Unexplained morning highs

Vedika

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Hi,
my blood sugars been quite high over the last few weeks when i wake up. At bedtime they are about normal. Can anyone explain please?
 

Westley

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Hi Vedika,
Have you heard of dawn phenomenon?
These morning rises as the result of hormone release are very common (and I know how frustrating it can be).

If you search this forum for this you will see lots of discussions and approaches to dealing with this problem:
http://www.diabetes.co.uk/forum/search/6110402/?q=Dawn+phenomenon&t=post&o=relevance&c[title_only]=1

I still find it one of the biggest challenges in my own control. What I do now, which sometimes works for me, is to inject a few units the moment after waking up, regardless of when or what I plan to eat (and if I do ever want to sleep a bit longer than usual, to still wake up at the normal time for this injection, then go back to sleep - not the most relaxing lie in, but better than starting the day high). The tricky thing is though that the size and timing of the morning rise seems to vary substantially, depending on many different factors.
 
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loafhead

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The easiest way to find out is to fast before bed, at least 4 hours since you last ate, go to bed, then wake up in the middle of the night and test. You could actually be having a hypo in your sleep which means your liver does a sugar dump, you could also be on an incorrect dose of background insulin or it is running out (depends on brand) in theory if you are on the correct dose, you should go to bed and wake up with roughly the same levels or you could have the Dawn phenomenon and the best way to test for that is continuous glucose monitoring.
 
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Vedika

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Hi,
my blood sugars been quite high over the last few weeks when i wake up. At bedtime they are about normal. Can anyone explain please?
Hi Thanks! Ive not come across the dawn phenomenon i will check out the link.
 

Vedika

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The easiest way to find out is to fast before bed, at least 4 hours since you last ate, go to bed, then wake up in the middle of the night and test. You could actually be having a hypo in your sleep which means your liver does a sugar dump, you could also be on an incorrect dose of background insulin or it is running out (depends on brand) in theory if you are on the correct dose, you should go to bed and wake up with roughly the same levels or you could have the Dawn phenomenon and the best way to test for that is continuous glucose monitoring.

Hi, Thanks for the advise as before this my sugars were fine, but my insulin dose was changed slightly. I have a continuous glucose monitoring meter attached to me for 7 days. This records all the night time sugars as well, I will get a better idea of what's happening and the changes required to my insulin hopefully. Let you know how i get on.
 
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Juicyj

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Night time testing will help, but it sounds to me like your basal is running out, requirements can change over time, what's your background insulin ?
 
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SamFergusson

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Hi @Vedika I've been having the exact same issue recently. I've been able to get an average of about 7ish before bed but then when I wake up I'm between 16 & 18, I was even as high as 23 today. I've decided to split my Levemir today, (half in the morning & half in the evening) to see if it was just running out at the end of the day!
Fingers crossed for tomorrow :)
I hope your readings give you a clear idea of what you can do to fix it :)
It will be interesting to see how your levels go throughout the night.
 
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loafhead

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I believe Levemir has a span of effective use of 12 hours it's half life is 5-7 hours, so what you may need to do is not split it, but do the normal morning dose and top it up for the night. I was wrongly advised to split Lantus for many years and that lasts 24 hours, but since switching to Levemir it has been better for me. To give you an example my dose is 22 in the am and 11 in the pm injecting roughly 12 hours apart.

I guess what I am saying is be cautious of a spike in the afternoon or early evening if you have split it.
 
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Ella5

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Hi,
my blood sugars been quite high over the last few weeks when i wake up. At bedtime they are about normal. Can anyone explain please?

Consult with your doctor asap. It is showing either you have too low bg levels during your sleep, or your insulin doesn't cover your need.

Edited by a mod due to inappropriate dose advice
 
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Ella5

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Hi @Vedika I've been having the exact same issue recently. I've been able to get an average of about 7ish before bed but then when I wake up I'm between 16 & 18, I was even as high as 23 today. I've decided to split my Levemir today, (half in the morning & half in the evening) to see if it was just running out at the end of the day!
Fingers crossed for tomorrow :)
I hope your readings give you a clear idea of what you can do to fix it :)
It will be interesting to see how your levels go throughout the night.

I split my Levemir dosage. I make 23 units in the morning and 8-14 units in the evening and it works for me very well. Good luck!

Edited by a mod
 
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Ella5

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I believe Levemir has a span of effective use of 12 hours it's half life is 5-7 hours, so what you may need to do is not split it, but do the normal morning dose and top it up for the night. I was wrongly advised to split Lantus for many years and that lasts 24 hours, but since switching to Levemir it has been better for me. To give you an example my dose is 22 in the am and 11 in the pm injecting roughly 12 hours apart.

I guess what I am saying is be cautious of a spike in the afternoon or early evening if you have split it.

I had also problems with Lantus. I couldn't find the right dosage. I had every night very low bgs, that I didn't remember in the morning. Now, when I use Levemir and Novorapid I'm satisfied and I can sleep calmly. I agree totally with your advice.
 

SamJB

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Nine times out of ten, it will be caused by a wrong dose of basal insulin. After that, the next mot likely cause is the dawn phenomenon. Finally, night time hypos are the least likely.

