BG spike when going to sleep?!

[Levy]

Hi all,

Since starting on the Libre, I have noticed that my BG spikes pretty steeply JUST after I go to sleep (any time between 23:00 and 01:00 - I'm a nightowl!) and was wondering if anyone else had found this?

I've posted a picture below to illustrate, but these are only a few examples! For my consultant, I have kept an extensive diary for almost two weeks and found that there was no connection between this and anything else:
- Timing of evening meal (due to my evening schedule, I can have my dinner anywhere between 6pm and 9:30pm - this doesn't impact on the timing of the spike)
- GI/type of evening meal (I have found it happens just the same whether I eat a virtually carb-free salad or pasta)
- Snacking in the evening (happens whether I snack or not)
- Exercise (happens whether I have exercised or not)
- Evening hypo (still spikes whether I experienced a recent hypo or not)
- Basal type (I was recently moved from Levemir 2x daily to Tresiba. It's still early days, but the last two nights I still experienced the same spike).

Literally the ONLY correlation I have managed to find, is that the spike always seems to happen just after I go to sleep - it feels more hormonal. It almost seems like a reverse DP if that makes sense. I was just wondering if anyone has experienced this and what you do about it? My current basal dose does bring it back within range overnight (which basically means it's too high because it's making me drop during the night)... I'd much rather not go that high in the first place!

 

[Deleted Account]

When do you take your basal dose?
I used to take my basal (Lantus) just before I went to bed and experienced a similar spike. When I moved my basal injection a few hours earlier the spike went away. This was explained by the Lantus profile - it takes a couple of hours to reach its maximum potency so by taking it just when I was going to bed, I had less basal at the time when I was not able to take bolus to compensate for it.

 

[Juicyj]

Hey @Levy When did you change over to tresiba ? If it really is early days as in a few days/week then i'd let it settle in for a bit longer first, it took me about 3-4 weeks to really start seeing the benefits of using it, and to get my dose right.

 

[Levy]

When do you take your basal dose?
I used to take my basal (Lantus) just before I went to bed and experienced a similar spike. When I moved my basal injection a few hours earlier the spike went away. This was explained by the Lantus profile - it takes a couple of hours to reach its maximum potency so by taking it just when I was going to bed, I had less basal at the time when I was not able to take bolus to compensate for it.

I used to take my Levemir at 9am and 9pm (although did play around with the timing of the evening dose - without success). I now take my Tresiba at 9am as well. As it's ultralong-acting, my consultant told me it would not matter whether I took it morning or evening as it lasts 48 hours anyway.

 

[Juicyj]

Hi @helensaramay Tresiba is a really flexible insulin so as long as you take a daily injection it shouldn't disrupt your blood glucose, it's just getting the dose right that would see an impact on your levels.

 

[Levy]

Hey @Levy When did you change over to tresiba ? If it really is early days as in a few days/week then i'd let it settle in for a bit longer first, it took me about 3-4 weeks to really start seeing the benefits of using it, and to get my dose right.

It's only been a week, and I understand that. I can slowly see my daytime lines changing and settling down a bit, however the evening spike is literally exactly the same as it was before. I'll obviously keep going with it, but my gut feel is that it's not related to that.

 

[Juicyj]

I'd still give it time to settle in a week is quite early - the only other thing I can think of that would cause this is relating to what you eat in the evening and delayed glucose spike due to fat eaten, as this would slow the carb absorption, or that your evening meal carb ratio would need adjusting. What time do you eat and what meal were these ?

 

[Levy]

I'd still give it time to settle in a week is quite early - the only other thing I can think of that would cause this is relating to what you eat in the evening and delayed glucose spike due to fat eaten, as this would slow the carb absorption, or that your evening meal carb ratio would need adjusting. What time do you eat and what meal were these ?

As stated in my OP, I have recorded and tested all of that extensively before moving over to Tresiba and my consultant and I were not able to find a correlation with food/exercise/hypos/snacks or anything of the sort.

The only thing I have noticed is that the spikes move with whatever time I happen to go to sleep, and always happen just after I go to sleep (whether that be 10:30pm or 1am)

 

[Juicyj]

Hi @Levy In that case give Tresiba a bit longer to settle in, it's a flat profile so you will see the benefits of using this in time, keep us updated as it's good to hear how you're getting on with it.

 

[Levy]

Hi @Levy In that case give Tresiba a bit longer to settle in, it's a flat profile so you will see the benefits of using this in time, keep us updated as it's good to hear how you're getting on with it.

Thank you and I definitely will. I have no doubt it will improve my general control, but I'm still hoping there might be others who are experiencing something similar during the night and I'm not some lone weirdo

 

[Juicyj]

You're not a lone weirdo - we all get these blips but they are just that, yesterday I couldn't get my blood glucose levels below 10, today it's back down again. I know within a week I was fed up with Tresiba as I thought it was supposed to be amazing, had to be patient though it took a few weeks to calm down and then I just got this lovely flat profile, I know it's tempting to change things straight away but give it a bit more time

 

[luca74ita]

Hi, i've a very similar situation from an year, i'm T1 from 1977 and i use tresiba from 2015.
Usually i have dinner at 8pm (light dinner with no complex proteins and approx 500 calories). At 11pm my blood sugar is ok (approx 80-120) and i start sleep, but approx at 1-2 am my blood sugar is very often 180-220 so i make a small correction. I use tresiba and i've tried to change the time of iniection (actually at 7pm) but i've no result. I've also tried to increase the units of tresiba but i had some hypo during the day so my only solution at the moment is set the alarm clock at 2am and check the blood sugar My doctor said that prob some hormones (cortisol, adrenalin..) are the responsible.

