flexibility as you can vary the morning and evening doses separately.

 

[digihat]

That’s slightly later than ideal. I find eating around 6pm works best. So it could be partly that. Also, your Toujeo could be running out as you take it in the morning. You could consider moving your Toujeo to the evening, or you could swap to a twice daily basal insulin like Levemir or one of the isophanes. These give more flexibility as you can vary the morning and evening doses separately.

Thanks for the suggestions

Due back at the hospital this week will bring up your suggestions with them see what they say. My doses routine is being tweaked to find what works best at the moment as its still early on with all this

 

[helli]

That’s slightly later than ideal. I find eating around 6pm works best. So it could be partly that

I too eat my evening meal at around 8pm. What is wrong with that?
I tend to go to bed around midnight so I have no active insulin on board (unless I have an extended bolus) and have digested my dinner.
Eating at 6pm is too close to lunch and does not give me time to do post work activities like the gym as exercising after dinner would mean exercising with active insulin on board.
Actually, I rarely finish work by 6pm so I would have no time to cook my evening (afternoon) meal.
In my circle of friends, colleagues and family, 8pm is a normal time for dinner unless they have young children.

 

[helli]

@digihat doyou have a CGM such as a Libre?
The reason I ask is the reason for your morning being higher than evening will depend upon how your blood rises overnight.
- if it continues to rise, all through the night, this is likely to be due to too little basal insulin, as @Inka suggests
- if it rises for a few hours and then plateaus, it is likely to be due to too little insulin with your evening meal. Some food will take longer to convert to glucose so their impact could be seen later. This is typically fatty or high carb meals such as curry, pasta with a creamy sauce or pizza. The added bit of fun is that our insulin to carb ratio may vary at different times of the day. So what works for lunch may not work for breakfast or evening meal.
- if it remains stable until the early hours of the morning, this is likely to be due to Dawn Phenomenon. This happens with most people, but only those of us with a dodgy pancreas will notice. In order to give us energy to start the day, our liver dumps glucose into our blood. This could happen in the early hours (around 3 or 4 o’clock) or later as you start to get out of bed. The latter is often referred to as Foot on the Floor.

This may sound complex but, we can get used to how our body works and what is the best insulin dose for the day or meal we have had.

 

[Inka]

I too eat my evening meal at around 8pm. What is wrong with that?
I tend to go to bed around midnight so I have no active insulin on board (unless I have an extended bolus) and have digested my dinner.
Eating at 6pm is too close to lunch and does not give me time to do post work activities like the gym as exercising after dinner would mean exercising with active insulin on board.
Actually, I rarely finish work by 6pm so I would have no time to cook my evening (afternoon) meal.
In my circle of friends, colleagues and family, 8pm is a normal time for dinner unless they have young children.

If you’re going to bed at midnight, then that works for you, being 4hrs plus after your meal. My 6pm was based on a bedtime more like 10.30pm (roughly). Although I do have children, I’ve never eaten at 8pm even prior to that. As you say, if you go to the gym after work, then that pushes everything later.

I’m now going to ask when you have lunch

 

[helli]

If you’re going to bed at midnight, then that works for you, being 4hrs plus after your meal. My 6pm was based on a bedtime more like 10.30pm (roughly). Although I do have children, I’ve never eaten at 8pm even prior to that. As you say, if you go to the gym after work, then that pushes everything later.

I’m now going to ask when you have lunch

Lunch is between 1:30pm and 2pm, usually.
Breakfast is at about 8am.

I have also always been a bit of a grazer but not after my evening meal.

 

[Inka]

Different schedule then @helli 🙂 I get up at 6am, have breakfast reasonably soon after, depending on circumstances so around 6.45 to 7.15am, then have lunch 12.30/12.45pm ideally, with my evening meal starting anywhere between 5.30 and 6.15pm (depending on children, tiredness and the like). I also have an afternoon snack 3/3.30pm and various nibbles through the day. I’ve got a fast metabolism and hollow legs

My point really to the OP was that if they ate too close to bedtime, there could still be food being digested which might be raising blood sugar.

