Spiking overnight on low carb

[SJS5]

HI
Has anyone got any advice on how to stop spiking overnight?

I eat a low carb diet and am on MDI ..novorapid and tresiba.
I've been following a low carb approach for 18m and found my blood sugars were much better controlled.
However I'm really struggling recently with my main meal at night .
During the day blood sugars tend to be fairly steady.

I usually have my evening meal at around 5.30pm..so this might be a, steak with veg or a low carb lasagne made with courgette not pasta for eg.
My blood sugars are usually around 4.5 -6.5: pre meal.
After meals they stay fairly stable and then start to creep up at around 10pm to 8-9mmols.
I'm often then waking at 2-3am with blood sugars at 13!
I have been taking extra novorapid as I go to bed but it feels like this has no effect at all and I end up stacking insulin overnight and then it eventually comes down to about 4-5 Mmols pre breakfast

How does anyone else work out the ratio for protein and fat ?

I can't give extra insulin pre meal as I find I go hypo post meal .

Many thanks

 

[Trevor vP]

I am T1 and follow a low Carb method as smaller numbers smaller mistakes but protein can really catch you out.

I find this really useful resource
https://waltzingthedragon.ca/

I use the logics of the Warsaw method, personally I find the amount of Bolus to much but I use the logics to catch the protein spike especially for a night time meal with a lot of meat.
Also try keep the amount of protein low and eat earlier at night so I can catch the protein spike. I have worked out through trial and error how much protein I can cope with without a spike.

hope this helps

 

[In Response]

Have you done a basal test?
It is possible your basal requirements are higher at night and that is what is pushing your levels up.
Tresiba’s flat profile is great if your basal needs are flat. If not, a twice daily basal which allows you to adapt to your body’s different day and night needs may suit you better.

 

[PeteN11]

I am also on low carb and found the same problem at night.
As my menu is recurring over say a 2 week period I started to keep a food and Insulin intake diary. I was then able to inject before bed to compensate for the protein spikes based on what had happened in the past.

 

[SJS5]

I am also on low carb and found the same problem at night.
As my menu is recurring over say a 2 week period I started to keep a food and Insulin intake diary. I was then able to inject before bed to compensate for the protein spikes based on what had happened in the past.

Hi yes I had thought about doing this

I do tend to eat the same sort of thing and thought I had worked it out !LOL
How long after your evening meal do you take the additional insulin?
I Cant seem to find a pattern.

How do you work out your ratios for Grams of protein.

I was calculating it at 50% = 1 CHO equivalant but I don't think its enough

 

[NicoleC1971]

Good suggestions here re basal regime but also consider fat content of the meal which will slow absorption of protein? Do you get this slight spike every evening meal? Are you back down again by morning or do you need to bolus again to be in normal range?
If you have any chance of getting one I'd say get a pump as it allows for more flexible dosing e.g. per hour and also by meal type (long extended dose to cover later digestion of protein) and the low carb way of eating which will involve higher levels of fat/protein typically.
If you have had diabetes for a while it also possible that delayed absorption of your last meal is slightly going on (gastroparesis) but I don't know if that is you.

 

[SJS5]

Good suggestions here re basal regime but also consider fat content of the meal which will slow absorption of protein? Do you get this slight spike every evening meal? Are you back down again by morning or do you need to bolus again to be in normal range?
If you have any chance of getting one I'd say get a pump as it allows for more flexible dosing e.g. per hour and also by meal type (long extended dose to cover later digestion of protein) and the low carb way of eating which will involve higher levels of fat/protein typically.
If you have had diabetes for a while it also possible that delayed absorption of your last meal is slightly going on (gastroparesis) but I don't know if that is you.

Hi

I don't meet the criteria for a pump as my last Hba1c was 50mmols.(best it's ever been and took a lot of hard work).This is all down to low carb and additional bolus injections
The consultant did say he could put me forward for pump but might be rejected and felt I was too focused on my blood sugars!! and should not worry if they rise overnight!
I can't do that as they will stay high all night if I don't correct and therefore I'm putting myself at risk down the line .My Hba1c is certainly not at the 50mmol range this last 2w .

