Blood glucose levels before bed

[Brownie1993]

I don't think so now. I never have night hypos but if I do I always wake up and know I'm having a hypo. But then how would that explain the 9 reading this morning, unless I did have a hypo and treated it?

 

[Brownie1993]

*no

 

[gemma6549]

If you went low without waking your liver would pump out extra glucose resulting in a higher reading this morning.

 

[Brownie1993]

Oh really, I'll assume that's the reason then! I did wake up later than normal today so yes I could well have gone low.. Thanks Gemma!

 

[Type1Bri]

That is within a rise of 2 mmol so is not that bad really

 

[Diamattic]

Do NOT rely on your liver to pump out glucose to save a low... If that was the case then none of us would ever hypo!

When you normally go to bed, when is your last bolus in relation to your bed time?
Also, are you active later at night? Exercise can drop your sugars for hours afterwards, which perhaps is causing you a low.

Perhaps you are normally sleeping with some insulin still in your system and thats dropping your sugars?

 

[gemma6549]

Do NOT rely on your liver to pump out glucose to save a low... If that was the case then none of us would ever hypo!

When you normally go to bed, when is your last bolus in relation to your bed time?
Also, are you active later at night? Exercise can drop your sugars for hours afterwards, which perhaps is causing you a low.

Perhaps you are normally sleeping with some insulin still in your system and thats dropping your sugars?

I don't think anyone is suggesting relying on your liver to pump out glucose. That would be foolish

 

[Dillinger]

I don't think so now. I never have night hypos but if I do I always wake up and know I'm having a hypo. But then how would that explain the 9 reading this morning, unless I did have a hypo and treated it?

That doesn't sound like a nightime hypo followed by a rebound. Technically that phenomenon is called the Somogyi Effect - http://en.wikipedia.org/wiki/Chronic_Somogyi_rebound but I would put money on it that that is not happening to you.

The Somogyi Effect is very rare and there is some argument that it doesn't actually exist (irrespective of the wisdom of Diabetes Nurses) ; I used the Freestyle Libre to look at my overnight blood sugars and they were naturally lowering and then rising in the morning; I was having perfectly normal dawn liver dumps. So the issue was not to change the over night doses but to increase the morning short acting and alas not to lie in too much...

So, I agree you should drop your long acting by maybe 1 more unit and see what happens over a few days. Also try not having any lunch and see what happens to your blood sugar in the middle of the day.

I would not want to be having to eat to my insulin in terms of snacks to cover too much long acting. I think that's really poor advice from your diabetes team.

Best

Dillinger

 

[Dillinger]

Hi brownie 1993 I was also diagnosed last June I am on 22 of lantus before bed I was told by diabetic nurse as long as levels are 10 or 11 at night that's fine but on those levels I hypo thru night so find I have to take mine a bit higher like u I also find that I am always hungry between meals I am on apidra through the day

Hi Jackie, that's really worrying advice from your nurse. 10 or 11 at night is not fine; that means about 8 hours at that level; if you are saying even at that level then you are still hypoing then your must reduce the Lantus.

Think also of the timing of your short acting insulin; http://www.diabetes.org.uk/Documents/Magazines/Insulinwallchart.pdf

Apidra lasts for about 4 hours with a fast peak. If you are going to bed within 4 hours of your evening injection and therefore taking your Lantus whilst you have active short acting then you may be getting a stacking up of insulin. Try and take your Lantus as late as possible and eat as early as possible. Ideally you should wake up with the same blood sugars (give or take 1.5 units) as you went to bed with.

There is good evidence that blood sugar levels above 7.8 mmol/l start to cause damage so your nurse is not being helpful.

Best

Dillinger

 

[Brownie1993]

Guys I'm really confused... I'm on 9 units of lantus right now and have been for a few days. Seems to be doing the job over night. But another issue for me now is that as I've reduced my lantus from 16 to 9, my carb ratio during the day has changed - I've found I'm needing more fast acting insulin at meals.