 

[digihat]

@digihat doyou have a CGM such as a Libre?
The reason I ask is the reason for your morning being higher than evening will depend upon how your blood rises overnight.
- if it continues to rise, all through the night, this is likely to be due to too little basal insulin, as @Inka suggests
- if it rises for a few hours and then plateaus, it is likely to be due to too little insulin with your evening meal. Some food will take longer to convert to glucose so their impact could be seen later. This is typically fatty or high carb meals such as curry, pasta with a creamy sauce or pizza. The added bit of fun is that our insulin to carb ratio may vary at different times of the day. So what works for lunch may not work for breakfast or evening meal.
- if it remains stable until the early hours of the morning, this is likely to be due to Dawn Phenomenon. This happens with most people, but only those of us with a dodgy pancreas will notice. In order to give us energy to start the day, our liver dumps glucose into our blood. This could happen in the early hours (around 3 or 4 o’clock) or later as you start to get out of bed. The latter is often referred to as Foot on the Floor.

This may sound complex but, we can get used to how our body works and what is the best insulin dose for the day or meal we have had.

Apologies for the delayed reply @helli

Yeah I have CGM libre which ive been using for a few weeks. I spoke with the team at the hospital yesterday when i went for a check up. We spoke about the overnight rises in blood sugar. They have put it down to not enough long acting/basal units in the morning which is currently at 24 this has been increased to 26 now and will start doing gradual tweaks until we find the sweet spot to keep it. I've attached a graph which shows the overnight trend at the moment

 

[rebrascora]

Which basal insulin are you using? It may be that it is running out of steam when you need it most towards the morning. Some basal insulins don't last the full 24 hours. Do be aware that by increasing it you may need to watch out for hypos during the day, especially if you need to keep increasing it to manage that huge rise that you are getting overnight. For many of us a split dose basal insulin is the answer where we take a dose in the morning to cover out daytime needs and another dose in the evening to cover the night. We can then adjust each dose separately to supply what we need when we need it rather than increasing one dose like this which may possibly cause problems with hypos in the afternoon in order to deal with the problem overnight. Not all basal insulins are designed to be split into 2 doses, so it might be that your team do not want to change your basal insulin just yet and see if they can sort the problem just by upping the dose of what you have, but if you are currently on a basal that can be split it may be worth asking about that option, particularly if you start to see your daytime levels dropping and causing hypos.

 

[digihat]

Which basal insulin are you using? It may be that it is running out of steam when you need it most towards the morning. Some basal insulins don't last the full 24 hours. Do be aware that by increasing it you may need to watch out for hypos during the day, especially if you need to keep increasing it to manage that huge rise that you are getting overnight. For many of us a split dose basal insulin is the answer where we take a dose in the morning to cover out daytime needs and another dose in the evening to cover the night. We can then adjust each dose separately to supply what we need when we need it rather than increasing one dose like this which may possibly cause problems with hypos in the afternoon in order to deal with the problem overnight. Not all basal insulins are designed to be split into 2 doses, so it might be that your team do not want to change your basal insulin just yet and see if they can sort the problem just by upping the dose of what you have, but if you are currently on a basal that can be split it may be worth asking about that option, particularly if you start to see your daytime levels dropping and causing hypos.

I am currently using Toujeo for my daily injections then using Novo Rapid for meal times. During the day I've mostly got a handle on keeping it under control except for when I'm doing gym/long walks still getting used to that. Ive had two low blood sugars over the weekend but dealt with them with my stuff i carry on me. They did say I could take it in the evening instead of morning haven't talked about splitting it yet will bring that up when im back to see DSN in a few weeks. For the moment they don't want to change too much and not overwhelm me. Been doing this for about a month now. Sugars have come down alot its just getting this night time rise under control now