T1, Confused over high BG overnight.

[mitchsi]

Hi,
I’m new to all this since coming out of hospital a week and a half a go but I’ve since managed to get my levels in the green with reasonable spikes for meals. I’ve just started to exercise again a little which meant the nurse suggested I drop my nasal from 26 to 24 as I hypo’d yesterday morning at 3 and 4. However last night I had a higher protein and mid carb for a later dinner with normal 8u bolus and my level went down nicely to 4.? but later is kept rising to 13 (2am) and stayed at about 10/11 till about 8am today. Picture attached.

I haven’t experienced this and wondered if a dodgy batch or incorrect injection or something else I do not know about.
I injected an additional 6u at 8:30 of basal as I do not want to stay at 10 all day (my time in range for the week is now 71%).
Does anyone have an explanation for this? Usually over night it reduces nicely.
Thanks,

 

[helli]

High protein meals can be a challenge if you eat them later as they take longer to digest which means you can get a later spike.
The other thing which can add to the "fun" is that your body will break down the protein into glucose if you do not have enough carbs. On some forums, you will see a lot about people with diabetes eating low carb diets. This does seem to be valuable to people with type 2. Some people with Type 1 can follow this diet but I found it far too complex and unnecessary.

 

[mitchsi]

Hi,
Thanks for the help.
Dinner was at 9 with 44g carbs and perhaps 56gP so not really low carbs just lower than usual for me. I’m having more carbs for lunch instead of dinner.
With those macros I’m not sure if the protein would convert to glucose significantly or not. It’s still trial and error.
Fats would have been moderately low except fats in chicken and Greek yoghart. I mostly had veg and fish.
I started to spike 2hrs later.
I exercised a little (ran a mile) before eating.
I don’t usually eat that late but it was a busy day.

 

[trophywench]

It's all very complicated cos I was told you only need 40% of the insulin you'd need for carbs, to break down protein into glucose so if you didn't have any carbs, and on fixed doses, I'd have thought that would have meant that you'd have been hypo. I don't think I have actually ever had a 'protein only' meal. I mean - salads or hot meals eg meat or fish with veg aren't entirely carb free, even if you have no spuds or bread, since even ruddy lettuce and cucumber has some carbs. So OK, I'd probably jab after it rather than before, once I saw what it was actually doing if anything to my BG, .but that's all, personally.

But really @mitchsi - I reckon your body hasn't settled down yet hence your own insulin pleases itself whether it's going to decide to respond or not, so don't think you should try too hard to learn 'long term' messages from it at the moment.

I'm rather concerned about the extra basal insulin to be honest - when we need 'correction doses' - these are always done with 'fast acting' ie bolus insulin - since basal insulin can stay active in the body up to the next 2 days depending on which exact one it is - and most normal people want to just get rid of spikes pretty quick in a few hours rather than having to deal with the effect of an overdose of basal for days after!

Please - test, test, test, mate.

Could you also please stick names of both insulins, in your signature? Thanks.

 

[Merryterry]

Wow. A little excersise doing a mile run? I

In diabetic terms I would suggest that is a lot of excersise. It would be for me if I could run.

 

[Inka]

Hi,
Thanks for the help.
Dinner was at 9 with 44g carbs and perhaps 56gP so not really low carbs just lower than usual for me. I’m having more carbs for lunch instead of dinner.
With those macros I’m not sure if the protein would convert to glucose significantly or not. It’s still trial and error.
Fats would have been moderately low except fats in chicken and Greek yoghart. I mostly had veg and fish.
I started to spike 2hrs later.
I exercised a little (ran a mile) before eating.
I don’t usually eat that late but it was a busy day.

Late evening meals are a pain to deal with and often go wrong in some way. I don’t know the reason for you having to eat late, but it’s best avoided I’ve found.

You say you mainly had veg and fish, so where did your 44g carbs come from? Green veg is usually ‘free’ as is most veg and salad with a few exceptions, so maybe you’re not having as many carbs as you thought.

Also, perhaps your basal reduction was too much. Have you experimented with, say, 25 units?

I injected an additional 6u at 8:30 of basal as I do not want to stay at 10 all day (my time in range for the week is now 71%).

