High sugars in the night

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Si100

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Type 1
Morning all,

I a a type 1 now for 30+ years

has anyone ever encountered a sudden raise of blood sugars in the early hours of the morning? sugars are fine when goung to bed and stable for a few hours then around 3/4am they suddenly shoot up
 
Hi and welcome to the forum.

A few things come to mind if this is a regular pattern....

1. Could this have been happening for a lot of years but CGM is only now allowing you to see it?

2. Your body has changed, and your basal insulin either needs tweaking or it is no longer suiting you body. Not sure if you are male or female but if the latter, menopause might be a possible cause as hormonal changes significantly affect BG levels.

3. Your diet or lifestyle has changed..... High protein or fatty meals are well known for causing overnight rises often referred to as the "pizza effect".... or are you perhaps less active for some reason.

Which basal insulin do you use and when do you take it or are you on a pump?
Have you ever done a basal test to check if your basal insulin/profile is holding you steady in the absence of food?
 
Could it be Dawn Phenomenon that you’re just spotting now? My blood sugar starts to rise around that time and my insulin needs increase (I’m on a pump). If not, perhaps your basal needs a tweak?
 
Welcome to the forum @Si100

I wondered about Dawn Phenomenon too. Diabetes does seem to like to change the rules from time to time, and my DP (which only happens after I have got out of bed) can vary from nothing very much to several units’ worth of correction being needed in different seasons and from year to year.

Dawn phenomenon - Wikipedia

en.wikipedia.org en.wikipedia.org
 
Since i've had the sensor i've seen it go up a lot, even without eating for many hours. The other week i must have taken like 30 units of the quick insulin within 3/4 or 5 hours just to keep it down because the readings went down a little (and slowly) with 4/6 units, then start going up again. Then i'd take another few units, it goes down again (slowly) then starts to rise. It was a rinse and repeat with no signs of it stopping. Then i had another day when i ate like around 5/6pm and didn't eat anything until 11 the next morning. My levels before i went to bed was 12 something and when i woke up to see my readings, it was 23. Now i'm injecting myself so many times a day with the quick insulin when the levels randomly go up.

I do feel like the sensor is inaccurate, that being said, i had the sensor, the new device (areo something) and the old one and all 3 had different results. At one point, my sensor said it was 3.1 and i didn't feel like a hypo. So i tested with the finger prick and it was like 5.9.

As of right now, i've taken 10 units total since 11pm as my results went from 15 to 13 and now it's saying 15.6 despite the fact i've taken another 2 units.

All i've had is a little bit of the sugar free water from Co-op. It shouldn't be enough to raise it by 3 levels when i've only had a few sips.

I do wonder if it could be the insomia or something else, but the sensor has made me feel much more worse off as the results never seem to go down.
 
Mickeyminime said:
Since i've had the sensor i've seen it go up a lot, even without eating for many hours. The other week i must have taken like 30 units of the quick insulin within 3/4 or 5 hours just to keep it down because the readings went down a little (and slowly) with 4/6 units, then start going up again. Then i'd take another few units, it goes down again (slowly) then starts to rise. It was a rinse and repeat with no signs of it stopping. Then i had another day when i ate like around 5/6pm and didn't eat anything until 11 the next morning. My levels before i went to bed was 12 something and when i woke up to see my readings, it was 23. Now i'm injecting myself so many times a day with the quick insulin when the levels randomly go up.

I do feel like the sensor is inaccurate, that being said, i had the sensor, the new device (areo something) and the old one and all 3 had different results. At one point, my sensor said it was 3.1 and i didn't feel like a hypo. So i tested with the finger prick and it was like 5.9.

As of right now, i've taken 10 units total since 11pm as my results went from 15 to 13 and now it's saying 15.6 despite the fact i've taken another 2 units.

All i've had is a little bit of the sugar free water from Co-op. It shouldn't be enough to raise it by 3 levels when i've only had a few sips.

