Night time spike

[tommy_boy]

Hello all, first time posting here as I require some advice surrounding night time blood sugar readings

I am 27 years old, have had type 1 for 13 years and only recently in the last few months seen this new pattern forming for the first time

Eating and dosed insulin around 8/9pm which is followed by a drop in blood sugar to low 4-5mmol . I can leave this untreated with fast acting glucose and still in the night my blood sugar will rise to 13-16 mmol

Other than these spikes my long acting lantus insulin is correct say if I don’t eat late at night no issues at any other times

Please can anyone advise on why this is happening and ways it can be prevented?

Thanks

 

[Tdm]

Ok, so your blood sugar drops after eating. This suggests your insulin is kicking in before the food. It could also mean that the insulin stops working before the food has finished digesting...so perhaps you need to take your insulin later. Is it fatty food? Fatty food can delay digestion.
Or perhaps you have become less insulin sensitive and need more bolus?
Or perhaps, because you are digesting whilst asleep, you are less insulin sensitive (excercise makes you more insulin sensitive whilst you exercise...conversly, resting makes you more insulin resistant).
Do you have a cgm graph to show us?

 

[Inka]

Boring answer but it’s easier to eat earlier. I find my basal doesn’t like late meals and I often go high in the night. If this is only happening when you eat late, then try avoiding that as much as possible.

 

[helli]

@tommy_boy do you mean spikes - BG goes high and comes down again? This would mean your bolus was taken too late but the dose was ok
Or, do you mean your BG rises and does not come down? This would mean you don't have enough insulin.

 

[tommy_boy]

@tommy_boy do you mean spikes - BG goes high and comes down again? This would mean your bolus was taken too late but the dose was ok
Or, do you mean your BG rises and does not come down? This would mean you don't have enough insulin.

The usual time it would take to notice the effects of the insulin show that it has brought my levels down too much (1-2 hours after dose) can go down as low as 3-4mmol

It is the hours that follow that where it rises to a high level even without consuming anything else

 

[tommy_boy]

Boring answer but it’s easier to eat earlier. I find my basal doesn’t like late meals and I often go high in the night. If this is only happening when you eat late, then try avoiding that as much as possible.

Yes I think completely cutting out the late night carbs / sugar is an immediate solution which I am happy to do it’s just because it is a new trend that I am curious about it

I have Always been able to eat late in the past and never had any random blood sugar rises in the night unless I had forgot to do my insulin

 

[tommy_boy]

@tommy_boy do you mean spikes - BG goes high and comes down again? This would mean your bolus was taken too late but the dose was ok
Or, do you mean your BG rises and does not come down? This would mean you don't have enough insulin.

Yes just that it rises and stays high throughout the night until the morning where it remains high until insulin correction brings it down

 

[Inka]

Yes I think completely cutting out the late night carbs / sugar is an immediate solution which I am happy to do it’s just because it is a new trend that I am curious about it

I have Always been able to eat late in the past and never had any random blood sugar rises in the night unless I had forgot to do my insulin

I’ve found that things can change over time. Sometimes they change back again, but often they just settle into something new. That’s the frustrating thing. All we can do is roll with it.

 

[Bloden]

I took Lantus for about five years. I was switched to Tresiba because Lantus stopped working for the full 24 hours. I worked out it was only lasting for about 16 hours in the end.

 

[everydayupsanddowns]

I took Lantus for about five years. I was switched to Tresiba because Lantus stopped working for the full 24 hours. I worked out it was only lasting for about 16 hours in the end.

That’s interesting @Bloden - must have come as a relief when you finally tracked it down.

Like when I realised that the slightly off-and-on fridge weirdness we had been having had cooked my Lantus, and that’s why things were behaving so weirdly!

 

[everydayupsanddowns]

Sorry you’ve been having these late rises @tommy_boy

Diabetes sure does seem to like moving the goalposts from time to time!

Are you often dipping below 4.0 after your evening meal? I wonder if your liver might be “helping out” dumping glucose after a low? Some people get that sort of counterregulatory hormone response after some hypos (though it can be a bit patchy, and you can’t really rely on it!)

The other possible contributory factor *might* be the timing of the insulin action vs the speed of absorption of the meal carbs - sometimes my diabetes seems to have a change of mind and meals absorb over much longer. Since I’ve been on an insulin pump, during those times I can use an extended bolus to ‘spread’ the insulin over a longer timeframe. On MDI, I’d split the dose - have half or a bit more up front, and the rest an hour or more later.
That way I’d avoid the ‘dip’ and more meal insulin would be active later on.

 

[SimonP]

I'd try splitting your evening bolus dose - try 50-50% to start with and see how you get on. Take the first half when you normally would, then the second half perhaps an hour and a half later (i.e. when you would previously have been going low) - see how your BG is trending at that point and adjust.

Eating a bit earlier is also useful while you're testing things.