High overnight BG but cannot fathom why

LancashireLass

LancashireLass

Well-Known Member
Relationship to Diabetes
Type 2
Morning all 🙂

I don't post in the forums very often, but I do generally visit every day and have a read around - I can generally get any answers that I need from reading other posts, but this has me stumped! I have a Libre sensor and am managing my BG as well as I have in a long time but I'm finding that overnight and just before waking, my BG seems to be climbing to very high numbers but I have no idea why this is happening.

Generally during the day time, I hover at between 5.5 and 8 depending on what I have to eat. I have my evening meal at around 6.30pm, sometimes followed by a small snack, but I do not eat anything at all after 8pm (that's my own little rule for myself). I usually check my sensor at around 10pm before turning in for the night and at that point, my readings are normal (normal for me), but I can see from my sensor data that during the night, I'm going as high as 13 - 14 and then just before waking, it's going even higher, up to 15-18 sometimes!! This has me quite concerned as I can't think of any reason for it :confused:

It could be an issue with the sensor I guess, but still, it has me worried and I wondered if anyone could offer any suggestions or advice please?
 
Sounds like Dawn Phenomenon.
What time does it start to rise?

I grew up in Lancashire! (Nelson)
 
Are you carrying much/any excess weight?
Levels rising like that overnight suggest your liver output is too high or your body is releasing very little insulin overnight. The metformin should help reduce the liver output, but it looks like you are on pretty much the max dose.
Could you possibly be coming down with something as that can inflate levels and particularly liver output? Have you started any new medication recently which might be causing it?

Whilst Libre can exaggerate the highs a bit, unless you are seriously dehydrated it is generally only 1-2mmols out and if this is a consistent trend in your levels then I would suspect the Libre is pretty much correct. You can of course double check any reading you are suspicious of with a finger prick to confirm it or give you an idea of how much Libre is out at that level.

I find exercise on an evening helps with this sort of overnight rise as your muscles will then recover some of their stores from your blood whilst you sleep, helping to bring levels down or at least prevent them rising so much.
 
harbottle said:
Sounds like Dawn Phenomenon.
What time does it start to rise?

I grew up in Lancashire! (Nelson)
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Looking at the sensor data it's around 3am that it starts to rise, so by the time I get up at 5.30am it is very often high.....higher than I am comfortable with!

A fellow Lancasharian huh, excellent!! :D
 
rebrascora said:
Are you carrying much/any excess weight?
Levels rising like that overnight suggest your liver output is too high or your body is releasing very little insulin overnight. The metformin should help reduce the liver output, but it looks like you are on pretty much the max dose.
Could you possibly be coming down with something as that can inflate levels and particularly liver output? Have you started any new medication recently which might be causing it?

Whilst Libre can exaggerate the highs a bit, unless you are seriously dehydrated it is generally only 1-2mmols out and if this is a consistent trend in your levels then I would suspect the Libre is pretty much correct. You can of course double check any reading you are suspicious of with a finger prick to confirm it or give you an idea of how much Libre is out at that level.

I find exercise on an evening helps with this sort of overnight rise as your muscles will then recover some of their stores from your blood whilst you sleep, helping to bring levels down or at least prevent them rising so much.
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I am carrying excess weight yes 😳
I feel OK in myself so I don't think I am coming down with anything and this has been happening for a little while now and there is no new medication.....this is why I am so stumped by it.
I have a finger pricker but it's very old indeed and I have no strips to go with it, so that would mean paying out for a new one which at the moment, I can't do. I do walk in the evenings too (we have a dog so there's no getting out of it lol)

Perhaps I could try taking my evening dose of Metformin later at night?
 
Metformin has a very long half life I believe so a few hours here or there will not make much difference to how it performs and it can be important to take it with food to reduce the risk of digestive upset, so either it means you eat later at night which will not help your overnight levels or you risk digestive upset which can cause inflammation which can make BG levels go higher, so I suspect there is no gain to be had from taking it later.

When you say, there is no new medication, what do you mean by that?

What dietary measures have you taken to help manage your diabetes?
 
rebrascora said:
Metformin has a very long half life I believe so a few hours here or there will not make much difference to how it performs and it can be important to take it with food to reduce the risk of digestive upset, so either it means you eat later at night which will not help your overnight levels or you risk digestive upset which can cause inflammation which can make BG levels go higher, so I suspect there is no gain to be had from taking it later.

When you say, there is no new medication, what do you mean by that?

What dietary measures have you taken to help manage your diabetes?
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You asked in your post if I had started taking any new medication, it means I haven't started anything new.