I do wonder if it could be the insomia or something else, but the sensor has made me feel much more worse off as the results never seem to go down.
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Hi @Mickeyminime when did you last do a check on your basal insulin doses?
This sounds very much like you need to do a check on your basal insulin, which should be dealing with your levels in between meals. It is good that you are correcting high levels but your overnight rise is one that the background insulin should be dealing with. Having said that the DP does confuse things a bit, but the sensor should show you if it is that.
Also is it possible that your insulin has been denatured?
Can you tell us what basal insulin you are using, and when you take it?
Are you checking your high readings with a fingerprick?
 
Si100 said:
Morning all,

I a a type 1 now for 30+ years

has anyone ever encountered a sudden raise of blood sugars in the early hours of the morning? sugars are fine when goung to bed and stable for a few hours then around 3/4am they suddenly shoot up
Click to expand...
Hi @Si100
I definitely found that my insulin needs changed as I ‘grew more mature’. My activity levels are a lot more varied now that I am retired, and I also find the weather impacts my insulin needs.
The sensors showed me what was happening overnight and like you my levels were rising in the early morning with no input of carbs. Just my body waking up and generously giving me glucose to get going.

It would help us in our suggestions if you let us know whether you are on MDI or a pump. The article @everydayupsanddownshas linked to is useful.
 
Mickeyminime said:
Since i've had the sensor i've seen it go up a lot, even without eating for many hours. The other week i must have taken like 30 units of the quick insulin within 3/4 or 5 hours just to keep it down because the readings went down a little (and slowly) with 4/6 units, then start going up again. Then i'd take another few units, it goes down again (slowly) then starts to rise. It was a rinse and repeat with no signs of it stopping. Then i had another day when i ate like around 5/6pm and didn't eat anything until 11 the next morning. My levels before i went to bed was 12 something and when i woke up to see my readings, it was 23. Now i'm injecting myself so many times a day with the quick insulin when the levels randomly go up.

I do feel like the sensor is inaccurate, that being said, i had the sensor, the new device (areo something) and the old one and all 3 had different results. At one point, my sensor said it was 3.1 and i didn't feel like a hypo. So i tested with the finger prick and it was like 5.9.

As of right now, i've taken 10 units total since 11pm as my results went from 15 to 13 and now it's saying 15.6 despite the fact i've taken another 2 units.

All i've had is a little bit of the sugar free water from Co-op. It shouldn't be enough to raise it by 3 levels when i've only had a few sips.

I do wonder if it could be the insomia or something else, but the sensor has made me feel much more worse off as the results never seem to go down.
Click to expand...
Like Sue, I think it sounds very much like your basal insulin is not enough. I find it amazing that I can need 10 or even 20 units of corrections throughout the day to keep me in range but just a couple of extra units of basal insulin can sort it all out and get me back on an even keel.

If you are relatively recently diagnosed in the last couple of years, it could be your honeymoon period coming to an end. I had 3 distinct stages about 6 months apart when I needed to increase my basal and like you I was having to inject A LOT of units of corrections to keep a lid on my levels and I really resisted increasing my basal dose but once I did so, it was so much easier and everything went back to the way it should be and it was such a relief not to be battling with my levels, every hour or two.

Hope you manage to fix it. If you are not confident adjusting your basal then speak to your nurse.
 
I take it the Basal is the slow one. If so then i'm taking 40 units now. 20 in the morning and 20 at night. My work patterens are varied so taking it will never be at the same time. When i was first diagnosed, i was never told how much to take. My mum who is type 2 told me how much she takes and i more or less followed her example. It wasn't until nearly 7 months later that i got told to take 20 units total, but split it every 12 hours, i.e 10 in the morning and 10 at night. I was however warned never to take 20 units of the quick insulin ever again. I was never told how long it takes and how many levels it was supposed to lower my levels down. I just remember having a lot of ugly hypos which after eating a lot, i either passed out or nodded off to sleep as i was extremely drained from it.

