Very high Blood sugar overnight and still rising

[Ruth1961]

HI
I am a new type 1 (5 weeks in). I had roast chicken dinner last night, and carb counted for roast potatoes and parsnips/adding 6U NovARapid. Finished eating at 7.45pm. BS didn't seem to rise with the meal....had Levermir 4U at 8.30pm, but at midnight, started to go up, and I was 14 overnight. Since waking I am rising - I had my Levermir of 30U at 8.30am, and no breakfast, as BS is still rising, currently 19 and still going up!. any ideas what is going on? I am otherwise well.

 

[ElenaP]

HI
I am a new type 1 (5 weeks in). I had roast chicken dinner last night, and carb counted for roast potatoes and parsnips/adding 6U NovARapid. Finished eating at 7.45pm. BS didn't seem to rise with the meal....had Levermir 4U at 8.30pm, but at midnight, started to go up, and I was 14 overnight. Since waking I am rising - I had my Levermir of 30U at 8.30am, and no breakfast, as BS is still rising, currently 19 and still going up!. any ideas what is going on? I am otherwise well.

Someone else may have a better answer, but for now, it would be helpful to get your glucose reading down. Your diabetes nurses should have told you to inject a correction dose of Novarapid when your readings go over 14 (without food.) Then your readings should come down within one or two hours.

(mod delete of dosing advice to comply with forum ethos)

 

[EllieM]

@Ruth1961 are you using a libre or dexcom to check your blood sugars? I would double check such a high reading with a glucometer in case you have a misreading sensor...

 

[robstancs]

Hi, I have been T1 for 30years. It’s different for everyone but for me, meals can digest slower when they have fats in and when I have a roast they tend to be carb heavy. It was not till I did the DAFNE that I realised that I had a significant morning phenomenon, which causes my blood sugar to rise by 10 just by waking up and I need to double dose novarapid before lunch. Carb counting alone is only part of the solution you will have to learn your patterns. If you have not done your DAFNE then try and do at as soon as you can. If you are thinking of adjusting your doses do it in small steps and with the advise of you diabetic nurse or doctor.

 

[MuttNJeff]

Apart from the good advice above, if you defer eating after taking insulin then you need to keep an eye on the levels - sometimes the levels can suddenly fall after an hour (or after much longer). As always, the general scare is excessively high levels in the long term, but hypos are a more immediate concern.

 

[SimonP78]

It may not apply to you, but otoh perhaps it does - I get low blood sugars when I'm starting to fight something (usually the day before I start feeling grotty), then am high the next day (and feel like I've got something) and remain that way until I've fought off whatever lurgie the kids have given me.

At the end of last week I had exactly the same situation you describe: I ate supper and did normal split bolus (first dose only), went low (unexpectedly) so had pudding (which I don't normally do), and then I kept going low all evening despite eating snacks every hour or so. I had to stay up until 2am eating things and hoping that blood sugar would not start come back down 30min later.

Then overnight I did go high (a few hours later) and was high in the morning when I got up at which point my dawn phenomenon also kicked in. I had the very slightest sore tummy the day before and had I not had the weird blood sugars I'd have assumed it was because I'd not eaten or similar.

 

[Sophielouise]

I have always found roast potatoes (the carbs mixed with fat) affect my blood sugars overnight. I also have the dawn phenomenon where blood sugars rise in the morning and find I have to overcompensate with novorapid before I can eat breakfast. I will ALWAYS dose novorapid in the morning if I am high even if I am not going to eat and then keep an eye on my blood sugars, you cannot depend on your long acting to bring your glucose down, it’s merely there to maintain it.

Also, once you have ketones (which you will after running higher than 14 for hours and we all have ketones in the morning after fasting all night anyway), you will need to have a little bit extra insulin than your normal correction dose as the ketones will cause a little insulin resistance.

I’ve been diabetic for 30 years, you’ll get the hang of it.