Hopefully you mean bolus here not basal. You shouldn’t use basal for corrections. Don’t worry about your Time in Range. Anything above 70% counts as very good control, and sometimes things just conspire to muck up our TIR, eg illness, stress, meals out, guests, weather, etc etc. You’re very recently diagnosed and I can’t stress enough the need to pace yourself - and, as I expect you’ve been told already here, to jettison any ideas of perfection. Type 1 is hard. You’re doing very well 🙂

 

[helli]

Wow. A little excersise doing a mile run? I

In diabetic terms I would suggest that is a lot of excersise. It would be for me if I could run.

I disagree. For an active person with Type 1 diabetes, this is not a lot of exercise.
I frequently run for a mile and I do not consider myself a runner.
Last night, I spent 2 hours climbing. Tonight, I will be doing an hour's spin class.

Having Type 1 diabetes should not be a reason not to exercise any less than anyone without diabetes.
Sadly, running a mile is more exercise than many people do regardless of diabetes.

 

[mitchsi]

I disagree. For an active person with Type 1 diabetes, this is not a lot of exercise.
I frequently run for a mile and I do not consider myself a runner.
Last night, I spent 2 hours climbing. Tonight, I will be doing an hour's spin class.

Having Type 1 diabetes should not be a reason not to exercise any less than anyone without diabetes.
Sadly, running a mile is more exercise than many people do regardless of diabetes.

Yeah I agree, it’s the 1.5hrs karate class I’m postponing for a bit, it’s a mix of aerobic and anaerobic and I know that intensity will stress me. 1 mile is not that difficult for me but it was already 8:30 and I hadn’t eaten.

 

[SB2015]

High protein meals can be a challenge if you eat them later as they take longer to digest which means you can get a later spike.
The other thing which can add to the "fun" is that your body will break down the protein into glucose if you do not have enough carbs. On some forums, you will see a lot about people with diabetes eating low carb diets. This does seem to be valuable to people with type 2. Some people with Type 1 can follow this diet but I found it far too complex and unnecessary.

I am with @helli on this. My head is full of the info I need about carbs, and there is no space to start remembering the protein values that I would need if I didn’t eat carbs. I stick to at least some carbs in a meal so that my body doesn’t start using the protein for the glucose that it needs.

A carb free meal at any time is going to mess with things, and especial late T night as you then have problems overnight. Worth thinking about.

 

[mitchsi]

Late evening meals are a pain to deal with and often go wrong in some way. I don’t know the reason for you having to eat late, but it’s best avoided I’ve found.

You say you mainly had veg and fish, so where did your 44g carbs come from? Green veg is usually ‘free’ as is most veg and salad with a few exceptions, so maybe you’re not having as many carbs as you thought.

Also, perhaps your basal reduction was too much. Have you experimented with, say, 25 units?

I injected an additional 6u at 8:30 of basal as I do not want to stay at 10 all day (my time in range for the week is now 71%).

Hopefully you mean bolus here not basal. You shouldn’t use basal for corrections. Don’t worry about your Time in Range. Anything above 70% counts as very good control, and sometimes things just conspire to muck up our TIR, eg illness, stress, meals out, guests, weather, etc etc. You’re very recently diagnosed and I can’t stress enough the need to pace yourself - and, as I expect you’ve been told already here, to jettison any ideas of perfection. Type 1 is hard. You’re doing very well 🙂

Thanks for the reply,
I did increase basal as it seems I was steady at a basal rate in the 10-12 range, after the 6u of basal I am steady at 4.5 to 5.5 but I should have used bolus in hindsight but it worked out well nonetheless.

The 44g last night came from a lot of veg, I still count veg as they still have 3-6% for a lot of them (disregarding fibre), it’s things like tartar and ketchup, milk and yoghart that adds up.

And I’m an impatient guy with time on my hands so I’m researching a lot but not stressed with it, trying to stay positive and get to a good level before work next week.

Very much appreciate the great support and resources here in this forum 🙂

 

[mitchsi]

Wow. A little excersise doing a mile run? I

In diabetic terms I would suggest that is a lot of excersise. It would be for me if I could run.

It’s all relative @Merryterry what ever gets your heart pumping and out of breath 🙂

 

[Inka]

Thanks for the reply,
I did increase basal as it seems I was steady at a basal rate in the 10-12 range, after the 6u of basal I am steady at 4.5 to 5.5 but I should have used bolus in hindsight but it worked out well nonetheless.

The 44g last night came from a lot of veg, I still count veg as they still have 3-6% for a lot of them (disregarding fibre), it’s things like tartar and ketchup, milk and yoghart that adds up.

And I’m an impatient guy with time on my hands so I’m researching a lot but not stressed with it, trying to stay positive and get to a good level before work next week.