Anyways, from 2019 i was told to take less and at the start of 2020 before the outbreak, i was told by the nurse and i quote "do whatever you want". I was never seen again by the NHS (England) from the start of 2020 until the end of 2022. I've not had a foot checkup since 2019 and since i've moved to Scotland nearly 9 months ago, the NHS from England haven't handed any info over to the Scottish one. As of 2023 though, i'm now taking 40 units of the slow, 20 in the morning and 20 at night. I normally try to take the slow around 8, but as my work hours are all over the place, i could or might have dinner around 11pm.

Yesterday when i went to work, my levels where in the 12/13 range and was like this many hours before despite taking the insulin both quick and slow. I skipped breakfast and only had a banana in the hopes that the levels would go up a little but not too much despite taking the insulin to combat it. However, my levels just kept rising, even after taking 6 units of the quick one and all i had was a banana. My level readings was 23 and again, all i had was a banana. It made me wonder if the insulin wasn't working so around 7pm i took 10 units of the quick to get it down and by 9pm, it went from 23 to 8. I skipped dinner and only had a snack to get it back up again when having a slight off feeling as i knew if i didn't eat, my levels could continue to drop.

I do sometimes wonder if its stress thats causing it, maybe a slight blockage maybe and the insulin is trying to push through. Who knows.
 
I'm really concerned about the lack of advice you have had. But you couldn't be in a better place here. I'm very newly diagnosed and so will let the vastly more experienced help you. The thing that helped me the most was a suggestion to get a book called Think like a pancreas by Gary Scheiner. He is an American Dr who is Type 1 himself. There is another book that is often suggested but I cannot recall what it is.
Take care.
 
Novorapid (orange) and Levemir (green) are the ones i'm using. I've been told that i'm going to have to go through that honeymoon period again due to no information given to them from the English side. When i first saw the nurse, she wasn't happy with the current results they got from the blood test up here which i believe was either 89 or 99. However, for me it was a big improvement as my last results from England was 119. That was worse compared to what it was back in 2020 which was somewhere in the 70's and before that if i remember correctly from 2019, my first results from diagnosis was 177. Wiredly enough, they don't seem to call it a honeymoon period up here, well, maybe in this area anyway. They seem to think that i might be type 2 as everyone in the family that has the condition is type 2. However, most have said it's type 1 which for me, it's more depressing with back and fourth information. I guess the honeymoon period was supposed to end for me back in 2019, but obviously the pandemic caused so many problems that i and others was removed from the list and never got seen until like 2/3 years later. Appointments where impossible even when the virus died down in my area (Havering London) and continued to be impossible before i moved up here to Scotland.

I was told by the nurse up here that i can if i wish, take a little less of the slow meds, however i did state that because of what went on back in London, i'd rather take at least 40 to try and get my HBA1C levels down until i'm happy and then slowly take a little less.

Sleeping has been an issue for me since childhood and i guess doing random hours wont help, that being said, i've at least been seen to up here, they gave me a sensor thing and do seem to be more in contact unlike those back home. The main annoying info i remember about the quick that seems to change was how long it takes, some say 5 minutes, others say 10, 15, 20 and so on. One nurse even said i'm supposed to take it before and after food, another said before it while a few others said after which for me, cause more head scratching than anything else as i'm like "urm, so do i do this or do i do that"
 
There are blood tests that can help determine your diabetes type @Mickeyminime Ask for the C Peptide and Type 1 antibodies tests. You sound a bit confused about the honeymoon period. It’s just when your own pancreas is still making a bit of its own insulin. It’s nothing to do with appointments or anything. Poor sleep can increase your insulin resistance so that might not be helping things.

You don’t need to scratch your head about the timing of your Novorapid. Experiment and take it at the right time for you. This might be 10 mins before you eat, or 20 or whatever. Look at your after meal spike and see.

Have you done a recent basal test? If not, that would be a good idea. You need to get that right because that’s the foundation you build on.
 
It sounds like you have not had anywhere near enough input and support to understand your insulin regime and how to use it effectively to manage your diabetes.

Just a few basics which you may or may not know...

