High blood sugars through night and in the morning

[Claire91]

morning all,
I posted on here a few weeks ago saying I was high through the night I was 11 units of levemir before bed and I went to the diabetes clinic to see a different nurse because mine had retired and didn't know that she was! Anyhow she said it looks like I'm hypoing in my sleep so to reduce it and change it by one unit less if I'm still high so I'm now on 4 units at night and I'm now waking up high at 3am to the point I need some fast acting insulin because I can't sleep. For example I was 11 before bed thought could not possibly hypo as I'm Normally 7 before bed and I woke up early hours with a blood sugar of 17.4 wanted to ask people do they think I should still decrease it ? Because I keep getting in touch with this nurse and just feel like I'm hassling her because she's a children's nurse. But I feel so tired of trying and just don't know what to do

 

[SB2015]

Hi Claire, everyone has different insulin needs so it is difficult to advise about what to do with your le emir, but you definitely need to get some further advice. Keep hassling the DSN, and keep a record of what is happening. It is patterns that help you to see what to do.

Things that could be causing your levels to be high in the night
- not enough Levemir
- Low GI food from your evening meal still releasing glucose after you go to bed
- your correction ratio at bed time is not correct to address the level when you go to bed.
- your Carb ratio is incorrect for the evening meal

I found when I was I a big muddle keeping accurate notes about what I ate, injected and was doing helped the DSN to help me.

I would definitely talk again to the DSN. If the DSN is in the paediatric team and wants you to switch to the adult team they can sort that out, but you need to get help from one of them.

I hope that you get things sorted out soon

I hope that

 

[DeusXM]

This may help - a post I did a while back that looks at the various reasons for high blood sugars in the morning. Based on what you've posted, it sounds to me like you've been given completely the wrong advice and you should probably increase your basal.

Deus's guide to morning blood sugars

 

[DeusXM]

Also, since I wrote this, I've since discovered a fifth reason, which I'll explain here for general info but doesn't sound like it applies to you.

'Feet on the floor'

What is it?
After you wake, your liver starts pumping out glucose. It's similar in many respects to dawn phenomenon but happens AFTER you get up and out of bed, not before

How do I know if it's this?
This one's easy-ish to catch, if you are confident that your basal is pretty much on point for the day. You do a reading the moment you get up. Then go about your usual routine (bet it doesn't involve breakfast, right?) and test at 30 minutes and one hour after getting up. If your blood sugar is clearly rocketing up, you've got 'feet on the floor'. You might be astonished at how quick/significant this can be - I personally have noticed my BG go up by as much as 3mmol/l in 15 minutes. It also won't necessarily happen at the same time every day - for instance, if you usually get up at 7am on weekdays, you might be high by 8am, but this won't happen on weekends when you get up later. The point is, your body does it when you get up, not according to what time it thinks it is!

How do I fix it?
Two options here. One is if you're not eating breakfast, eat something - basically exactly as you'd fix dawn phenomenon. You can retrain your body.

The other option (if you don't want to eat breakfast) is a little more risky but if you know what you're doing with insulin isn't actually too bad. Once you get a feel for how much your blood sugar goes up once you get up, simply take a correction bolus as the first thing you do on getting out of bed. This'll offset the liver dump. You can do the same thing with a pump by simply increasing your basal rates at the appropriate times.

 

[Claire91]

So if I increase my levemir tonight and I've been having 4-5 is it to extreme to go back to 7?

 

[Robin]

Sorry, I wrote this this morning before I went out, and have just discovered I didn't post it!
Hi Claire. Firstly, if you need help from your diabetic nurse, then you need help and it's her job to sort you out, so don't think you're hassling her.
However, it may help if you can give her a chart to show what exactly is happening overnight, so keep a record of your levels, especially the
3am highs, and maybe set the alarm for a couple of different points during the night, if you can bear to and haven't got anything too important the next morning.
The nurse was right to suggest hypos in the night if you were waking to high levels, it's one thing that a lot of people don't realise can happen, and they go on raising their basal when they should be lowering it. But if you've proved that's not the case, then she will see that you need to be raising it not lowering it further.
Have you been told to contact the clinic every time you change your levels? I don't know how long you've been diagnosed, but most people when they have got the gist of it tinker with their own doses, and get there by trial and error.
The other thing to consider is getting a Freestyle Libre, not funded by the NHS at the moment, unfortunately. (Have a browse on here, it's been discussed, particularly if you can find what Everydayupsanddowns has said, he trialled it.) It gives you a readout of what's been happening to your BG levels on a continuous trace, so you can see what happens overnight without waking up and testing.