 

[Levy]

Hi, i've a very similar situation from an year, i'm T1 from 1977 and i use tresiba from 2015.
Usually i have dinner at 8pm (light dinner with no complex proteins and approx 500 calories). At 11pm my blood sugar is ok (approx 80-120) and i start sleep, but approx at 1-2 am my blood sugar is very often 180-220 so i make a small correction. I use tresiba and i've tried to change the time of iniection (actually at 7pm) but i've no result. I've also tried to increase the units of tresiba but i had some hypo during the day so my only solution at the moment is set the alarm clock at 2am and check the blood sugar My doctor said that prob some hormones (cortisol, adrenalin..) are the responsible.

Hi, really sorry I've missed this response! At the moment that's what it looks like for me as well.

Still no change with Tresiba - in fact it was easier to manage with Levemir as I had a much higher evening dose which was bringing the spike gradually back down overnight, hence why I never noticed it before starting on Libre.

I tried to pick the conversation back up with my consultant and steer it towards hormones but he's being incredibly unhelpful by saying he thinks the readings look fine... I'm between 12-15 all night, which is a third of my day, so definitely not fine with me!

I tried a pre-emptive bolus before bed to stop the spike from happening but this doesn't seem to be making any difference. It's almost like between bed and 3am I'm resistant to insulin and it spikes up no matter what, and only later it will come back down.

Getting so annoyed with this!

 

[donnellysdogs]

Although tresiba is flat, I too got rises from 10pm no matter what andI still dropped substantially after.

I'm back to 3 shots of insulatard a day and much better of.

 

[Levy]

/

Although tresiba is flat, I too got rises from 10pm no matter what andI still dropped substantially after.

I'm back to 3 shots of insulatard a day and much better of.

I did get it on Levemir before that as well. I was changed onto Tresiba to try and fix the problem but it hasn't (if anything it's made if worse due to the flat profile) so thinking of switching back.

In the meantime I'm no closer to finding out what's causing the spike and my consultant isn't of much use

 

[donnellysdogs]

Its just a natural spike for some... and flat line insulin wont cope no matter when its taken.

I can only get my spike snd dips sorted by having insulatard. Means 3 jabs a day but hey ho. Levemir and Lantus werent any good either for me.

 

[Levy]

Its just a natural spike for some... and flat line insulin wont cope no matter when its taken.

I can only get my spike snd dips sorted by having insulatard. Means 3 jabs a day but hey ho. Levemir and Lantus werent any good either for me.

Is that a mix of short and long acting? I vaguely remember being on that for a while when I was first diagnosed.

Glad it's doing the trick for you. I'm in the process of changing clinics so I'm hoping my next team will be more helpful in getting me to a solution!

 

[donnellysdogs]

Insulatard contains a type of insulin called isophane insulin. This is known as an intermediate-acting insulin. When injected under the skin it starts to work within 1 to 2 hours and its effects last for about 16 to 24 hours.
Its peak is 4-8 hours so I can split it in mornings, get peaks when I need, less when I need and just a small amount at 4-6pm ses me ok over night.

I dont think is normal thinking to split the dose though but I worked out when my peaks and troughs are and feel happier on it than any other background.

 

[Neonataldiabetes]

When do you take your basal dose?
I used to take my basal (Lantus) just before I went to bed and experienced a similar spike. When I moved my basal injection a few hours earlier the spike went away. This was explained by the Lantus profile - it takes a couple of hours to reach its maximum potency so by taking it just when I was going to bed, I had less basal at the time when I was not able to take bolus to compensate for it.

That's really interesting, I'll give it a go with tresiba, it's been tracking up 5 hours after whatever i do. THANKS

 

[JessL]

Hi! First time using this forum so hoping im replying in the right place! I know this is like 3 years after you posted this but I wanted to say I have the exact same issue. Exactly as you described. I was wondering did you ever find a good solution? I’d be interested to share experiences I am on tresiba, found that I didn’t get this issue on levemir but I did get really bad DP haha they don’t make life easy as a diabetic do they!

Hi all,

Since starting on the Libre, I have noticed that my BG spikes pretty steeply JUST after I go to sleep (any time between 23:00 and 01:00 - I'm a nightowl!) and was wondering if anyone else had found this?

I've posted a picture below to illustrate, but these are only a few examples! For my consultant, I have kept an extensive diary for almost two weeks and found that there was no connection between this and anything else:
- Timing of evening meal (due to my evening schedule, I can have my dinner anywhere between 6pm and 9:30pm - this doesn't impact on the timing of the spike)
- GI/type of evening meal (I have found it happens just the same whether I eat a virtually carb-free salad or pasta)
- Snacking in the evening (happens whether I snack or not)
- Exercise (happens whether I have exercised or not)
- Evening hypo (still spikes whether I experienced a recent hypo or not)
- Basal type (I was recently moved from Levemir 2x daily to Tresiba. It's still early days, but the last two nights I still experienced the same spike).

Literally the ONLY correlation I have managed to find, is that the spike always seems to happen just after I go to sleep - it feels more hormonal. It almost seems like a reverse DP if that makes sense. I was just wondering if anyone has experienced this and what you do about it? My current basal dose does bring it back within range overnight (which basically means it's too high because it's making me drop during the night)... I'd much rather not go that high in the first place!

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