Your basal (long acting) insulin which you take morning and night is designed to mop up the glucose that your liver secretes into your blood stream day and night. I see the liver as being a bit like a back up generator which keeps things ticking over in between meals and through the night. It rarely releases a uniform amount of glucose and so it is unusual to need uniform amounts of insulin to deal with what it releases but it does follow a rough pattern in that it often releases very little glucose in the very depths of the night and usually more in the morning to give you energy for the day ahead. If your day and night routine is disrupted by shifts this can make it more challenging, particularly if you work night shifts regularly. Sometimes you need to have different basal doses for the days and nights when you are working and when you are on days off.

I use Levemir which I think is what you use and my day and night doses are very different. In the morning I need a lot of Levemir as soon as I wake up (usually 22 units) and before I get out of bed, but on a night at bedtime I need very few units, usually somewhere between 0 and 5units. If I have had a very active day I reduce it by one of two units and if I have been active for 2 or 3 days on the trot I don't need any at night. My daytime dose is usually pretty stable but if I continue to do lots of activity or exercise and my night time dose is down to 0 then I start to reduce my morning dose. No one told me these doses and strategies and I was on 7 in the morning and 7 at night but I was having a lot of nocturnal hypos. when I first started adjusting it myself and that was during my honeymoon period when my pancreas was still producing some insulin. As it gradually stopped producing insulin, I had to increase the daytime dose so that if I skipped a meal here and there at different times of day, my levels stayed stable....
This is how you do a basal test, by skipping breakfast one day and lunch the next and then dinner the next and seeing what your levels do in the absence of food and of course meal time insulin. The idea is that the basal should keep you within 2-3mmols during those periods where you skipped meals. If it is rising then that suggests you need more basal insulin and if it is falling then you need less. Getting those basal insulin doses as close to optimum as possible to keep your levels stable in the absence of food and fast insulin is as important as having level foundations on a building. If you start off wonky at the bottom and build on that, the undulations get worse the higher you build and the structure is unstable. If you can get it flat to start then things start to be much easier to manage and make more sense.

Whilst there are some people who need the same dose morning and night it is unusual and most people need less at night and more in the morning. That said, there will be some people who need more at night and less in the morning, but you need to do some testing to see what your body needs. If I don't have enough basal I need lots and lots of extra fast acting insulin to keep my levels in range. So I might end up injecting an extra 10 or 20 units each day for a couple of days until I get frustrated and increase my basal insulin. Just 2 extra units of Levemir can make it all settle down again despite needing 10 or 20 units of fast acting insulin to do the same job the previous couple of days. What I am saying is that just small amounts of increase in your basal dose can have a very significant impact, so getting that right is crucial.

As regards fast acting, bolus insulin, are you carb counting and adjusting your doses to match what you eat? If not, then you are going to have turbulent levels and again nothing will make sense unless you eat the same sort of meals every day and just learn what those meals need.
Timing is really important and we are all different. Most of us need to inject before eating but it depends on the particular insulin you have (some are faster than others) and the time of day (breakfast usually needs longer than evening meal) and what you are going to eat (things like pizza or pasta in a creamy sauce or fish and chips where there is a lot of fat often need some before the meal and some an hour or two after.... so that nurse was partially right). Then your BG when you inject is also a factor to consider. If your levels are in the 4s or 5s, then the insulin you inject will kick in a lot quicker than if you are 10 or above because high BG levels cause insulin resistance. I can sometimes inject and then wait 2 hours before eating if my levels are mid teens. That is not convenient generally and usually pretty frustrating too, so I proactively keep my levels under 10 as much as possible.

The other thing to consider with fast acting insulin is exercise. If you exercise or do strenuous activity within 3-4 hours of injecting meal time insulin, you are more likely to hypo because the exercise makes the insulin more effective... or I should say it makes you more sensitive to the insulin. For that reason, people reduce their meal time dose if they know they are going to be active after the meal. If you do a physical job during the day, then you may need less insulin for breakfast and lunch but perhaps less (edit.... this should read "more") for evening meal, especially if you sit and watch TV afterwards, but if you go to the gym after your evening meal then you would need less.

