Why Does BS Go UP Before Bed

[GLF]

Hiya, been getting a real handle on my BS thanks to advice given here, but having a persistent problem with BS rising late evening.
I ALWAYS eat my evening meal at 6pm and have good BS two hours later - around 4.5-6.5. I do not eat again, or snack or drink alcohol , at most only one black sugarless coffee, yet by 11-11.30 my BS is around 9-10,. This is a very regular pattern. I have humulog before each meal. and split lantus so I have 10 units at around 8am and 9 units at about 11pm. Has the Lantus just run out? I thought it lasted at least 18 hours. Please can someone suggest what might be causing this and how I can tackle it - Thanks

 

[nannybarbara]

Hi GLF

I can't answer your question because my pattern is virtually the same as yours! I'm on Humalog and Lantus too. It doesn't go up to 10 or 11, but I'm regularly clocking high 7-ish probably because I usually have a glass of dry red wine, and I eat a little later. If I go to bed later it will rise once the wine has worn off. I'd be very interested in any replies.

Regards,
Barb

 

[cugila]

Hi GLF.

I am not an Insulin user so cannot help you with that, doseage etc. Hopefully someone who is more experienced with that side of it will see your post ?

What may be happening is that you are low a couple of hours after your evening meal and maybe drop even lower, your body then compensates and 'liver dumps' so pushing your pre-bed numbers up.
Maybe a little carby snack mid evening might help to counteract this. Keep the levels more stable.

 

[nannybarbara]

The best reason for a biscuit ever! Love it! Pass the rich tea, please.

Message to Son and Husband: Don't you dare eat my biscuits - I NEED them.

 

[GLF]

Would love to eat some yummy snack in the evening - but I am not going low as I have tested every hour to check this. It starts to rise about 4 hours after last meal, despite a good post meal level. Have cut out the much loved glass of wine as I thought this would be the culprit - but alas no.

I have started having a couple more units of humulog before bed to get it down a bit - can't sleep if sugar is too high.

Do you have your lantus strictly 12 hours apart.> I have been told by one DN that I must have the split doses 12 hours apart and then by a different DN that it doesn't really matter!! Who to trust?

So anyway by morning I can have not eaten for about 14 hours and still have a BS of around 8 - very frustrating and demoralising.

SOMEONE out there must have some ideas please!!!

 

[nannybarbara]

Hi GLF

I was originally told to have the lantus in one lump in the evening and to keep to the same time (or at least within one hour). I took it upon myself to split the dose so that I now have 9 units am and 7 units pm. I read (somewhere) that doses should be 12 hours apart. It now ocurrs to me that Lantus is slow background stuff, so if we're leaving the evening one until later, then perhaps that is the reason for the rise? The morning one has run out of steam, and it takes a bit longer for the evening one to get going. I think I'll try to make the evening dose much closer to 12 hours.

I've been fiddling around with little doses of humalog too, but it didn't seem to make any difference in the evening. It worked brilliantly to stop fasting BG rising before breakfast.

No doubt an experienced insulin user will point us in the right direction.

Regards,
Barb

 

[cugila]

I'm sorry GLF, I must have misread your post ? I thought you said that by around 8pm, two hours after your meal your readings were between 4.5 to 6.5 ? That is fairly low for most people who are Diabetic and well wiithin the guidelines of no more than 9 mmol/l for a T1.

So it is the pre-breakfast (fasting) level that concerns you...? Well, it is also a very similar process called the Dawn Phenomenon which does the same thing as the liver dump while you sleep. If you go low during the night which 14 hours without any food could quite possibly do to you, then again the body's natural defences 'kick in' and it dumps glucose into your system therefore your Bg levels will rise.

Do you know what your level is immediately before bedtime ? What also is the level immediately on waking, before any exercise, shower or food etc ?

Incidentally a small glass of Red Wine does help the Bg level to drop, so it can be beneficial.

 

[GLF]

Hi Cugila, thanks for your replies. yes it is my evening BS that is worrying me. I don't think 6.5,mmol is particularly low is it?? or enough to cause me to liver dump is it??? I am happy with my post evening meal levels and they stay there for a while but around 10pm and 11pm my levels are rising and I don't know why. Therefore am going to bed with a BS of around 11 taking some humulog to bring this down then going to sleep. Dawn phenomenon is another issue altogether I think.

I agree with you NannyB about having the lantus 12 hours apart and I shall try this now. It feels like the Lantus has just run out as you say by the late evening, So will try and have it earlier in the evening. Let me know how you get on. Did think it lasted a bit longer tho' didn't you??

 

[cugila]

Hi GLF.

