BG Riding High During The Night.....

[Henry_Sugar]

Afternoon All,
As you can see for my signature below I'm using the Medtronic Closed Loop Set Up, it's all big & clever and my bloods have been lower than they have even been. One of the best parts of this is that during the night my blood reading usually are about 6mmol/L, constantly through the night.
Well lately, for the late couple of weeks, it's been riding high during the night, I either get a high warning from my pump or when I awake and check it's been up to 12/13mmol/L. I'm not during anything different, and am kinda hoping for some reason it may just be down to the stomach cramps I've had over that time period.
Just wondering if anybody else has been in this situation and had a solution?

Many thanks to anybody taking the time to reply......

 

[Chas C]

Cannot comment on stomach cramps but sounds odd if you have had it for two weeks, does not sound like a normal upset. If your stomach is struggling to digest food its always possible its being digested overnight. Do you eat late in the day, if so maybe try having your last meal earlier. If this does not work I'd speak to my DSN about the cramps and night time highs. I'd probably try increasing basal for the highs just in case its a summer thing (changing seasons etc). Hope you can get it sorted.

 

[Juicyj]

Hello Henry - when are you eating at night time, so time and what type of food are you eating ? protein/fat ?

Do you periodically do any basal fasting tests ?

Regular patterns indicate basal rates need adjusting but would help to know a little more first.

 

[Henry_Sugar]

Cannot comment on stomach cramps but sounds odd if you have had it for two weeks, does not sound like a normal upset. If your stomach is struggling to digest food its always possible its being digested overnight. Do you eat late in the day, if so maybe try having your last meal earlier. If this does not work I'd speak to my DSN about the cramps and night time highs. I'd probably try increasing basal for the highs just in case its a summer thing (changing seasons etc). Hope you can get it sorted.

Hi Chas,
I have no idea if the stomach cramps are a factor,thankfully it's looks like they are stopping, I'm only picking up on it because it's the only thing thats different, everything else I do is the same.
My last meal is around 22-00, 13-00 breakfast, 17-30 lunch & 22-00 tea, 03-00/04-00 bedtime, yeah i know a Uk based guy on new York time !!! This set up is constant & my brilliant DN has helped readjust my bolus settings.
I'm on the closed loop set up so the SmartGuard should correct for me, so it's automatically adjusting my basal for me, and apart from this hiccup it's been doing so excellently. A month ago my GMI was 6.5.

 

[Henry_Sugar]

Hello Henry - when are you eating at night time, so time and what type of food are you eating ? protein/fat ?

Do you periodically do any basal fasting tests ?

Regular patterns indicate basal rates need adjusting but would help to know a little more first.

Hi Juicyj,
22-00 ish is my last meal, bedtime about 03-00/04-00, food wise normally some soup with a few wheatmeal crackers, I haven't been eating anything different from when my bloods were good at nightime.
I don't do basal fasting tests, re basal rates, I'm on the Medtronic Closed-Loop set up, so normally the SmartGuard software gives me micro doses to slowly correct my rising blood readings.

 

[Juicyj]

Hi Henry,

It's still a good idea regardless to do basal fasting tests - more so on closed loop systems to check for patterns, I use the tandem Slim and G6 but from time to time when things go off sync I check basal rates are ok.

Can you eat earlier on in the evening to see if this is causing the high, just to ensure food is digested and quick acting insulin has completed it's action before bed ? it may well be delayed digestion causing the night time high.

 

[Henry_Sugar]

I have no idea how to a basal fasting test, but will do an internet search to find more.

I would prefer to keep it the same if possible, after all its been working fine so far.

I'm still hoping that these stomach cramps fully disappear, and then I can re valuate if I'm still riding high during the night.

Many thanks again for your knowledge and help.

 

[Juicyj]

This is the best guide available online: https://www.mysugr.com/en/blog/basal-rate-testing/

I was told by my Tandem rep to do fasting tests from time to time as closed loop systems aren't infallible and still require fine tuning, but more so when repeated patterns are indicating changes are required but best to act under your DSN's guidance though for this if you haven't done them before. The closed loop system will make quick acting insulin corrections based on the predictive outcomes from sensor readings, but getting basal ratios fine tuned ensures the pump is making the best decision for each time frame. I find pumps can take a while to respond and correct a high.

 

[Henry_Sugar]

thanks for that link, I will miss my 22-00 meal for a while and see how it all pans out.

Now pls bear with me as I'm probably being a bit thick here, if my readings are good with no meal, that probably means that my last meal is the problem, and hopefully it's those stomach cramps right ?

So what happens if my blood still runs high doing the night ? I don't have any basal ratios because the SmartGuard software does all the heavy lifting for me? As far as I'm aware, there is no way to adjust the SmartGuard software as it does it itself via my Guardian Sensor 4 readings ?

Have I got that right ?

 

[Chas C]

thanks for that link, I will miss my 22-00 meal for a while and see how it all pans out.

Now pls bear with me as I'm probably being a bit thick here, if my readings are good with no meal, that probably means that my last meal is the problem, and hopefully it's those stomach cramps right ?

So what happens if my blood still runs high doing the night ? I don't have any basal ratios because the SmartGuard software does all the heavy lifting for me? As far as I'm aware, there is no way to adjust the SmartGuard software as it does it itself via my Guardian Sensor 4 readings ?

Have I got that right ?

I'm not sure you have got it right. You still need to have a basal profile set up in your pump where you program your hourly etc basal levels over 24hrs. Its these that may need adjusting hence others talking about basal fasting as this shows you if your taking the right background and if you need to adjust it up or down.

 

[Juicyj]

Agree with Chas - your pump will still have a basal profile, unsure if your DSN or Medtronic rep has gone through this with you, but it's useful to duplicate the profile so you can make adjustments to the profile and then revert back if the tweaks don't work, as you're not sure about this please go back to your DSN to review it with them, personally I am ok with doing my own as been left to it without a consultant review in over 4 years but will also cross check against my data too to see if I can identify patterns/trends from this instead of basal fasting tests too.

 

[Henry_Sugar]

thank you both Chas & Juicyj for your thoughts, I do have basal settings for my pump but my DN told me those settings would only be used IF the SmartGuard software was switched off.
Another example was when I received a new pump & the SmartGuard software requires upto 72 hours of data before it started working. Therefore it was "off" for 72 hours so the basal settings programmed into my pump were "activated"

Hope that made sense, I will digout the War & Peace manual and try to confirm one way or the other.....

Just out of interest are either of you on the Medtronic Closed-Loop set up ?

Feel free to tell me to mind my own business

 

[dancer]

@Henry_Sugar the only things we can change in the 780G system are carb ratios and active insulin time. Have you tried raising your night time bolus or reducing your active insulin time (or both)? If this doesn't work all you can do is ask your DSN what she can suggest.