Very much appreciate the great support and resources here in this forum 🙂

Ok, at least you know about the bolus for corrections now 🙂 You should have a correction factor - ie how much one unit of insulin will drop you. You also need to be aware of any insulin on board. If in doubt, err on the side of caution. You might also have been told to only correct before meals.

You’re talking to one of the world’s top veg fans I eat loads of the stuff! I still don’t count the ‘free’ veg though because you don’t need to if you eat a normal diet. The only time I would consider counting them a bit would be in a calculation for a protein plus free veg meal - ie a meal with no bread/potatoes/quinoa/rice/pasta, etc.

I rarely eat those because it’s actually easier to have some carbs with the meal even if it’s a low amount eg 25 or 30g. (Note - I mean countable carbs when I say that.) You’ve seen the result of that in your meal where you went down to 4.something and then rose to 13 and stayed 10/11 all night. That’s what happens. Compare that with the same meal and say, a 6oz baked potato (30g carbs) or 30g carbs of bread or whatever, and you’ll find the result much more predictable.

 

[mitchsi]

Ok, at least you know about the bolus for corrections now 🙂 You should have a correction factor - ie how much one unit of insulin will drop you. You also need to be aware of any insulin on board. If in doubt, err on the side of caution. You might also have been told to only correct before meals.

You’re talking to one of the world’s top veg fans I eat loads of the stuff! I still don’t count the ‘free’ veg though because you don’t need to if you eat a normal diet. The only time I would consider counting them a bit would be in a calculation for a protein plus free veg meal - ie a meal with no bread/potatoes/quinoa/rice/pasta, etc.

I rarely eat those because it’s actually easier to have some carbs with the meal even if it’s a low amount eg 25 or 30g. (Note - I mean countable carbs when I say that.) You’ve seen the result of that in your meal where you went down to 4.something and then rose to 13 and stayed 10/11 all night. That’s what happens. Compare that with the same meal and say, a 6oz baked potato (30g carbs) or 30g carbs of bread or whatever, and you’ll find the result much more predictable.

That’s great advice thanks Inka.
I’m currently counting all carbs minus fibre if fibre is significant but you advise not to worry about the veg carbs if there’s more starchy or simple carbs like from wheat/potatoe for instance? Increasing veg has been my approach to this new condition for better health and filling myself up - I’m awaiting this book on mastering diabetes by Khambatta for
more ideas on plant based eating except with carbs.
Last night was quite odd but like some else mentioned I perhaps need to be more patient.

Are you vegetarian or incorporate meat? And what do you do about fats if you don’t mind sharing.

I’m flying solo at home but it’s reassuring to be part of this forum.

 

[mitchsi]

It's all very complicated cos I was told you only need 40% of the insulin you'd need for carbs, to break down protein into glucose so if you didn't have any carbs, and on fixed doses, I'd have thought that would have meant that you'd have been hypo. I don't think I have actually ever had a 'protein only' meal. I mean - salads or hot meals eg meat or fish with veg aren't entirely carb free, even if you have no spuds or bread, since even ruddy lettuce and cucumber has some carbs. So OK, I'd probably jab after it rather than before, once I saw what it was actually doing if anything to my BG, .but that's all, personally.

But really @mitchsi - I reckon your body hasn't settled down yet hence your own insulin pleases itself whether it's going to decide to respond or not, so don't think you should try too hard to learn 'long term' messages from it at the moment.

I'm rather concerned about the extra basal insulin to be honest - when we need 'correction doses' - these are always done with 'fast acting' ie bolus insulin - since basal insulin can stay active in the body up to the next 2 days depending on which exact one it is - and most normal people want to just get rid of spikes pretty quick in a few hours rather than having to deal with the effect of an overdose of basal for days after!

Please - test, test, test, mate.

Could you also please stick names of both insulins, in your signature? Thanks.

@trophywench thanks, my opinion this morning rightly or wrongly was that I was stable at 10-12mmol and needed to bring that level down, it seemed to work out as I didn’t eat till 2pm and was stable at around 5.
You’re probably right about my body is still stabilizing I’m just impatient with time on my hands until I go back to work next week 🙂
I have the libre2 CGM fitted so I have the luxury of regularly monitoring.

 

[silentsquirrel]

That’s great advice thanks Inka.
I’m currently counting all carbs minus fibre if fibre is significant but you advise not to worry about the veg carbs if there’s more starchy or simple carbs like from wheat/potatoe for instance?