I thought by now, with no disrespect to Barbara, we might have had some more responses from more experienced T1's and Insulin users. Maybe later ?

Dawn Phenomenon and Liver Dumps cannot be discounted, they are both part of the bodies natural defence mechanisms and do have an effect on levels throughout the day plus what level you wake up to.

Anyway, that's me done. I can't think of anything else. Hope you get to the bottom of it.

 

[Sid Bonkers]

I ALWAYS eat my evening meal at 6pm and have good BS two hours later - around 4.5-6.5. I do not eat again, or snack or drink alcohol , at most only one black sugarless coffee, yet by 11-11.30 my BS is around 9-10,.

Hi GLF, probably got nothing to do with it but what do you usually eat for your evening meals, is it often high in fat content of some sort as this might affect the speed at which your BG levels peak (pizza effect)

 

[GLF]

HI Sid Hmmm yes last nights dinner did have some fried veg and spinach in yoghurt dish and salad, so guess quite a bit of fat there. Had heard that fat slows down absorption but didn't realise it could do it THAT much - but I am no expert here. Why doesn't it do it during the day then aswell I wonder???

Also thought that of late have just slumped on the sofa of an evening (exhausted by half term) and maybe my stomach is emptying too slowly. During the day am rushing around after meals - well when I say rushing - I really mean tidying up!

ANymore thoughts?

 

[fergus]

Hi GLF, type 1 cavalry here at last! :lol:
A few possibilities occured to me.
First, the timing of basal dose splits may be responsible for your late evening bg surge. While I don't think there's any absolute necessity to split the dose by 12 hours ( Lantus' activity profile makes it quite slow to take effect and to tail-off) it certainly could be that yours is pretty much done by late evening and you're going without sufficient coverage for a short while. There can be quite a range of activity profiles between different people, so once again, we're all different. For me, Lantus seemed to last around 20 hours. If you brought your evening split back, or pushed your morning split forward, that might solve the problem.
Another possibility is a condition known as gastroparesis, or delayed stomach emptying. This can be a result of elevated blood sugars over a prolonged period. It can cause damage to the nerves controlling muscles in the stomach so that the release of glucose from digestion is delayed. It can equally cause insulin users like us to go hypo as the bolus dose overtakes the digestion process, or cause bg levels to rise significantly much later than expected.
As Sid says, there's also the possibility that the contents of the meal itself can slow the digestion sufficiently to have this effect. Dietary fat is particularly good at slowing things down.
I hope you get to the bottom of it, and let us know how you resolved it. Good luck!

fergus

 

[LizzieP]

Hi GLF,

This happens to me too and I think that Sid is on the right track here...If I have had a protein heavy or fatty meal then I will almost always have a rise of about 2 points at the 3 hours post prandial (which is bedtime for me). You could try keeping a food diary for your evening meals and bs readings and track it that way for a couple of weeks to see if there is a pattern. It might be nothing to do with it but worth a go to see if you can adjust things from the results you get. And maybe you eat more in the evening than at lunch which might be why the results differ from the ones you get from your evening meal. Perplexing, isn't it? :?

 

[sugar2]

Hi,

What Fergus said really!

Somethuing occured to me though. Is this pattern typical after every meal, and it is just that you are picking it up in teh evening because you are testing before bed...where as you wouldn't habitually test 4 hours after you lunch time meal?

Id=f it is just an evening thing, my money would be on teh lantus running out too. I am on levimir, and had to "fiddle about with timing" etc to get it to suit me

Good luck!

 

[nannybarbara]

From the replies, I think there's plenty of room for a bit of experimentation. I'm going to try pushing the morning forward by an hour or two first.

Previously, I'd even thought of upping the morning dose a couple of units, but I really didn't want to do that!

Thanks for everyone's input - much appreciated.

Regards,
Barb

 

[GLF]

Hiya

And yes thanks everyone for the input it is really appreciated and nice to know others have this too.

I shall definitely do the lantus 12 hours apart. Will also watch the evening meals, as for me this is only happening in the evenings - I stay pretty level all day. But am begining to feel what can I eat for supper, low fat, low protein, low carbs, - what is left?! Lettuce :lol:

Am gonna try fasting tonight re Bernsteins suggestion

 

[AndyS]

Hiya,

I have noticed this quite a bit recently. I seemed to do quite well for a while then had a period of a week or so when my BG went high and refused to come down until I got really quite agressive with my bolus insulin doses. The end result is that in some cases my ratios have doubled.

This thread has been brilliant as it has given me a load of things to try out so hopefully will make some progress.

Thanks for raising this GLF

Andy