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Still don't understand

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bigheadmike

Well-Known Member
Relationship to Diabetes
Type 1
Hey guys, I had a reading of 7.0mmol last night before bed and 14.2mmol on waking this morning. I slept my normal amount but felt very tired when i woke.

Does anyone have an idea why this would be. i dont mind the feeling tired but the readings are a little off putting.

I've been trying to be very good.

28u lantus at 2200 and average of 30u humalog per day (about 4 injections) for meals.

I would like to get to the bottom of this but my DSN is on leave for 3 weeks.
 
Mike, some people end up with high levels in the morning (due to release of glucose from the liver) if they've had an undetected hypo during the night. The only way to tell is to set an alarm and check your BG level occasionally at 2/3am. There are plenty of other possibilities - did you have a large meal or a late meal or lots of low GI carbs or high in fat? All these would slow digestion and cause a sneaky rise in levels long after bedtime...
 
dawn phonomiana(sorry wrong spelling) im sure someone will be along with an answer soon
 
EDIT: remembered, there's one more!

There's four main reasons why your readings might be significantly higher in the morning than the evening:

Dawn phenomenon

What is it?
Before waking, your body starts pumping out glucose and hormones that increase insulin resistance, which causes your blood sugar to raise.

How do I know if it's this?
Set your alarm to go off a couple of hours before you'd usually wake, and test. If your reading at this time is normal and your morning reading is high, it's probably dawn phenomenon

How do I fix it?
With difficulty. Some options include eating a higher protein meal before bed, which gives your body the fuel it'll need in advance of the morning. You can also try eating a larger breakfast in the morning to train your body to expect a food hit, so it doesn't start dumping sugar. Or you can look at altering your basal timings.

Somogyi effect

What is it?
When you have a hypo in your sleep and don't wake up, it's believed your liver starts pumping out glucose to treat the hypo - which then causes higher blood sugar levels in the morning.

How do I know if it's this?
Set your alarm to wake you at something like 2am or 3am and then test. If your reading is sailing pretty close to hypo territory, it may be this what's happening. Also, those who believe this happens to them also seem wake up with hangover-like symptoms - very tired, headachey etc.

How do I fix it?
Decrease your basal. You shouldn't take preventative action by eating and then go to bed with higher numbers - it'll stop the hypos but it'll just make you fat and then in 10 years time you'll have a foot fall off.

Delayed dinners

What is it?
Protein takes 4-6 hours to start breaking down into glucose but it can be quite significant. A high protein meal can cause your blood sugar to go up quite a lot, but quite late on.

How do I know if it's this?
Test before your evening meal, two hours after, and 4-6 hours after. If your latest reading seems unusually high, it's probably the protein.

How do I fix it?
Either change the proportions of your meal, or increase your basal. Changing the proportions is probably better.

Insufficient basal

What is it?
Your liver will slowly output glucose through the night. If you don't have enough insulin in your system, this will raise your blood sugar.

How do I know if it's this?
Test before going to bed, test again during the night (maybe once or twice) and then test again in the morning. If you see the readings consistently increase throughout the night, you probably don't have enough basal insulin.

How do I fix it?
Adjust your basal insulin until your readings look better.
 
Last edited:
DeusXM
What great info, wonder why this isnt given out by the Dr's.....my Aunt was diabetic and told me about the high in the morning and you may have had a hypo in the middle of the night, but not all that info you have just give out. thank you very much
 
Deus your info is invaluable to us. I've just read your words twice, i get frustrated as i now eat more protein than ever now and eating on average 60g carbs each day and i didn't know too much protein can make u high in the evening, also my partner also likes to eat late 9ish and of late we eat separately as i don't want to be waking with highs which has been similar to Mike! This dawn phenon is so bloody confusing, im having a down day today i didn't sleep well and didnt sleep well last night with the heat,it seems everything affects D even my 11 year old son suffering hayfever and didn't sleep well so when I drove him to school and dropped him off i went to franki and bennys for a lighter breakfast 1 sausage, scrambled egg. 2 rashers of bacon and approx 20g carbs with tiny pots. I covered the pots with novo and when I woke up i was 11! I've had a good cry today but i must buck myself up and go for a walk. I've ordered dr bernsteins book on line, trying to get as much info as poss. What I am trying to say is thank u for your wonderful explanations of things 🙂
 
i went to franki and bennys for a lighter breakfast 1 sausage, scrambled egg. 2 rashers of bacon and approx 20g carbs with tiny pots. I covered the pots with novo and when I woke up i was 11!
Click to expand...

