Overnight levels

[Greg]

Hi,

So i realise this is a pain in the bum for a lot of type 1s, but hopefully somebody has a bit of advice, last time i asked a question the answers helped me immensely!

Background info....type 1 for 4 years, started playing rugby and going to the gym a lot in the past 1.5 years, got the exercise pretty much sorted and don't often have hypos or spike around it. I take Humalog for instant and Lantus for a base line each evening (16 units)

The problem i'm having now is that i'm going to sleep and nearly every day waking up with levels between 16-18, and no matter what i do i can't seem to get them down to the right sort of level.

Now i know for a fact i've had overnight hypo's (waking up sweaty in middle of night or in morning) but thats not very often that i actually wake up (or wake up sweating in the morning) so to combat that i tried to lower my baseline and take long lasting snacks before bed, pretty much same thing still happened and the same thing happens if my blood is high (say 13 for example) just before i goto sleep, i still wake up with it in the high teens.

To combat it i have pretty much the same thing for breakfast every morning, and know if i take X amount of insulin it will be perfect 2 hrs later (6-8) this obviously isn't ideal as i want to be waking up with good levels!

Any thoughts/suggestions?

Thanks in advance and let me know if i've missed any info!

 

[Northerner]

Hi Greg, sorry to hear about this One thing you really need to get sorted out is the possibility of night hypos, particularly if you say you don't always wake up from them. To be blunt, you may not wake up at all one day Sometimes when you fall low in the night your liver will react eventually and release glucose, causing the rebound highs as you know, but you cannot rely on this - you must ensure that you are always safe through the night. Do you ever do 3am tests to see what your levels are like during the night? Yu may need to do a few nights where you do regular tests at two hour intervals in order to see what is happening - whether you are dropping low and rebounding or just continually climbing through the night. Alternatively, your clinic may be able to provide a CGM (Continuous Glucose Monitor) to ascertain what is happening.

How soon after waking are you taking your reading? Some people's levels can climb considerably just in the first hour after waking as the liver gives your blood sugar a 'boost' for the day.

 

[Greg]

His thanks for the reply!

No I havnt done tests at that time for a while I did have a monitor put on by the clinic but all they suggested was stuff I already knew I.e snack before bed as it was hypos I was having, or take less insulin after exercise etc

Just out of interest what do people have as snacks before bed?

 

[Northerner]

His thanks for the reply!

No I havnt done tests at that time for a while I did have a monitor put on by the clinic but all they suggested was stuff I already knew I.e snack before bed as it was hypos I was having, or take less insulin after exercise etc

Just out of interest what do people have as snacks before bed?

I'm not a very representative example as I don't have any insulin overnight any more, but generally if your basal insulin is at the right dose then you shouldn't need a snack at all before bed - if you do, then it means the dose is too high, because it's only supposed to be there to match the trickle of glucose released by your liver when you are not eating - not to deal with any extra food. It's quite possible that, even on the nights when your levels are high before bed, you are still dropping low and getting rebound highs in the morning. In an ideal world (yeah, right!) your BG should not vary by more than a couple of mmol/l overnight. I would highly recommend doing the overnight testing to try and pin it down. How long is it since you had the CGM? Things change and you may not be reacting in the same way as you did when it was done. As you have got used to the exercise you will have become much fitter and more sensitive to the insulin and you could have radically different requirements now than a few months ago - this certainly happened to me!

 

[everydayupsanddowns]

Hi Greg

Sounds like a few nights of basal testing throught the night would really help.

If you think you have cracked your overnight hypos, the other possibility is that you are suffering from Dawn Phenomenon - a rise in BGs from the liver often from around 4-5am onwards designed (in our cave dwelling forebears) to help 'fire up the burners' and help get us out hunting.

Quite awkward if you are playing at being your own pancreas, but some people manage to control it by altering timing and/or splitting their Lantus into two injections approx 12 hours apart.

