High overnight BG but cannot fathom why

LancashireLass said:
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?
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Good morning. There is a condition called nocturnal hypoglycemia. If your monitor is ok, might be worth asking about this.
 
Thanks @helli
I adjusted the bike last night so obviously no effect yet but will see how it goes - I suspect that may have been the problem because I definitely "sway" side to side when pedaling so it is probably caused by this and not anything more sinister.
I have short legs and they are fully extended (almost stretched) when the pedals are at their lowest, however I thought this was the correct position to be in. I will have to trial the seating position over a little longer and see what happens!
 
LancashireLass said:
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.
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Actually with those medications you are taking you should be prescribed a blood glucose monitor and strips by your GP so you should ask.
But inexpensive ones are the GlucoNavii, TEE2 and Contour Blue which have the cheaper strips. But do ask at your surgery first.
 
Leadinglights said:
Actually with those medications you are taking you should be prescribed a blood glucose monitor and strips by your GP so you should ask.
But inexpensive ones are the GlucoNavii, TEE2 and Contour Blue which have the cheaper strips. But do ask at your surgery first.
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I would second the Contour Blue - I've used one for just over 12 months to monitor BG and had no issues. Strips are £8.74 ex vat for a pot of 50 on the diabetes UK shop; make sure you pick the one with VAT relief.
 
helli said:
Hypoglycaemia is low blood glucose. The OP has described high BG.
How would this be related?
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Because if her numbers dropped (hypoglycaemia), her body could bring them up too high. My numbers dropped in the night (the 48hr monitors alarm went off more than once each night) and then my numbers first thing would be high. They said they would have been even higher in the night after the sudden drop, as my body went into panic mode.
 
I would be very surprised if they will prescribe test strips as well as Libre in your situation and you might risk losing the Libre since you are not on insulin, if you push your luck. I personally don't see a huge need for double checking the highs when you are not on insulin as you are not able to do anything much about them. Those of us using insulin might want to calculate a correction dose and that would be when we might do a finger prick first to verify the level to ensure we don't calculate too big a correction and end up hypo.
You do however need to check if you possibly feel hypo and I think that Libre is a reasonable way to corroborate that. Yes, it can give false lows, but if you feel low and Libre says you are low, then I think that is enough verification.
 
PurpleHoney said:
Because if her numbers dropped (hypoglycaemia), her body could bring them up too high. My numbers dropped in the night (the 48hr monitors alarm went off more than once each night) and then my numbers first thing would be high. They said they would have been even higher in the night after the sudden drop, as my body went into panic mode.
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Libre and other CGM are prone to what we call "Compression Lows" where if you lie on the arm with the sensor it causes a false low reading and then when you roll off it, the sensor returns to it's previous level. It is very unusual for levels to suddenly drop through the night without insulin and normally when basal insulin is too much, it is a slow descent into "the red" rather than a sudden drop. Yes, if you do have a genuine hypo through the night and you are unaware of it and don't wake up and treat it, the liver will release extra glucose to counteract it, but the OP is using a Libre sensor and would know and hopefully mention it if there was a hypo preceding these high readings.
 
Leadinglights said:
Actually with those medications you are taking you should be prescribed a blood glucose monitor and strips by your GP so you should ask.
But inexpensive ones are the GlucoNavii, TEE2 and Contour Blue which have the cheaper strips. But do ask at your surgery first.
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I have asked but they have said no and I would rather have the Libre so will stick with that
 
rebrascora said:
Libre and other CGM are prone to what we call "Compression Lows" where if you lie on the arm with the sensor it causes a false low reading and then when you roll off it, the sensor returns to it's previous level. It is very unusual for levels to suddenly drop through the night without insulin and normally when basal insulin is too much, it is a slow descent into "the red" rather than a sudden drop. Yes, if you do have a genuine hypo through the night and you are unaware of it and don't wake up and treat it, the liver will release extra glucose to counteract it, but the OP is using a Libre sensor and would know and hopefully mention it if there was a hypo preceding these high readings.
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You're correct. I do get occasional low readings (and the low alarm) but these do not precede the night time highs, I'm generally at my average at bedtime and it starts to creep up in the early hours, there is no pattern or link as far as I can tell
 
Leadinglights said:
Are you still on insulin as looking at your first posts from a few years ago I think you were and they must have prescribed a monitor then.
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I've never been in insulin since diagnosis, only tablets and I have never been prescribed a meter, I bought my own
 
PurpleHoney said:
Because if her numbers dropped (hypoglycaemia), her body could bring them up too high. My numbers dropped in the night (the 48hr monitors alarm went off more than once each night) and then my numbers first thing would be high. They said they would have been even higher in the night after the sudden drop, as my body went into panic mode.
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This is highly unlikely. People with type 2 diabetes not on insulin don't just go low and then suddenly high. They tend to stay on average higher than normal. Even if we do get low (Due to exercise) the level will gradually creep up to reach an equilibrium point which is dictated by how much insulin is being released, insulin resistance and how much excess gluconeogenesis is going on.

Morning highs are nothing to do with 'panic', but a consequence of hormones and the circadian rhythm dictating their release. Unfortunately the condition means it's hard to deal with the rise hence the elevated levels that can sometimes last until the afternoon.

If you're using sensors the night-time low is probably caused by lying on the sensor.
 
PurpleHoney said:
Because if her numbers dropped (hypoglycaemia), her body could bring them up too high. My numbers dropped in the night (the 48hr monitors alarm went off more than once each night) and then my numbers first thing would be high. They said they would have been even higher in the night after the sudden drop, as my body went into panic mode.
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This used to be referred to as the Somogyi Effect.

Part of the possible counterregulatory hormone response to low blood glucose, where you can get a liver dump.

In folks with T1 this possible hypo-fix gets blunted over time, and the last time I read/heard about Somogyi it was that the theory hadn’t really been borne out in clinical observation of CGM data.

I think it can happen from time to time, but it’s unpredictable and somewhat rare?
 
This effect was a theory from the early 20th century, but has never been proven. I believe it may well have been disputed now, as there appears to be no link between morning hyperglycaemia and low levels in the evening. The current belief is that morning levels are linked to hormones and metabolic syndrome.

pubmed.ncbi.nlm.nih.gov

The Somogyi phenomenon. Sacred cow or bull? - PubMed

Posthypoglycemic hyperglycemia (Somogyi phenomenon) occurs infrequently in insulin-treated diabetic patients. When it occurs it is often in children and adolescents, or patients with a short duration of diabetes. Marked hyperglycemia (greater than 220 mg/dL) after hypoglycemia results from a...
pubmed.ncbi.nlm.nih.gov pubmed.ncbi.nlm.nih.gov
 
Hello,

Really well done for the weight loss and the HBa1c results.

I am not sure but for Metformin there are two types, the slow release may help.
Also regarding the high BG, am not sure I think could be insulin resistence and connected to your liver.

There are loads of helpful people on hear who am sure will point to you to the right direction.
 
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