Well, the other thing to bear in mind is that sausages aren't actually that low-carb - sausages tend to be anything between 10-20% carbohydrate from from rusk filler. It's not a lot but it might be your carb count was out. Plus, without a before-eating reading, your 11 reading doesn't really mean anything - you might have been at 11 or 12 before eating, in which case you bolused correctly but you were running high at the time anyway.
 
Hi DeusXM. I see I misunderstood about the sausages. My readings on waking which was 2 hours before i ate was 5.9 i was hungry then ate 30g of crunchy bran didnt test again before the sausage etc i should have. Will take the rusk into account in sausages in future. Maybe i didn't cover the crunchy bran with milk enough grrr
 
Did Doctor Somogyi actually say that your foot will drop off? - I don't recall that particular paragraph LOL They must have edited it out of the version I read ! You'd have thought the Japanese would have had a much more flowery way with words ....... :D

Pound to a penny you've had a hypo.

Lantus injected at night is always a bit of a moot point, cos if you go to bed at say 11 or 12, the last time you most likely want a peak in your insulin is in 5 hours time.

You need it to fall when your own Dawn Phenomenon hits, which is nearer 'waking up' time - so if you get up 7.30 ish, you probably need it from around 6am. In which case you'd need to inject it around 1.30am. Potty.
 
Oh my oh my Trophywench 1.30am that would be me to! Why can't we have a day off without thinking about lantus. Hypos, writing things down lol. Sorry i find the lantus thing hard to understand grrrr 🙂
 
i was hungry then ate 30g of crunchy bran didnt test again before the sausage etc i should have. Will take the rusk into account in sausages in future. Maybe i didn't cover the crunchy bran with milk enough grrr
Click to expand...

I would say you would almost certainly have been higher then, when you ate your meat breakfast. Always test before each meal - otherwise you've no idea how much to bolus.
 
DeusXM. There is so much information in this thread I have had to start a cut and paste folder. Are there any books that cover these points. I am just beginning to rethink my eating and bolus timings because of the previous post about fats.
 
Hi Bessiemay i am the same ive re-thought my eating and fats and protein to. I need some books also so much to take in and learn but i am determined 🙂
 
Type 1 Diabetes in children, teens and young adults - actually suitable for T1 of any age.

That's written in readable English, by Ragnar Hanas.

If you want the other definitive work, written more like a textbook but still readable in smaller portions, Using Insulin by John Walsh.

And for pumpers, the pumpers 'bible' - Pumping Insulin, also by John Walsh.

Or even, Think Like a Pancreas, by Gary Scheiner.

All available at Amazon of course, or to order from a bookshop near you.
 
Whether Somoyogi actually exists or not is controversial.
Two studies were unable to demonstrate it using continuous monitoring and both suggest that if it does happen then it is rare. ( I remember a third one with similar results with children but can't find it at the moment)
They found that going to bed with a level at 5mmol/l or under islikely to result in a hypo but that also results in a low morning reading.
http://link.springer.com/article/10.1007/s00125-005-1946-5?LI=true
http://europepmc.org/abstract/MED/23672623
I used a continuous monitor when I suspected hypos and for me that was the case. There were brief falls during the night to just less than 3.5mmol/l but a spontaneous rise to low 'normal' rather than high levels.
 
Thanks trophywench I have ordered the Ragnar Hanas one to start with. I was diagnosed about 10 years ago and only now feel I am starting to understand. Hopefully this will lead to lower hba1c.
 
This used to happen to me, and this may not be for everyone, but i used to have morning highs, so they put me on the pump, this helped a bit but did not sort it totally. All i was taught was carbs = x amount of insulin equation. After joining this forum, i found out that fats and protein also have a knock on effect. Used this knowledge and for the first time, my waking levels were below 10 constantly. I have now stopped using my pump (i hated the thing) but the only way i found to deal with that back ground problem was my Glargine that i take 12 units ounce a day, i now split it, 6 in the morning and 6 around 7pm. I found this looks like it works for me (pending hba1c test in two weeks).

Now this is how i have sorted myself out, but the old diabetes is no script disease, so we all have to tweak it.

I also find i I have Pizza, Pasta, Curry or Chinese the fats affect me the next day, so i avoid these foods, but i know some on here have these foods with no effect.
 
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