At only 5ft3, I used to weigh over 20 stone and am now around 13 stone, so whilst I still have some to lose I've come a very long way and am proud of that. The bulk of that came from lowering carbs and doing some exercise (I was a true couch potato and never moved before) but if I go too low on the carbs, I find that I get tummy problems from the Metformin, so I am not going any lower than I am at now and I don't measure my carbs as such, I just know what my body tolerates from years of doing it
 
harbottle said:
Sounds like Dawn Phenomenon.
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Certainly does!
LancashireLass said:
I am carrying excess weight yes 😳
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@LancashireLass

That's your answer; at least it was mine when my GP said my HbA1c was well over 100. Echoing your July 2021 comment, 'Time to get a grip and get my weight down'.

HbA1c is a marker for excess weight and visceral fat. Losing weight is the way to get HbA1c down and to restore your health.

If you haven't seen them, have a look at these:

Lancashire GP's advice:
- https://phcuk.org/wp-content/uploads/A_5_page_low_carb_diet_leaflet_Unwin_2021-converted.pdf

Essex GP's advice on foods to eat/not eat most of the time:
- https://www.lowcarbfreshwell.com/documents/8/Freshwell_Red_Amber_Green.pdf

What should we eat? Especially the Weight Loss srction
- https://www.zoeharcombe.com/2021/08/what-should-we-eat/
 
JITR said:
Certainly does!

@LancashireLass

That's your answer; at least it was mine when my GP said my HbA1c was well over 100. Echoing your July 2021 comment, 'Time to get a grip and get my weight down'.

HbA1c is a marker for excess weight and visceral fat. Losing weight is the way to get HbA1c down and to restore your health.

If you haven't seen them, have a look at these:

Lancashire GP's advice:
- https://phcuk.org/wp-content/uploads/A_5_page_low_carb_diet_leaflet_Unwin_2021-converted.pdf

Essex GP's advice on foods to eat/not eat most of the time:
- https://www.lowcarbfreshwell.com/documents/8/Freshwell_Red_Amber_Green.pdf

What should we eat? Especially the Weight Loss srction
- https://www.zoeharcombe.com/2021/08/what-should-we-eat/
Click to expand...

Thanks, but did you read the rest of my post? I guess not 🙄
 
Sorry I misunderstood you. I thought you were saying that there were no new meds that could be offered to help deal with your diabetes.

Wow! What amazing weight loss! Well done! That really is impressive and must make it even more disappointing to see these overnight rises.

If dietary adjustment isn't possible, then I would say that probably more meds are going to be needed to help manage your levels if that trend continues. With it happening overnight into morning, it definitely looks to be either your liver that is responsible or possibly failing insulin production.

How far and how fast is your evening dog walk. Can you build it up to be longer or more exertive.

I am currently using my stairs in the house to increase my exercise, especially when it is cold, wet and dark outside. I did 20 ascents and descents of my stairs last night before bed on the trot. It takes less than 15 mins and really gets your heart and lungs working and muscles burning. I do 30 in the morning as well, but I built it up from 10, so do start low if you consider doing it and build it up slowly. It is really good exercise and doesn't involve any special equipment, provided that you have stairs of course! 🙄
 
rebrascora said:
Sorry I misunderstood you. I thought you were saying that there were no new meds that could be offered to help deal with your diabetes.

Wow! What amazing weight loss! Well done! That really is impressive and must make it even more disappointing to see these overnight rises.

If dietary adjustment isn't possible, then I would say that probably more meds are going to be needed to help manage your levels if that trend continues. With it happening overnight into morning, it definitely looks to be either your liver that is responsible or possibly failing insulin production.

How far and how fast is your evening dog walk. Can you build it up to be longer or more exertive.

I am currently using my stairs in the house to increase my exercise, especially when it is cold, wet and dark outside. I did 20 ascents and descents of my stairs last night before bed on the trot. It takes less than 15 mins and really gets your heart and lungs working and muscles burning. I do 30 in the morning as well, but I built it up from 10, so do start low if you consider doing it and build it up slowly. It is really good exercise and doesn't involve any special equipment, provided that you have stairs of course! 🙄
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No problem and thank you! 🙂

It's generally 30 minutes to an hour depending on the weather, but given that pooch is with us it can be a little stop/start because she wants to sniff everything along the way. Perhaps the dog walk and the exercise walk needs to be separate.....I must admit it's tricky to get any kind of rhythm going, so maybe it's not as beneficial as it could be.

We live in a ground floor flat so stairs are out :rofl: But I do have an exercise bike that I use every other day for 20 minutes (if I go on it every day I get aching in my hips).