 

[frankyscouse]

HI
I am a new type 1 (5 weeks in). I had roast chicken dinner last night, and carb counted for roast potatoes and parsnips/adding 6U NovARapid. Finished eating at 7.45pm. BS didn't seem to rise with the meal....had Levermir 4U at 8.30pm, but at midnight, started to go up, and I was 14 overnight. Since waking I am rising - I had my Levermir of 30U at 8.30am, and no breakfast, as BS is still rising, currently 19 and still going up!. any ideas what is going on? I am otherwise well.

Hey Ruth ,look on YouTube and type in Richard Bernstein ,he is the oldest type 1 diabetic , he will break down everything ,but basically it's low carb , potatoes , gravy etc is full of carbs , I tend to avoid pasta ,/rice / potatoes etc because I spike (not what we want to hear ) but that's the reality.
Tips
.also try eat before 7 pm ,will give your body to break down the sugars ,

Go for a walk or exercise after every carb meal ,that will lower your blood sugars.


What really helped me was my cgm (Libra sensor) ask your Dr or diabetes nurse
It shows you what foods spikes you and what doesn't

Remember plenty of foods that do not spike means you take less insulin.


But definitely check out Dr Bernstein on YouTube also he has a book called diabetes solution.

.good luck .

 

[Margi1975]

HI
I am a new type 1 (5 weeks in). I had roast chicken dinner last night, and carb counted for roast potatoes and parsnips/adding 6U NovARapid. Finished eating at 7.45pm. BS didn't seem to rise with the meal....had Levermir 4U at 8.30pm, but at midnight, started to go up, and I was 14 overnight. Since waking I am rising - I had my Levermir of 30U at 8.30am, and no breakfast, as BS is still rising, currently 19 and still going up!. any ideas what is going on? I am otherwise well.

This is just a suggestion, one of many possible causes: the continuing rise in the morning could be to do with what is known as the ‘dawn phenomenon’. Blood glucose often rises when you get going in the morning, when I last heard (twenty years ago on a DAFNE course), the reason was unknown. that could be very different now of course. I would suggest you talk to your diabetes nurse, show her your test results over the whole 5 weeks if possible and discuss adjusting your doses of both insulins with them. Five weeks is a very short time and it can take a while to get to get your basal insulin at a level that keeps your glucose level all day if you took food and bolus out of the equation. Believe me, it took me years, but mine started long before we could make such adjustments. And look at the ratios of Novorapid to carbohydrates with the nurse as well, that one is very important and the necessary ratios can change throughout the day, so for example you may need 1:2 at breakfast, 1:1.5 at lunchtime and something different again for dinner in the evening. Of course those are figures I’ve plucked out of the air as an example, not suggestions for what might be right for you.

But when your levels go up do use your Novarapid to bring it down. Discuss with your diabetes nurse about quantities. And I don’t know what the format is nowadays, but if it’s not been organised already, try to get on a DAFNE (dose adjustment for normal eating) course as soon as possible. It is a fantastic educational programme that teaches you a huge amount about your diabetes and how to manage it. I did mine 30 years into my diabetes life and I learned more in that five days than I had in the previous 30 years. I don’t know what format the course takes now, another 18 years on, but the principal will be the same. I’m 48 years in now and still have a blood sugar yo-yo going mad all over the place. Good luck, with care and dedication you’ll crack this and live long and well.

 

[Helen R]

Chicken, like other meats, are pure protein. These take much longer to break down/ digest. They eventually turn to glucose, so this may also be part of your overnight and continuing morning high.
I also have the very annoying dawn phenomenon. Novo Rapid dose and hour before breakfast usually helps

 

[Benb]

It goes without saying but I will reinforce again here and say that everyone is different and have different sensitivities with food and BS.
For me, I have cut all high carb foods which means no potatoes, pasta, rice or normal breads. Most fruit barring a few strawberries, raspberries or blackberries. With measured bolas and basal, this has flattened the variances between highs and lows and kept mainly within range (TIR).
Personally, I would test and measure for certain foods that you can tolerate and use a CGM to keep real time readings.
Libre is not always as accurate but it gives me a good indication and have been using this for a couple of years with success with regards to reduced dawn phenomenon, measured insulin, correct level of exercise (I do keep to regimented walks and gym visits daily) and maintain a TIR of 97% (over 90 days) as a result. My variances are circa 16%. If you look at targets that is recommended, this is a good to excellent measure.
I understand many do struggle and will need to test and measure accordingly but when you find that sweet spot, you will have better control and know when such overnight highs could occur.
Finally, I still have occasional short term highs overnight (which is while I sleep and out of my control) which will be my next investigation to how this could be better managed (if possible).
good luck and keep well