Here's what I'm confused about...
Yesterday I woke up at 7.5. Had breakfast, took 6 units of novorapid. Didn't eat until lunch, tested before lunch and I was 3.7. So, either I took too much novorapid, or it was my lantus...
Today, I woke up. BG was 6. Had the same breakfast as yesterday, same amount of insulin. I've just done a test to see whether this was the right amount and my result was a whopping 11.
So I'm a bit confused right now.. How is it that I'm at 11 after the same breakfast as yesterday and same amount of insulin, but yesterday I was at 3.7..?

 

[Brownie1993]

Seriously considering going back to 16 units of lantus, my daytime readings were so much more stable/less complicated!

 

[Type1Bri]

Hi Brownie

It could be that your Lantus was set too high and therefore your carb ratios during the day were incorrect as your Lantus was mopping up some of the extra carbs
Could be a case of starting over again with your ratios during the day, I would say thats the best thing to do. If your basal is set wrong then your ratios will never be correct as they will be being offset by the Lantus issues
It is really confusing some days, think logically about it all and it becomes clearer
Have you been on the DAFNE course?
Have you carried out any basal testing?

 

[Brownie1993]

So how do I know if and when my basal is set correctly? Is basal testing where you fast and see how much your BG drops? I haven't done it before. And no I haven't done the dafne course

 

[Type1Bri]

When you do not eat any carbohydrate at all the basal insulin should hold your BS levels steady, within 1.5mmol of the starting value
The best thing is to do some research in basal testing and carb counting principals
There are many threads around on here about these subjects, I think it is @noblehead who very often adds some great links on both subjects

 

[Brownie1993]

So basically, comparing your bg levels just before bed and just waking up would be a valid basal test would it not?
Thanks mate , will take a look at those!

 

[Type1Bri]

Mmmm overnight basal testing would also involve at least one reading during the night, usually at 3am, but more than 1 reading would be better
Overnight has many other issues attached to it, dawn phenomenon, symorgy effect etc etc, its all sent to try us

 

[noblehead]

So how do I know if and when my basal is set correctly? Is basal testing where you fast and see how much your BG drops? I haven't done it before. And no I haven't done the dafne course

The following explains how to do a basal check:

http://www.salforddiabetescare.co.uk/index2.php?nav_id=1007

But don't just change things going from one days readings, you say you were 3.7 yesterday and 11 today pre-lunch, were you more active yesterday morning than today as this can make a big difference to bg levels, but if this isn't the case then see how tomorrow morning goes, if your high or low then look to do a basal check the following morning.

 

[Brownie1993]

I wasn't particularly more active yesterday morning.. I walked casually for 20 minutes which I didn't do the day before. But a 20 minute walk in the past has never altered my BG levels by much at all.

Thanks for the info though @noblehead! Really don't know when I'm going to find the time to do all these basal checks though.. I'm in my final year of university with exams in the next two weeks, so I can't really afford to be missing meals over the next few days. I need to be eating well. Great timing all this is isn't it haha

 

[Type1Bri]

Just one more spanner to add to the works!!! Stress will effect your BS levels as well. I am going through a really stressful spell at work atm and mine are running higher than normal

 

[smidge]

I think the real difficulty with basal level is that it's not an exact science. I believe most people's basal subsidises their bolus or vice versa to some extent. I've used Insuman basal which subsidised bolus considerably - it was fine as long as you pulled back on your bolus ratio for the meals where the basal was at peak; I've used Levemir which kept running out so I had to subsidise it with my bolus, increasing the dose to cover the fact the basal wasn't meeting my needs; now Tresiba which doesn't seem to subsidise or need subsidising so my bolus has gone to a different ratio again - however, it doesn't hold me completely stable - it has a very flat action, but I don't think my needs are really very flat!

In the end, basal does have an impact on the amount of bolus you need and vice versa - they are inseperably entwined. You just find the best balance for you. It's not perfect, but it's the best we've got to work with.

Smidge