Random highs - hormonal, more basal?

[pawprint91]

So for the past month, I would say on average every other day, my bg has risen around 9pm/10pm even when otherwise looking steady (usually I catch it before it hits 12 with a correction). However, on two occasions now it has now gone above 14. Pictured above is my graph from last night. Dinner was not a meal with a lot of fat or protein and was eaten around 6pm. I fell asleep at 9.30pm with bg saying 5.3 on finger prick about half an hour before that. You can see what happened ... woke up 2 hours later to find it was 14. As far as I'm aware I don't think I have delayed digestion issues - I certainly have never experienced rises like this before! Could it be hormonal? Or do I need to increase my basal - would 1u stop a rise to this degree? After I (over) treated it, you can see bg goes back up and is fairly steady until I got up at 7am. Any advice/experiences welcome - and thank you @rebrascora for encouraging me to post this - I've never shared a graph before! 🙂

 

[trophywench]

What did you actually have for dinner, and what time?

 

[pawprint91]

What did you actually have for dinner, and what time?

Chicken kiev (with barbecue sauce, not garlic), potatoes and peas at 6pm. Edit to say that I had what I would consider a 'normal portion' - I also ate some easter egg, and then bolused afterwards as I wasn't intended to eat any but got carried away, hence why I think it hovered around the 4.9 mark for sometime on the graph, finger prick did actually say 3.9 but I only had one sip of orange juice around 8pm to fix this.

 

[rebrascora]

It certainly is a bit of a sneaky, cheeky whopper isn't it!! 🙄 Especially waiting until you nod off before it made an appearance!
You weren't having stressful dreams were you? Or watching a cliffhanger sports match or thriller. They can do that to me!

What time do you inject your basal insulin? I am right in thinking you are using split dose Levemir, aren't I?

Sometimes I get a spike like this on an evening for a few weeks off and on and I find bringing my evening Levemir dose forward helps, so that there is a bit more overlap of the evening dose with the morning dose. I normally inject my evening basal at 11pm, so bringing it forward to 7 or 8pm can really help. If you already inject at 7 or 8pm, then that isn't going to help. Maybe going for a short walk after your evening meal would knock it on the head.

I don't think increasing you evening basal dose is the answer because the rest of the night looks to be reasonably steady give or take what look like a couple of possible compression dips.

 

[trophywench]

I don't think basal's the answer either. The only way I have found to deal with this type of thing for me, is to usually have either an extended or multiwave bolus for my dinner - but you can't do this with MDI so no help to you. You could try 40%/half/60% upfront and the rest about an hour later and see if that helps?

 

[TheClockworkDodo]

I suspect if you increase your basal you'll just end up going low in the night - I've had similar problems and increasing basal doesn't stop the post-meal spikes, it just means more hypos at other times.

The only things which work for me are pre-bolusing (to an extent, obviously you can't pre-bolus by half an hour when your blood sugar is already in the 4s before your meal), splitting my meals so I eat half and then eat the rest an hour or two later (not something you can really do with a chicken kiev), and doing something like the short walk @rebrascora suggested immediately after eating.

But I'm still getting RH-type spikes and crashes which look much like your graph every time I eat rice at the moment - no idea what's going on with that as I've been eating it for years with no problem, but wondering whether I might have to give it up now.

 

[pawprint91]

It certainly is a bit of a sneaky, cheeky whopper isn't it!! 🙄 Especially waiting until you nod off before it made an appearance!
You weren't having stressful dreams were you? Or watching a cliffhanger sports match or thriller. They can do that to me!

What time do you inject your basal insulin? I am right in thinking you are using split dose Levemir, aren't I?

Sometimes I get a spike like this on an evening for a few weeks off and on and I find bringing my evening Levemir dose forward helps, so that there is a bit more overlap of the evening dose with the morning dose. I normally inject my evening basal at 11pm, so bringing it forward to 7 or 8pm can really help. If you already inject at 7 or 8pm, then that isn't going to help. Maybe going for a short walk after your evening meal would knock it on the head.

I don't think increasing you evening basal dose is the answer because the rest of the night looks to be reasonably steady give or take what look like a couple of possible compression dips.

No dreams, sports matches or thrillers were happening

I actually injected around 9pm last night instead of my usual 10/11pm and I do think it helped - I didn't have the spike - so might bring it forward to 8.30pm tonight and see if that helps again! I also saw it was on the up (7.7 with the diagonal up arrow) so I decided to brave it with a couple of units of NR and that seems to have caught it, for last night at least!

@trophywench & @TheClockworkDodo if I keep going a bit low after dinner before the random climb, then I'll definitely try a split bolus, thank you both!