Continued rises 4-5 hours after eating at night

[Wutanga1]

Any experience with this? Briefly, my daughter who has had T1 for around a year seems to have BG rises 4-5 hours after dinner, into the night. See below for an example from tonight. We don't give high carb or high fat dinners generally - her dinner last night was around 25 grams. Often at bedtime she's a relatively stable 5-6 mmol/l. Then a couple of hours into sleeping, the rise starts.

The obvious reason could be basal - but we already raised hers from 7 to 7.5 units of Lantus. We're not that keen to go higher as even 7.5 sometimes seems to give her multiple hypos at night. We give her Lantus at 8pm usually, but yesterday we dropped it back to 6pm (trying to catch the rise with the start of Lantus absorption).

Any ideas/tips for how to deal with this?

 

[Wutanga1]

As a point of info - the drop early morning in the image above was in part related to a correction dose given at 1am.

 

[nonethewiser]

With her dsn consent you could try giving lantus dose earlier in day, split dose or even try alternative basal to lantus, could even enquire about switching to insulin pump at some point as this can deliver small precise doses over 24 hour time period.

 

[SimonP]

She appears to have gone a bit low (I know it's above the line, but how accurate is the sensor) around 9pm, that may generate a spike in glucose later on as her body reacts. It's quite hard to know quite what's going on without being able to see the times and quantities of insulin and food. E.g. what time was the 25g carbs for supper, etc.?

Do you log the combined data in e.g. an app, it's vastly more useful when you can see all the data on the same plot. I use XDrip+ but there are other options.

 

[helli]

@Wutanga1 I apologise in advance but I have a few questions
- do you only see this rise 4 -5 hours after her evening meal or do you see it after other meals?
- how stable are her levels during the day?
- you mention 7.5 units of Lantus gives her multiple hypo during the night. Howe long ago was it that you tried this?
- you mention her dinner was not high carbs (25g) or high fat. What was it?

Without knowing what happens during the day, it is difficult to make any suggestions with regard to basal.
Given her diagnosis was a year ago (and I assume she is a child), it is possible that she has come to the end of honeymoon period and does need more insulin.

My other thought is that there may have been something in her evening meal which is causing this. I know you said it is not high fat but even something like pasta can slow down my carb absorption and affects me more than a simple insulin to carb ratio.

 

[rebrascora]

Hi. I am not sure if it applied to children as well as adults but if you don't eat enough carbs you body will break down protein into glucose and that typically starts releasing 2 hours after a meal and is a slow and steady release over several hours, which is what this looks like. I follow a low carb way of eating and almost always need to inject for protein release 2 hours after a meal as well as some up front for the carbs in the meal. I think 30-40g carbs is enough to stop the protein release so it might be worth increasing her carb intake a bit or noting if these rises occur when the meals she has are slightly lower carb than usual, assuming they don't happen every night.

 

[pawprint91]

Everyone else’s responses on here are far more insightful and probably more relevant! I have also had T1 for nearly a year now and a similar thing has begun to happen to me! If the basal is split dose (or even if it’s not) I brought forward the dose by an hour/90 mins to have more of an overlap and that seemed to work for me to an extent (but not every time). I asked the DSN about it and she said it could be hormonal but could also be “unexplained” - helpful, I know! However if it’s only on occasion and not every night, it is perhaps more likely linked to the digestion of food, as others have said.