I am sure that you will feel overwhelmed by all this and all the things that you need to think about in order to work out doses, but if you take it one step at a time and start with doing some basal testing to get your basal doses right then it will gradually become easier and make more sense.

It is like learning to drive a car. When you sit in the driver's seat of a car for the first time, there are so many things to think about and you have to consciously check the mirrors are set up right and the seat adjusted for you to be in the right position and make sure it is out of gear before you start it and then look in your mirrors, indicate select first gear, slip the clutch and pull away, and then dip the clutch again and select second etc, all the time looking at road signs and thinking about where you are going and how to get there and what the other traffic is doing and which lane you need to be in..... driving really is incredibly complicated when you break it down into individual steps but after a while with practice, you start to do a lot of the stuff without even thinking about it and it just becomes second nature. This is what happens with diabetes too once you understand how it works and learn to use the insulins you have in the right way.

It is not your fault that you don't know how to manage it but you can learn a lot from the people on this forum and we would be happy to help you but you need to devote some time and effort to learning. See it as an investment in your future health, because with levels that high for several years you are putting your future health at risk. Dedicate an hour or even just 30 mins a day to learn more. Start by doing some basal testing. It might take a week to get some useful data but we can help you interpret it although you will need to keep some records although once you have Libre that will help a lot, especially if you haven't had it up till now.

We are here to support you and help you with this and try to explain things but you will need to devote a little time to it. Only you live your life in your body with your diabetes and we are all different in our lifestyles and food choices and how our diabetes affects us, so we really can't expect a nurse that we see twice a year or whatever for 15-30 mins to really be able to effectively tell us the doses we need for all that time in between. You have to become your own expert in your own diabetes and once you do, it all starts to make sense and become so much easier. I really hope we can help you get to that stage, because at the moment you sound totally lost and that is no criticism of you, but just a lack of support and education in diabetes management.
 
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Sorry for the late reply.

No, i've not had a test, this is infact the first time i've heard of it. Same goes with the word basal as it's never been used or mentioned once be it in England or here in Scotland.

Yesterday i had 4 units of the quick insulin before food by 10 minutes. Nothing happened, then an hour later my levels went up so i took another 4 units, then nothing happened other than it continued to rise so i took another 4 and that still did nothing. By 3 hours later, i took another 6 and it slowly went down a few hours after that until sometime in the early morning, it started to go down quite quickly until it stopped around the 8/9 area, then my levels started to go back up again despite the fact i didn't eat anything since yesterday. All i had was 4 sausage rolls and i barely had anything to eat before that as i'm skipping meals to avoid my levels sky rocketing.

I'm not sure if it was this post, but nearly 2 weeks back, i only had like a mug shot for breakfast as i had no milk for cerial. I had 4 units before that and my levels went from like 9 to 16, then 16 to 23. I was at work at the time when i was checking my sensor and i honestly wondered if it was giving false readings. My manager was wondering how it was possible for something like a mug shot to cause my levels to sky rocket so high when something like that should only need like a few units and make your levels rise maybe just a little, but not that high.

It sounds like they failed to mention about certain foods, like pizza or pasta for example to which you stated insulin before and like an hour or 2 later which i more or less did with the sausage rolls.

I did look around on google, however when information seems to be different, i guess that causes more confusion as its knowing whats right and whats not, kinda like when the different nurses said different things about the quick insulin, take before and after food, don't take it before or don't take it after. They also never mentioned about how the insulin works quicker with lower levels than it does with higher levels. I guess thats the reason why i'm taking even more quick insulin because it just goes up or takes ages going down.

My current job isn't as active as my last one as i've moved from a big city to a small village/town. My last job i skipped taking insulin on my work days as the hypo's caused issues both getting the job done, taking a few breaks and so on. Getting screamed at or disaplined was taking a toll so i skipped the meds to get the job done. Now that i'm up here, i'm taking my meds at break time if i can and maybe a little extra if my levels go up and i'm not that busy at work dealing with people.