If you are in the UK and using UK websites for carb values you shouldn't be subtracting fibRE - it isn't included in the carb values. In the US fibER is included, so needs to be subtracted to get what they call net carbs.

 

[Inka]

I’m pescatarian @mitchsi 🙂 I was vegetarian for years, vegan for a while, and now eat some fish. I don’t have a huge amount of it, but try to eat some oily fish plus white fish on occasion. When I go through a meal planning stage, I often choose a week’s meals by their type, eg 1 day of oily fish, 1 raw vegan, 3 or 4 vegetarian and 1 or 2 days flexible (I choose whatever works or whatever I want).

For fats, I eat oily fish, avocado, olive oil, nuts, seeds and occasionally some butter. I also use coconut oil for cooking. I also have some treat items like chocolate that has fat in. For me personally, I found it hard to keep my weight up when I ate very low-fat vegan. I’m naturally very slim and seem to have a fast metabolism.

Yes, most non-starchy veg is ‘free’ (no need to count the carbs). Exceptions are obviously potatoes, but also parsnips and things like butternut squash (and lentils and pulses). Nuts are also ‘free’ unless you use a large quantity, eg in a nut roast.

 

[mitchsi]

If you are in the UK and using UK websites for carb values you shouldn't be subtracting fibRE - it isn't included in the carb values. In the US fibER is included, so needs to be subtracted to get what they call net carbs.

Ah thanks for that - I’m reading an American book

 

[rebrascora]

Blooming heck! Injecting 6 additional units of basal in the morning to deal with a level of 10 was a bit of a wild idea!! How did you come upon the number of units or was it just fished out of thin air. I find basal insulin far more powerful than bolus insulin so an extra 6 units would have me hypoing all day long! Do be careful tonight as even if you have got away with it today, that extra basal could well come back to bite you badly whilst you sleep or this evening, especially if you exercise tonight.
With correction doses, they generally start you off with a conservative correction factor of 1 unit of fast acting (BOLUS) insulin drops you 3mmols, so 2units would drop you 6mmols. So if you were on 10. 1.5 units of fast acting insulin would be a recommended correction in that situation. 6 units is a massive increase even if it isn't going to kick in for several hours and will build up slowly, it could hit you like a ton of bricks later and could affect your levels well into tomorrow too, because of the overlap with tonight's basal dose.... assuming you generally take your basal at night? Do keep plenty of hypo treatments by the bed and your testing kit just in case.

I am all in favour of experimenting but you have to do it cautiously with one eye closely on keeping yourself safe. I also think you are expecting too much too soon and trying to work out the whys and wherefores of random events. Diabetes is about looking for patterns, rather than reacting to one off results. There are so many factors which will impact your levels over which you have no control or have no knowledge, that a lot of it doesn't make sense. If it repeatedly doesn't make sense with the same meal several times, then you might be able to work out why it is happening like protein release or whatever. Protein release usually starts about 2 hours after the meal it will usually exhibit as a slow steady drift upwards over several hours, not the sharp rise your graph seems to show.

I have it in my mind that you may be an engineer and are wanting to manage your diabetes like a machine or mathematical equation and unfortunately it doesn't really work like that. Biological systems are messy and don't conform to x + y = z. The result might be z+3 one day and z - !.6 another day. Your body will digest foods differently to mine or someone else's and some foods will give you results that you really don't expect.... Like lentils for me. My body manages to extract nearly twice as much glucose from lentils as they are supposed to contain.... I suspect some of the fibre is partially digestible by some people. Some people find potatoes are their nemesis or bread or porridge which is supposed to be slow release but even with cream my body seems to go wild on it!

You seem to be going to great efforts to calculate your carbs very exactly but your basal insulin is such a numb tool to do the job it does, that there is usually a bit surplus (in your case today probably quite a lot surplus ) which will buffer those low carb veg, so try not to get too bogged down with that. The gold standard for carb counting (DAFNE) ignores the beans in chilli and those in sweetcorn and peas and just counts the major carb content from potatoes and pasta and rice and pastry and bread etc.
It doesn't sound like you are adjusting your bolus doses yet to match your food, so you absolutely can't expect exact or even particularly similar results.

 

[mitchsi]

I’m pescatarian @mitchsi 🙂 I was vegetarian for years, vegan for a while, and now eat some fish. I don’t have a huge amount of it, but try to eat some oily fish plus white fish on occasion. When I go through a meal planning stage, I often choose a week’s meals by their type, eg 1 day of oily fish, 1 raw vegan, 3 or 4 vegetarian and 1 or 2 days flexible (I choose whatever works or whatever I want).