 

[JanieMc]

HI
I am a new type 1 (5 weeks in). I had roast chicken dinner last night, and carb counted for roast potatoes and parsnips/adding 6U NovARapid. Finished eating at 7.45pm. BS didn't seem to rise with the meal....had Levermir 4U at 8.30pm, but at midnight, started to go up, and I was 14 overnight. Since waking I am rising - I had my Levermir of 30U at 8.30am, and no breakfast, as BS is still rising, currently 19 and still going up!. any ideas what is going on? I am otherwise well.

I’ve been a T1 for 48 years. It sounds to me that your basal rate ( background insulin)at night is wrong and needs increasing. Easier to do if you have a pump but a bit of a nightmare if you are injecting it once or twice a day, because that means its effectiveness is dropping well before you take your morning dose. I don’t know whether you see a GP or a hospital specialist dept for your diabetic care. I had this same problem many years ago and moving to pump delivery was a godsend in terms of solving this problem and many other control issues. When the Libre sensor was given to me, my control became remarkable. I’m now consistently above 90% in target.
It doesn’t sound as if your bolus amounts are wrong enough to cause the rise that you’re describing so please don’t blame yourself. It’s so very hard to master it and you’re doing your best. I recommend getting referred to a specialist hospital team if you’re not already with one. They have the resources to give you access to better education and technology. Have you done a DAFNE course yet? Google it…it’s worth it.
Other things to consider here…
if by morning, you haven’t eaten since tea time the day before, your liver my be releasing glycogen ( stored sugar - I’m over simplifying here- ) this increases your levels and is quite often responsible for what is often called the dawn phenomena.
Are you coming down with anything ?
Your period might cause it too.
I hope you work it all out lovely.

 

[Owenn01]

Hi Ruth - wow; 5 weeks in; you are indeed a 'newbie' to this and what you describe I suspect is perfectly normal for a new starter to this management game.
First - don't panic! This may be the first time but it definitely won't be the last where you encounter an effect that throws your understanding of the condition. I've been Type 1 for almost 50 years now but there are still times where I'll get a rising blood sugar which I struggle to account for. I have historically struggled with higher levels first thing in the morning but using a Freestyle Libre sensor definitely helps there as you can be much more reassured about where your levels are at all times, and I can monitor this 'rise' simply and deal with it accordingly. Just to put this into perspective - when I started, the way to test one's balance was to drop an effervescent tablet into a dilute urine sample and wait and see what colour it turned to - 'Blue is good' was the aim....
A few people above have mentioned giving a small dose of NovoRapid to counter the rise in blood sugars; as an 'early diagnosed' this may seem a little daunting to do but just start with a small dose and monitor the effect - you'll soon get the hang of how much has the lowering effect you are looking for. Also - you will also start to recognize which foods can give you 'sugar climbs' like this - for me, it's corn based products (tortilla's etc.) and - of all things - chickpeas (which I love!). There will be others which catch you out and, to be honest, in this day and age there are likely to be processed foods which contain ingredients aimed at improving the 'feel' and quality of the food, but which may also have an adverse impact on the carbohydrate uptake - it'll seem like a hit and miss thing but you will soon start to recognise a 'cause and effect' pattern. The thing is, we all have different metabolisms and the body's physiology is very adaptable - especially if taking other medication or if you have other conditions - so it's not surprising that 'one approach does not fit all' really.
Finally - and possibly not mentioned above - there is also a classic 'honeymoon period' with Type 1 diagnosis where everything seems to go swimmingly well - and for some time as well. Then suddenly, you'll experience a bout of being completely out of balance and getting that back will be a seemingly impossible task. I had such a spell after a year; my eldest (Type 1) had it after 9 months, so the timing is different but I believe all Type 1's go through the same experience. Again, don't worry about it when it happens, it will sort itself out but will require a bit of effort on your part and the Hospital to re-establish a possibly different or modified regime. The big thing is don't worry or get stressed - both will also impact quality of balance on your part so keep calm!
I wish you every success - and don't forget early days may seem the hardest as you are changing the way you live - but it is manageable and shouldn't impact your daily life once you are comfortable with it; it's certainly not stopped either my son or myself from doing the things we've wanted to do!
Take care and best regards, Neil.

