High blood sugars before bed every day

[EngineerMe]

Hi there!

Just trying to get some advice on whats been going on with my blood sugars!

Pretty much everyday for the last couple weeks, before I go to sleep, my blood sugar has rocketed up. I use the Libre and its the same pattern every day.
I eat dinner around 7-8pm (quite big meal), my blood sugar peaks (around 10mmol) within an hour or so then drops to a minimum around 5 mmol/l at 10pm. Even if I eat nothing more, it then rises and rises to 13 + mmol/l around 11pm when I want to go to bed.

I then end up doing a few additional units of novorapid to bring it back down so I'm not high all night. I do levemir 8:30 am in the morning and around 8:30 pm at night. If I go to bed on a reasonable number the levemir keeps my blood sugars pretty level over night, with maybe a slight drop.

I'm a bit puzzled, because if I just wasn't doing enough novorapid with dinner, why would I peak, go down then go back up again? I tried increasing novorapid ratio one day but ended up going hypo at the minimum point.

Any advice would be greatly appreciated, let me know if some pictures of my trends would be of more use!
Cheers!

 

[GrantGam]

Hello

If you could share a few images of your BG trends, that would only help us get a better idea of what might be happening.

Does this happen every evening, regardless of what you eat? Could you give us a few examples of what you've eaten when this happens?

Is there anything you do between your evening meal and 11pm that could cause your BG to rise? Exercise, something slightly stressful, etc?

If I was to make a guess on the information you've provided, I would go with protein or fat in your evening meal causing the delayed BG spike.

Hope you're well!

 

[slip]

My first impression is the same as Grants really except I was thinking more along the lines of pasta/pizza/rice type dishes but fat and protein will do the same, all these have a relative slow starting effect on your BG, and gradually rise and rise and rise, covering the carbs with the full amount of insulin before you eat can cause a hypo ~2hrs after eating as the insulin kicks in before the carbs do - split bolusing helps with this. But I also suspect you may be under calculating the total carbs as well, I know I struggle most working out carbs for my evening meals and can sometimes get what you describe.

 

[JoeT1]

I'm also seeing this ride before bed, as my Lantus is 16 units at 10pm, it could be that it's not lasting the full 24hrs and needs splitting. I'll wait to see my diabetic nurse though.

Non movement seems to really affect me as well. For example I'm on holiday currently, and I see even if I give myself a correction with my normal bolus, if I don't move, it's not really coming down much.

On the other hand, I'm only diagnosed 3 weeks so I've a lot to learn, despite reading Think like a Pancreas in almost record time

 

[EngineerMe]

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Thanks for your replies! I've tried to upload screenshots of my trend graphs for a week or so, almost all days have the same trend evening. I hope this is helpful. (Note: I haven't changed the time on my reader yet because I don't want to lose an hours data!)

Yes I do have quite carby meals in the evenings as I'm not able to eat a main meal at lunch. A few examples would be chicken curry with rice, sausage pasta, tortellini, quorn stir fry with noodles, chicken fajitas.

I think you are probably right that it is due to what I'm eating, but could it be a combined effect with not much levemir left in my system causing me to rise? Tempted to do an evening basal test...

I'm also seeing this ride before bed, as my Lantus is 16 units at 10pm, it could be that it's not lasting the full 24hrs and needs splitting. I'll wait to see my diabetic nurse though.

Non movement seems to really affect me as well. For example I'm on holiday currently, and I see even if I give myself a correction with my normal bolus, if I don't move, it's not really coming down much.

On the other hand, I'm only diagnosed 3 weeks so I've a lot to learn, despite reading Think like a Pancreas in almost record time

I think Lantus is a bit longer acting than levemir, but I don't think any of the long acting insulins really last for 24 hours. Definitely something worth chatting about about with your diabetic nurse!

You sound like you're pretty on top of it for only being diagnosed 3 weeks ago!

 

[slip]

Thanks for the graphs, and for the example meals - I'm sticking to what I said earlier.

I doubt the basal is running out however you don't say how much you take and what sort of build your are - basal effectiveness/longevity is based around u/kg, but the only way is to do a full basal test spread over several days.

Might also be worth really concentrating on one meal, weighing and measuring the carb content properly, you may be surprised at what you find especially when factoring in fat/absorption rate.

You can certainly see the 'small rise-dip-bigger rise' most days even with out knowing exactly what and when you ate and bolused.

Mon 23rd was good in that you took 4.5u correction and that brought you down nicely and stayed fairly level the rest of the night and the same for Tuesday, with 3.5u the night before. But those corrections are the only things 'logged' on the system so I can't really comment further.

Out of interest did you have a drink Saturday 28th evening?

 

[EngineerMe]

Thanks for the graphs, and for the example meals - I'm sticking to what I said earlier.

I doubt the basal is running out however you don't say how much you take and what sort of build your are - basal effectiveness/longevity is based around u/kg, but the only way is to do a full basal test spread over several days.

Might also be worth really concentrating on one meal, weighing and measuring the carb content properly, you may be surprised at what you find especially when factoring in fat/absorption rate.

You can certainly see the 'small rise-dip-bigger rise' most days even with out knowing exactly what and when you ate and bolused.

Mon 23rd was good in that you took 4.5u correction and that brought you down nicely and stayed fairly level the rest of the night and the same for Tuesday, with 3.5u the night before. But those corrections are the only things 'logged' on the system so I can't really comment further.

Out of interest did you have a drink Saturday 28th evening?

Thanks for your reply

Regarding the basal, I do 5 units at 8:30 am and 13 units at 8:30pm and I'm slim, weigh about 50kg.

Sounds good, I'll try to focus on getting my mealtime insulin right. I've never done split insulin before, is there any rules to this if I wanted to do it?

I did correction doses (usually around 3-4 units) for all of these, I just don't usually bother to record it on the reader! I couldn't really say why for the days you mentioned it gets back in range more quickly while others its a lot more gradual.

Nope I didn't, I was just up late playing poker with my friends

 

[slip]

5 units at 8:30 am and 13 units at 8:30pm

That puts a different spin on it! Usually the number of units when splitting levemir are 'similar' - although we are all different! I take 18u in the morning and 23u in the evening - but it's also generally accepted that usually the morning basal is bigger than the evening one - obviously we didn't get that bulletin

That AM 5u is probably running out, a full basal test will say for sure.

 

[EngineerMe]

That puts a different spin on it! Usually the number of units when splitting levemir are 'similar' - although we are all different! I take 18u in the morning and 23u in the evening - but it's also generally accepted that usually the morning basal is bigger than the evening one - obviously we didn't get that bulletin

That AM 5u is probably running out, a full basal test will say for sure.

Interesting, I thought we were the normal ones haha! It always made sense to me, if you're less active (nightime) you need more basal insulin. But I guess human biology is a bit more complicated than that!

Generally if I'm very active (e.g. long runs or walking alot), or very inactive during the day I'll see the effect in my night time trends not so much the actual day. As you say, everyone is different!