Night-time Lo (or high?)

[Age_wills]

Hi there,
I've been type 1 for nearly five years now and current use novo rapid as my quick-acting and lantus as my slow-acting insulin. I usually take about 18 units of lantus at about 6pm. Recently however, I've been waking up in the mornings with very high readings - over 15, which is very disconcerting as my reading before going to bed has been around 10, which I thought would have been ok to go to bed on. Is my high reading down to my blood sugar rising during the night or is my lantus bringing it down so low (and my body not waking me up) that I'm having a hypo in the night and not realising it? Have I effectively been going unconcious in the night? Would this cause my blood sugar to shoot up? I'm aware of the Dawn Phenomenon but surely this wouldn't bring it the blood sugar level this high? It's been over 20 some mornings! I have tried taking less lantus be hasn't seen to worked, anybody ever experienced anything similar?

 

[ljwilson]

I would say that 10 is high to go to bed on, I tend to go to bed between 5-6 and wake up with 8-10

Lorna

 

[cugila]

It could well be down to the DP effect. There are also some members on here who have had issues with Lantus as well, so that is also a possibility.

The only positive way to check this out is (Oh Joy !) to set your alarm for every two hours throughout the night and test when you wake. You should then see the trend. If you do drop very low and then afterwards start to rise as well then you need to make sure that you have a small carby snack before bedtime. 10 does appear to be high for a pre-bedtime reading, as Lorna says.

Too much Insulin, too little food can all be contributing factors. Hopefully a more experienced T1 will come along and be able to give you much better advice.

 

[janabelle]

HI, I also had this problem while on Lantus. Interestingly enough there's been a few postings similar to this of late, one relating to Levemir.
I don't know anything of this Dawn Phenomenon that I keep hearing about recently, and I have been type-1 for nearly 21 years. However while I was on Lantus, I could also wake up with high blood sugars for no reason. It varied from day to day, and had no bearing on activity or diet-it was very random. I wasn't going hypo overnight either, I did get up regularly to check my BG,as i was constantly needing to wee all night-don't remember ever having a full nights sleep on Lantus :cry: .
As previous poster suggested, it is probably a good idea to get up and check your BGs overnight, for a few nights at least, to see what's happening.
Some people believe that Lantus and Levemir are not true 24 hour basal insulins, and with many people posting that they are having to split their dose to get 24 hour coverage, this is becoming increasing evident. Many people also seem to have reasonable control on analogue insulins,and only experience problems with erratic BG control after months or even years on it. These people are usually considered to be insulin resistant, but a change of insulin can often solve the problem,and improve BG control.
Let us know how you get on with the night-time monitoring, and hope it improves soon. All those ups and downs must be making you feel awful.
Jus

 

[kegstore]

Dawn Phenomenon affects everybody, diabetic or not. It's just diabetics handle it less well because of our insulin issues!

If you have a bad hypo in the night and don't wake, your liver will dump glycogen into the bloodstream to get your bg level up. Unfortunately it overdoes this somewhat so you end up with scary bg numbers on waking.

As Ken said, the only way to know what is going on is to test your blood every couple of hours during the night.

I go to bed no higher than 7 and wake at around 4-5, but I have DP sussed with my basal profile.

 

[Age_wills]

Hi again,
Thanks for the responses, I will do a 2-hourly check tonight to see what's happening overnight. It seems strange as I've had a few, not many, night-time hypos during the past few years and my body has always woken me up so I don't know whether I'm losing my hypo warnings (have had low- warnings during the day though) or maybe I'm not actually going low over night but actually my levels are rising (have no idea why??).
My thinking behind the BG around 10 before bed is that if my lantus is taking my levels down overnight then 6/7hours sleep would take it down to a nice 4 or 5 in time for when I wake, but obviously this doesn't seem to be happening - did happen before for a while, was waking up with spot on levels but now it seems to have changed, so now I'm trying to muck about with my lantus units to try and counter it - but I guess I need to find out what is actually happening overnight first! Frustrating!
But thanks for the help, it's very helpful to talk to other diabetics

 

[fergus]

Hi there,

In my opinion, your problems probably stem from some combination of the phasing of your basal dose, your elevated blood glucose levels, and perhaps the Lantus itself.
First off, 10mmol/l is not a safe bg level at any time and you'd benefit from getting that down to something in the 5's or 6's. That will have all sorts of long term health benefits.
Secondly, Lantus isn't really designed to lower your blood sugar as you are using it. That might sound odd, but its real pupose is to counteract the glucose your body makes all by itself. If a Lantus dose is correctly set, it should be able to keep your bg at a pretty stable level throughout the day without eating any food at all. Yours is, or was, lowering your bg by a few points overnight so may well be set too high.
Thirdly, Lantus doesn't work for 24 hours in many people. Its action can be finished in as little as 18 hours, which will leave a 6 hour period during the day when bg levels creep up without actually eating anything. A good solution to this is to split the dose in two, separated by a few hours.
This would enable you to go to bed at a healthier bg level, use less Lantus overnight so that your bg is much the same the following morning, so avoiding possible hypos. Then simply take the balance the following morning so that your numbers stay stable during the day.
I'm not convinced your bg will have started high at bedtime, fallen off the cliff overnight, and leapt up again by morning. It's never happened to me in 29 years, but we are, as they say, all different. It may be more likely that it simply started high, then kept rising.
Finally, there are those who simply don't do well on Lantus and do better with an alternative basal.
I've used Lantus and Levemir and personally found no difference, but it's something to consider if you keep experiencing problems.

All the best,

fergus

 

[Age_wills]

Hi again,

So I checked my BG throught the night and low and behold, it was ok - typical!
I went to bed on 11.1 - a bit high I know but I have been concerned that I was going too low in the night and not waking up so I wanted to play it safe
2.40am - 6.6
5.30am - 8.5
7.30am - 8.2
10.30am - 6.0 (allowed myself a lie-in due to waking up every couple of hours!)

So it seems ok, which is odd but good I guess. Do anyone have any ideas on why it rose a little between 2am and 5am?

Thanks again for all the help

 

[ljwilson]

To be honest with you, i would try and get those levels down, if I was at 11 I would feel quite rough, I like to be between 4.5 and 6

Lorna

 

[NickW]

What (and when) had you eaten and injected in the few hours before you went to bed? Had you eaten and injected Novorapid in the couple of hours prior to your 11.1?

I only ask because your blood dropped quite a lot (11.1 to 6.5) in the first few hours, then was more stable. At a guess, this sounds like you'd eaten something late on that spiked your blood sugar, and the fast acting that you took to it brought it back down tonormal; could this be what happened there?

 

[Age_wills]

Hi Lorna,
I have to say I'm very envious of you - how do you manage to have such good levels? I know 11 is too high, but if I went to bed on say 6, my lantus would bring me down to under 4 and I'd have a night-time hypo, so I'm unsure on how to go to bed on a nice level i.e. under 8 and also wake up at a good level and not go under 4 in the night. I take 18 units of lantus at 6pm. I don't feel bad when I'm at 10 or 11, because I'm rarely at that level for long.
The readings I supplied above - I'd eaten a small pot of rice pudding at about 11pm which had 19g of carbs in it (so I gave myself 2 units of novorapid to counter this (is that how it works? I am desperately trying to get onto a DAFNE programme!)
Another question also - do people tend to take their novorapid before they eat or afterwards? Or does it not really matter/depend on the person?
Thanks again for all the help