I've decided to take the 10 units day and night of the slow one to see if it makes any difference, so far i guess it's difficult to tell, specially if i'm taking so much of the quick one.

That being said, i guess i have been doing the tests without knowing it was a test as i'm skipping at least breakfast and maybe dinner or breakfast and lunch depending on what goes on and there have been moments it just goes up randomly. Mostly it goes up slow when i don't eat, but a simple banana seems to make it go up a fare bit. On my days off i might walk a bit to the beach and all, it's just me up here atm and with work, those hours and days are all over the place from morning, midday and late afternoon. The insomia doesn't help, but thats been like this since i was little.
 
Basal = your slow background insulin that you take once or twice a day.
Bolus = is the fast insulin you take before a meal or as a correction dose.

I didn’t know what a mug shot was but I looked on Tesco just now and the one I saw had more than 40g carbs in it. Did you check the carbs on the packet and use your ratio to calculate the correct amount of insulin to take @Mickeyminime ?

TBH, it sounds like your blood sugar is all over the place. Don’t rely on your team sorting that for you. Diabetes is a lot about being your own expert. Do a basal test first because that’s crucial to get right. Then you need to look at your mealtime boluses. Once you’ve got your basal dose(s) right, you can look at your boluses meal by meal.

You’re taking quite a lot of your fast insulin, but without doing a basal check it’s impossible to know if that’s just because you’re not having enough basal or if there’s something else going on.
 
Mickeyminime said:
Yesterday i had 4 units of the quick insulin before food by 10 minutes. Nothing happened, then an hour later my levels went up so i took another 4 units, then nothing happened other than it continued to rise so i took another 4 and that still did nothing. By 3 hours later, i took another 6 and it slowly went down a few hours after that until sometime in the early morning, it started to go down quite quickly until it stopped around the 8/9 area, then my levels started to go back up again despite the fact i didn't eat anything since yesterday. All i had was 4 sausage rolls and i barely had anything to eat before that as i'm skipping meals to avoid my levels sky rocketing.
Click to expand...
That all suggests to me that your morning basal (long acting) insulin dose is not big enough to keep you steady which is why you are needing so many "stacked corrections" ie one corrective dose after the next when the first one is still active. This can be very dangerous unless you know exactly what you are doing with your insulin and keep track of the active insulin in your system. Each dose of NovoRapid lasts for 4-5 hours so if you inject some more an hour or two after the first one you have two lots of active insulin in your system and you then added another one on top. If you then did a lot of exercise or physical activity, all those stacked corrections could potentially drop your levels like a stone and leave you very dangerously hypo, possibly even unconscious. I have done it myself but with smaller doses and I always keep track of when I inject each one and how much of that insulin is left when I jab the next one etc, so that I know roughly how much glucose I would need if I suddenly started to drop low, plus I am retired so I can mostly keep a close eye on it, so do be careful if you are tempted to do that again but my thoughts are that your morning basal may not be enough and generally it is suggested to increase by no more than 10% at a time, leave it a few days and see how that works and then increase again if necessary. If you are increasing your daytime dose then I personally consider decreasing my evening one because there is overlap and the increased day time dose could cause you to hypo overnight if you keep the same night time dose, but I would look at my overnight graph and see if levels were also rising throughout the night or if they were dropping slightly or staying the same.
 
'A banana' is far from being something simple to eat - when you have diabetes. Ever since I've had diabetes I have never ever been able to eat more than about a third of one - send my blood glucose shooting up into the stratosphere. We haven't bought any for at least 20 years!
 
The best 2 thing i did for my diabetes management were reading 'think like a pancreas' and relying on myself to manage my diabetes, rather than the nurses etc. Oh, and posting here...
As others have said, get a basal dose that keeps you level if you skip a meal/overnight, the sort out your insulin to carb ratios...which may differ between working days, weekends etc
 
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