This is why I am so puzzled by it, it seems that this is going to happen no matter what I do and that a medication adjustment may be the only option, but that scares me :(
 
helli said:
Sorry to be pedantic but this is only true for someone with type 2 diabetes.
In fact, weight loss is a big indication of high BG (and, hence, high HbA1c) for someone with Type 1.
But the OP has type 2.
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However, you are quite right, I could have been specific.

Note:
JITR said:
HbA1c is a marker for excess weight and visceral fat.
Click to expand...
Research has shown this is particulary true for prediabetes. The relation may be more volatile after progression to T2D.
 
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LancashireLass said:
Thanks, but did you read the rest of my post? I guess not 🙄
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No, I did not see your post just before mine, if the that's the one you meant.

To avoid its side effects I did not take Metformin. I opted for a real food version of the Newcastle diet instead, less than 800 cal per day. It got my BG down to normal in days.
 
Sounds like you are doing what you can.

It may be that doing shorter sessions on the exercise bike more frequently would help you build up more exercise in shorter bursts that would be kinder to your hips. So maybe 10mins every day and then 2 x 10 mins morning and night one day and 10 mins once a day the next and so on.

My knees complain when I do more exercise but it is actually good for them and whilst they start sore the next day, if I work through it, it eases off and the more I push myself, the more I am able to do and the stronger my knees and the muscles and tendons that support them get and those muscles can really help burn glucose whilst I am exercising and then suck it back out of my blood whilst I sleep, to replenish their stores and drop my levels.
 
rebrascora said:
Sounds like you are doing what you can.

It may be that doing shorter sessions on the exercise bike more frequently would help you build up more exercise in shorter bursts that would be kinder to your hips. So maybe 10mins every day and then 2 x 10 mins morning and night one day and 10 mins once a day the next and so on.

My knees complain when I do more exercise but it is actually good for them and whilst they start sore the next day, if I work through it, it eases off and the more I push myself, the more I am able to do and the stronger my knees and the muscles and tendons that support them get and those muscles can really help burn glucose whilst I am exercising and then suck it back out of my blood whilst I sleep, to replenish their stores and drop my levels.
Click to expand...

I'll try breaking up the exercise a bit and see if that helps, thank you. Other than that I'll just have to speak to the docs at my next appointment and see if they have any ideas.....thank you for your input 🙂
 
LancashireLass said:
Looking at the sensor data it's around 3am that it starts to rise, so by the time I get up at 5.30am it is very often high.....higher than I am comfortable with!

A fellow Lancasharian huh, excellent!! :D
Click to expand...

3am is around the time the body starts releasing hormones, so that time fits in with dawn phenomenon. The liver starts to make glucose but the body is unable to deal with it due to insulin resistance/lack of insulin being produced - unfortunately none of the medications really seem to help with it, and the hormones produced actually inhibit the action of insulin.

Dawn phenomenon - Wikipedia

en.wikipedia.org en.wikipedia.org

I moved away from Lancashire when I was 18 and have lived in the Midlands + a few years in Sheffield since 1989... I still have family up around Pendle, though, and visit every now and then.
 
I know you say you have a Libre but you should really have some test strips as well as to be able to confirm your Libre data if the readings are either high or low as it is not reliable under those circumstances especially as in your signature you are taking glimepiride which works by increasing insulin levels in your body, which decreases your blood glucose. It also helps your body use insulin more effectively. Are you still taking this medication as it has the potential to cause low blood glucose.
Also a Lancastrian born in Rochdale.
 
Small confession before getting to business......"technically" we now fall under Greater Manchester (they changed the borders back in the 70's) but to me, we will always be Lancashire 😉

I am still taking the Glimepiride yes and I do sometimes get unexpected lows. I will have to search for a new BG meter and get one ordered I guess, as you say @Leadinglights it would be a good idea to have a cross check but I wouldn't trust my current meter.....over to Amazon.....if anyone has any suggestions on one that is cheap to buy but also has cheaper strips, I would be really grateful.
 
Twenty minutes every other day on an exercise bike should not lead to hip pain.
You may want to discuss this with your doctor and get it checked out.
The problem with shorter exercise such as 10 minutes is it has a tendency to push your BG up. Your liver dumps glucose to give you the energy for the activity and you stop before your muscles have a chance to start using that extra glucose.
That said, the longer term impact is valuable even short exercises.

The other thing to consider is whether your bike is set up correctly for you. Your legs should be slightly bent when the pedals are at the bottom. If they are straight, your body will sway from side to side which may be putting the stress on your hips. Likewise, if your saddle is too low, your body will be cramped up and again add stress. If your saddle moves forward and back, you may find it beneficial to try that in different positions too.

If it was me, I would
- check the bike position
- start with 10 minutes each day and increase it each week to see how my hips coped.
- discuss the hip pain with my doc
 
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