For fats, I eat oily fish, avocado, olive oil, nuts, seeds and occasionally some butter. I also use coconut oil for cooking. I also have some treat items like chocolate that has fat in. For me personally, I found it hard to keep my weight up when I ate very low-fat vegan. I’m naturally very slim and seem to have a fast metabolism.

Yes, most non-starchy veg is ‘free’ (no need to count the carbs). Exceptions are obviously potatoes, but also parsnips and things like butternut squash (and lentils and pulses). Nuts are also ‘free’ unless you use a large quantity, eg in a nut roast.

@Inka many thanks for sharing, very interesting and useful. I’m generally a massive meat eater but enjoy fish so I’m moving more to veg, fish with a reduced meat consumption compared to previous (I was anyway aware I ate too much red meat).
I was eating quite a bit of avocado’s so will keep that up.

 

[mitchsi]

Blooming heck! Injecting 6 additional units of basal in the morning to deal with a level of 10 was a bit of a wild idea!! How did you come upon the number of units or was it just fished out of thin air. I find basal insulin far more powerful than bolus insulin so an extra 6 units would have me hypoing all day long! Do be careful tonight as even if you have got away with it today, that extra basal could well come back to bite you badly whilst you sleep or this evening, especially if you exercise tonight.
With correction doses, they generally start you off with a conservative correction factor of 1 unit of fast acting (BOLUS) insulin drops you 3mmols, so 2units would drop you 6mmols. So if you were on 10. 1.5 units of fast acting insulin would be a recommended correction in that situation. 6 units is a massive increase even if it isn't going to kick in for several hours and will build up slowly, it could hit you like a ton of bricks later and could affect your levels well into tomorrow too, because of the overlap with tonight's basal dose.... assuming you generally take your basal at night? Do keep plenty of hypo treatments by the bed and your testing kit just in case.

I am all in favour of experimenting but you have to do it cautiously with one eye closely on keeping yourself safe. I also think you are expecting too much too soon and trying to work out the whys and wherefores of random events. Diabetes is about looking for patterns, rather than reacting to one off results. There are so many factors which will impact your levels over which you have no control or have no knowledge, that a lot of it doesn't make sense. If it repeatedly doesn't make sense with the same meal several times, then you might be able to work out why it is happening like protein release or whatever. Protein release usually starts about 2 hours after the meal it will usually exhibit as a slow steady drift upwards over several hours, not the sharp rise your graph seems to show.

I have it in my mind that you may be an engineer and are wanting to manage your diabetes like a machine or mathematical equation and unfortunately it doesn't really work like that. Biological systems are messy and don't conform to x + y = z. The result might be z+3 one day and z - !.6 another day. Your body will digest foods differently to mine or someone else's and some foods will give you results that you really don't expect.... Like lentils for me. My body manages to extract nearly twice as much glucose from lentils as they are supposed to contain.... I suspect some of the fibre is partially digestible by some people. Some people find potatoes are their nemesis or bread or porridge which is supposed to be slow release but even with cream my body seems to go wild on it!

You seem to be going to great efforts to calculate your carbs very exactly but your basal insulin is such a numb tool to do the job it does, that there is usually a bit surplus (in your case today probably quite a lot surplus ) which will buffer those low carb veg, so try not to get too bogged down with that. The gold standard for carb counting (DAFNE) ignores the beans in chilli and those in sweetcorn and peas and just counts the major carb content from potatoes and pasta and rice and pastry and bread etc.
It doesn't sound like you are adjusting your bolus doses yet to match your food, so you absolutely can't expect exact or even particularly similar results.

Hmm well you’re correct I’m an R&D electronics Engineer, Immused to looking at patterns and yeah my data set is very limited. I seemed to have got away with the basal adjustment as I thought something was off with the basal injection from the night before to settle me at 10-11. See the attachment, it kinda worked out alright.
I’ve just learnt to ignore the vege carbs which helps and I’ll look into the DAFNE info, many thanks for this info. Also thanks for the protein 2hr advice.
I’m trying to a absorb as much info as possible and experiment a little, I am varying the bolus a little but I’m not so sure of the carb to unit at the moment. For the basal I found previously I didn’t react to strongly to the adjustments and if my 24u last night was done correctly I certainly did not react strongly to that (it was reduced by 2) with this I got the 6u, estimated off limited experience.

I’ve attached todays latest chart out of interest.