Once you've eliminated hypos and DP, you need to get your basal dose right. In his book, Think Like a Pancreas, Gary Scheiner suggests that for every 1.6 mmol/l change in overnight levels requires a 10% change in dose of basal insulin. Make sure you don't eat or inject within a few hours of bed, though. I change my Lantus almost on a daily basis - works a treat for me.
 
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tim2000s

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So here's the point about background insulin @Vedika . As long as your blood glucose level is in a reasonable range (4-8mmol/l) you should not see a change in blood glucose of more than 1.6mmol/l over a fasted period as it is supposed to counteract the body's production of insulin.

What we and you don't know is what is going on with your overnight blood glucose. There are a number of possibilities as to why this may be, but you won't know which it is until you do a basal test, the details of which can be found here: https://mysugr.com/basal-rate-testing/

It means you will have to get up during the night and test yourself to understand the profile, but its the only way to find out what happens, and more importantly, when.

While this might be uncomfortable, it is the only really good way to work out why you are having issues. Once you understand what you glucose levels look like, you can start to decide on how you want to deal with them.
 

steveBN1

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The dawn phenomenon in my experience can be erratic as well, most days almost non existent for me but on a few days quite significant (e.g. a rise of at least 2 mmol between the small hours and waking). Having been put on Lantus, one injection before breakfast, my initial experience was good compared to Insulatard. Then, once I'd been on Lantus for some time I realised it was not covering the full 24 hours consistently, often resulting in a BG rise of 4 to 6 mmol between the small hours and getting up before breakfast, which made it difficult to optimise my dose properly. I have now split my dose 50:50 between morning and evening (7 units each, 12 hours apart) and this has sorted out the 24 hour cover problem and I can live with the ,for me at least, smaller dawn effect. Lantus' makers may claim it gives a flat 24 hour duration, but it really doesn't for some people.

The additional benefits for me of splitting the dose are a reduced tendency to become hypo just before lunch and when on long walks, being able to reduce my daily dose by 6 units and fewer correction doses of Humalog. My last HbA1c was 37 mmol/mol.

Distinguishing between different effects, such as dawn phenomenon and duration of your basal dose, can be a pain in the whatsit. You may find there are at least two variables to take into account. Best of luck and do plenty of BG testing after adjustments.
 

Meghalton

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Hi @Vedika I've been having the exact same issue recently. I've been able to get an average of about 7ish before bed but then when I wake up I'm between 16 & 18, I was even as high as 23 today. I've decided to split my Levemir today, (half in the morning & half in the evening) to see if it was just running out at the end of the day!
Fingers crossed for tomorrow :)
I hope your readings give you a clear idea of what you can do to fix it :)
It will be interesting to see how your levels go throughout the night.
Ohhhh tell me how this goes as I think mine runs out in the morning too, maybe that could be the answer!!
 

SamFergusson

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Ohhhh tell me how this goes as I think mine runs out in the morning too, maybe that could be the answer!!
Hi,

Well my first attempt resulted in a 2am low. So a 50/50 split was obviously too much. Today I have done a 60/40 to see how that pans out. Will let you know if it works
 

donnellysdogs

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Hi,

Well my first attempt resulted in a 2am low. So a 50/50 split was obviously too much. Today I have done a 60/40 to see how that pans out. Will let you know if it works

My levels of basal fluctuate a lot...I was going low just on 3.5 units at bedtime.. Due to changing the timing of another drug I take my basal is now 8.5 at night but my day one has lowered!! It was the other way round..

It is a case of testing over night and proper basal testing for mornings, afternoon and evenings.

I find I can change qty of levemir basal everyday which is a god send for me. I plan my day time basal when I wake up depending upon the stress or physical activity for the 12 hours ahead..

I do need a bolus shot in the morning when I actually open my hours to counteract waking phenomenon....

Play around with your rates, personally I wouldn't work by percentage changes and makesure you keep an eye on how different days affect you.. Ie if you work or days off, illness etc
 

Antipodes

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Hello all
Just jumped onto this thread - as I have had this inexplicable morning high for the last 7 days. My waking BSL is usually really good - between 4 - 6. I have played with Lantus splits over the years to avoid night time hypos - and thought my system was pretty good - then this. No significant change in diet, exercise, stress, illness etc - hence being baffled.
Anyone found the same problem - and methods to address it?
 

Antipodes

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The easiest way to find out is to fast before bed, at least 4 hours since you last ate, go to bed, then wake up in the middle of the night and test. You could actually be having a hypo in your sleep which means your liver does a sugar dump, you could also be on an incorrect dose of background insulin or it is running out (depends on brand) in theory if you are on the correct dose, you should go to bed and wake up with roughly the same levels or you could have the Dawn phenomenon and the best way to test for that is continuous glucose monitoring.
Hi
Great suggestion that it could actually be a hypo rebound overnight - I hadn't thought of this one.
Thanks for the suggestion, will look into it. I swear I learn more from other diabetics than every single endocrinologist I have ever been to.....
thanks again
 

SamFergusson

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Hey @donnellysdogs Yeah I'm struggling at the moment as I have been unwell. Hopefully as I get better I will get a better understanding of what is happening. I can now see what you mean about not being able to do a simple % split though lol. I think I'm going to have to amend it to circumstances per day. :)