This page is *very* useful in establishing whether your Lantus is doing its job properly: http://www.diabetes-support.org.uk/info/?page_id=120

I used to find that if my Lantus was out, even just by a unit or two, the rest of my levels went into complete chaos and completely misbehaved.

 

[Greg]

So, tried a bit of change last night

went to bed around 11:30 with it at 16, ate about 9 after doing a heavy gym session so not as much insulin afterwards, 75% of normal amount

took 14 units rather than 16 of baseline

woke up at 3am, tested it, at 18

woke up in the morning, tested it, still 18

Am i missing something here? i don't see why it would go up!

 

[Northerner]

So, tried a bit of change last night

went to bed around 11:30 with it at 16, ate about 9 after doing a heavy gym session so not as much insulin afterwards, 75% of normal amount

took 14 units rather than 16 of baseline

woke up at 3am, tested it, at 18

woke up in the morning, tested it, still 18

Am i missing something here? i don't see why it would go up!

For a 2 mmol/l rise overnight, this is well within the accuracy tolerances of most meters, which can vary by 20% (+/-10%). Also, your BG is influenced by the action of other hormones whilst you sleep, so whilst your insulin may be lowering it other hormones may be raising it by stimulating the liver. Given the inaccuracies in measuring I would say your BG was rock steady, which is desirable, but at too high a level to start with.

 

[trophywench]

Do the basal test as per Mike's link. Test at more times than just 3 am. You need to know what's happening ALL night not just once. Plus you need to know what's going on all flipping day, too. PITA, isn't it? LOL

Could try taking your Lantus earlier, it might be you are going high through lack of basal after your dinner. Or you may need to split it. Or you may need to bin it and try a different insulin .... until you know what's actually going on with your BG, there's not much point in taking guesses, is there?

 

[Greg]

Ok so, went to bed with a much better BG at 9.7
Woke up 2am (11.3), 4am (9.8) before getting up at 7:30am....(12.6)
I was a little bit late for work (bloody housemate in the shower!) so i decided to have breakfast at work...had breakfast eaten by 8:45am, blood tested...22 BG...err what?

Definitely no hypo during that time as i was obviously awake, so how on earth has it nearly doubled in the space of 90min? The only thing i had in this time period was a protein shake which contains 1.5g of carbs for a 25g scoop (and i only have 1 scoop)

Could this be my liver doing the 'Dawn Phenomenon', if so any way round it?

Any thoughts?

 

[Northerner]

...Could this be my liver doing the 'Dawn Phenomenon', if so any way round it?

Any thoughts?

It does sound like it. If I delay eating something after getting up in the morning then my levels will rise a lot. Or rather, what I do is as soon as I get up I have my breakfast insulin but then I might not actually eat until half an hour later or more. This stops my BG from rising and also means that when I come to eat the breakfast my insulin is already starting to peak and nicely matches the food. However, this approach may not work for everyone and there may be a risk of hypo, so you do have to monitor it properly until you are sure how you react as an individual. On the face of it, it looks like I need a lot of insulin for the carbs in my breakfast, but in reality I am matching not only the food but my liver's extra output. Someone on a pump would basically do the same thing by setting a higher basal rate for this time period, I think.

DP in some people is reduced by eating a small protein snack before bed - slow to digest so your liver thinks that you have food and doesn't need any help - or have something to eat straight away when you wake which has a similar effect. 🙂

 

[Greg]

Well that makes an unbelievable amount of sense, I've always had to take almost double insulin:carbs ratio if not more in the mornings and the doctors never told me about DP. I never even considered that my liver would be doing that!

 

[everydayupsanddowns]

Mr Liver has a *lot* to answer for in terms of messing up levels and generally making things much tricker to get right. Particularly since he will just change his mind every now and then and throw another spanner in the works.

 

[DeusXM]

DP in some people is reduced by eating a small protein snack before bed - slow to digest so your liver thinks that you have food and doesn't need any help - or have something to eat straight away when you wake which has a similar effect.

Another method that can work for people is a small (SMALL!) amount of alcohol before going to bed, like a glass of red wine. The alcohol keeps your lower pre-occupied.