 

[DeusXM]

So if I increase my levemir tonight and I've been having 4-5 is it to extreme to go back to 7?

In the absence of a CGMS/Libre, I'd set yourself up for having a bit of a c**p night tonight.

Do your usual Levemir dose (4-5u).

Test when you go to bed and write it down.

Set your alarm for about 2am ish. Wake up, test, write it down, go back to sleep.

Repeat at 4am.

Test first thing in the morning.

If all these readings are either the same(ish) or increasing, you are definitely not having hypos at night. Do also check for ketones in your urine first thing - everyone usually has trace ketones in their urine in the first pee of the day but if your basal is too low, you'll probably have moderately high ketone levels.

If you've successfully proved you're not having hypos at night, then yes, start incrementally increasing your basal.

For the record, I'm 99% certain you're not having hypos at night but I'm recommending you do the above test just to doubly make sure.

 

[Claire91]

I rung up my diabetes nurse and she said it was my old nurse the one who had retired but was doing an extra shift, and I was so glad because she knows my diabetes best. She agreed with me that I needed more insulin at night and she advised me to take 8 units and if I'm still high when I wake up on Saturday to wake up at 2 to do a blood test Nf if I'm high I need more levemir at night! I did say this to the other nurse but she said I was hypoing at night but I said I thought I needed more insulin rather than less insulin! We will see what happens

 

[Claire91]

Also I have been diabetic type 1 for 14 years

 

[trophywench]

So - don't you normally just adjust it, and mention it to the clinic next time you happen to go? By this stage of your journey you really ought to be.

My normal DSN wasn't on last time I went and I asked the other one for some basal testing log sheets (easier to see what's occurring when they're in black and white in front of me) which she handed over and said 'Ring me when you've done them and we'll discuss adjustments' - and then looked at me as I must have looked how I felt - gobsmacked that she expected me to do that? - and then added quickly Oh - unless you're happy to sort it out yourself? of course! I laughed and said 'Definitely, thanks - only if I have a problem when I do, will you get to know!'

 

[Claire91]

Yes I do normally do it on my own, but I have made previous posts on here , and this has been happening since November so obviously feel unwell from being high constantly and my DSN actually said there is not a pattern to my bloodsugars so was puzzled herself !!

 

[SB2015]

Hi Claire

Do you keep any written records of what is happening?

I have found then I find things wobble I go back to recording.
I note: time, BG , correct, carbs, what I had been doing.
After a week I look back (it also stops me making changes based on one weird result)
Look for patterns and then decide what needs changing when.

I know others prefer to use the electronic records but like Jenny I like to see things in black and white.

 

[Claire91]

Yes I have a notebook where I write down what I'm eating, and the insulin I gives and the correction dose. My DSN said there isn't a pattern and she's given me advise which I will follow and hopefully it works, I contacted them as I was obviously concerned why I was so
High and my adjustments weren't making a difference , so contacted them as its been like this since November ! Woke up and it was 11 this morning which is better than 18!

 

[Robin]

Oh good, I'm glad it's heading in the right direction. You'll get there!

 

[everydayupsanddowns]

Hi Claire

In your situation I would use Deus's suggestion and go through a test-review-adjust by testing your levels through the night. It's really the only way to see what is goin on unless you fund yourself a Freestyle Libre which can show you what is happening overnoght without you having to wake up.

My experience was, the more tests I did, and the more I wrote down the less random my diabetes eventually seemed, because I had more information to try to spot patterns and see the wood from the trees.

Good luck with it - let us know the results of your midnight, 2am, 4m and 6am tests 🙂