 

[msav1066]

Dear Ruth,

I would strongly recommend as a 'newbie' you reach out to your diabetic support team for advice, everyone is individual and what works for one person is unlikely to work for another. As a diabetic of 35 years plus I too woke up this morning with unusually high blood sugars which left me scratching my head. Sometimes you just don't know the reason. However, through the understanding I have gained over the years I know what I need to do. When I don't, I reach out to my support team. Please please please do not adjust your insulin without guidance from your team. It can daunting and as has been said elsewhere at time a little overwhelming but you will get there. As you start on this road to manage your diabetes with the correct support you will succeed. I wish you all the best

 

[jrussell88]

Any errors in dosing will be amplified by high-carb meals; lower carbs are easier to control so as others have suggested, an adjustment to your diet may help your BG control.

You should discuss with your diabetic team using doses of Novarapid to correct high blood glucose levels.

If the BG rise was in the middle of the night it sounds more likely to have been basal-related or another issue, than your dosage of Novarapid.

If you're confident in your calculation of the carbs, and you haven't previously done so, you might want to discuss checking your carb ratio - insulin dosage for carbs - and running basal rate tests with your diabetic team as it could be that either or both would benefit from tuning. A continuous glucose monitor will be very helpful for this, Libre or similar. Bear in mind that you may have different carb ratios at different times of the day, as insulin sensitivity is affected by physical activity. This also applies to correction doses.

FWIW, with these numbers correct, I sometimes find my BG rising significantly overnight without a clear cause. I have eaten exactly the same meals, and had the same sort of day twice running. One night is fine, during the other my BG has risen steadily by 6-8mmol/L. Potential causes could include infection, dietary intolerance, previous activity, but once these are ruled out, sometimes it just happens was the eventual conclusion of my hospital team. It's frustrating but I try to correct it as soon as I spot it happening.

Good luck and let us know how you get on.

 

[MarkDonnelly]

HI
I am a new type 1 (5 weeks in). I had roast chicken dinner last night, and carb counted for roast potatoes and parsnips/adding 6U NovARapid. Finished eating at 7.45pm. BS didn't seem to rise with the meal....had Levermir 4U at 8.30pm, but at midnight, started to go up, and I was 14 overnight. Since waking I am rising - I had my Levermir of 30U at 8.30am, and no breakfast, as BS is still rising, currently 19 and still going up!. any ideas what is going on? I am otherwise well.

Hi
I agree with a lot of the replies, coming from a T1 for 30 years, carb counting and Daphny are only part, it will take you a bit longer to figure out your patterns and ratio's, plus if you are coming down with a infection this can also mess with your BG
You can set an alarm in the middle of the night to check if BG is rising and correct with fast acting dose, trust me after 30 years I'm still learning

 

[nikgill]

HI
I am a new type 1 (5 weeks in). I had roast chicken dinner last night, and carb counted for roast potatoes and parsnips/adding 6U NovARapid. Finished eating at 7.45pm. BS didn't seem to rise with the meal....had Levermir 4U at 8.30pm, but at midnight, started to go up, and I was 14 overnight. Since waking I am rising - I had my Levermir of 30U at 8.30am, and no breakfast, as BS is still rising, currently 19 and still going up!. any ideas what is going on? I am otherwise well.

You should eat something when inject, within 10mins to get the novorapid to work. This may sound odd but the insulin needs something to work against.
I've been type 1 for 50yrs and my blood goes up overnight by 4 or 5 marks, I have been advised that the liver extracts sugars overnight that cause the blood to rise. So may well be worth speaking to your Diabetes Nurse and they may increase Levermir overnight.