In answer to your question yes they rise every night regardless of what my meal is and yes I have to bolus.
I sometimes feel I'm injecting water as it takes ages to go down to normal range .

It seems to start to drop around 3 -4am

 

[NicoleC1971]

Hi

I don't meet the criteria for a pump as my last Hba1c was 50mmols.(best it's ever been and took a lot of hard work).This is all down to low carb and additional bolus injections
The consultant did say he could put me forward for pump but might be rejected and felt I was too focused on my blood sugars!! and should not worry if they rise overnight!
I can't do that as they will stay high all night if I don't correct and therefore I'm putting myself at risk down the line .My Hba1c is certainly not at the 50mmol range this last 2w .

In answer to your question yes they rise every night regardless of what my meal is and yes I have to bolus.
I sometimes feel I'm injecting water as it takes ages to go down to normal range .

It seems to start to drop around 3 -4am

I find that my supposed fast acting insulin seems not to do the job too! My hba1c hovers mid 50s but pump was justified by my high exercise levels.
Like all of us you are anxious about complications etc. but I think it would also be detrimental to your mental and physical health to get up in the middle of the night to bolus!
I wish you luck with the basal regime but in the meantime perhaps you can up the protein/bolus ratio then split the dose between mealtime and bedtime to account for the delayed absorption.

 

[jonathan183]

The profile of insulin does not match the protein/fat content of meals. I'd consider having the meal earlier so you are still awake and correct later with the same insulin - but that means at least 2 injections
Dr Bernstein's approach is to use an insulin which is a better match to the protein/fat combination. I think people have run into trouble due to the longer acting time period compared with the rapid acting.
I'd go with the first approach based on insulin you are used to ...

 

[PeteN11]

How long after your evening meal do you take the additional insulin?
I Cant seem to find a pattern.

The at meal dose for me lasts around 2-3 hours so I take more after that. I normally have to be up every 4 or so hours to go to the toilet so any additional injections are not are problem.

How do you work out your ratios for Grams of protein.
I was calculating it at 50% = 1 CHO equivalant but I don't think its enough

I do not do any such thing. Even after my Bertie course and counting carbs I found it of little use.
I just experimented and kept to my previous results. I do not care if I venture into the teens at night. I just adjust and make a note for the future when I have consumed the same food and see if it happens again.
Having a 13 at night for me is no big deal as long (as long the Steak was good) and it is not regular occurrence.
I would rather be adjusting throughout the night with a quick release Insulin than filling myself with a long acting Insulin. If that goes wrong your only option is more carbs and the cycle continues.
I also note you are new here and assume you are newly diagnosed which for me meant having to wait a couple of years for things to calm down and get near to the same.

Good Luck.

 

[SJS5]

The at meal dose for me lasts around 2-3 hours so I take more after that. I normally have to be up every 4 or so hours to go to the toilet so any additional injections are not are problem.

I do not do any such thing. Even after my Bertie course and counting carbs I found it of little use.
I just experimented and kept to my previous results. I do not care if I venture into the teens at night. I just adjust and make a note for the future when I have consumed the same food and see if it happens again.
Having a 13 at night for me is no big deal as long (as long the Steak was good) and it is not regular occurrence.
I would rather be adjusting throughout the night with a quick release Insulin than filling myself with a long acting Insulin. If that goes wrong your only option is more carbs and the cycle continues.
I also note you are new here and assume you are newly diagnosed which for me meant having to wait a couple of years for things to calm down and get near to the same.

Good Luck.

Thanks for the advice..No I'm not a new diabetic.
I've had it for 29 years!
More recent is the low carb approach.
I'm sure I worried about high readings less when I was younger

I think having the libre also makes you see things you weren't aware of before.

 

[SJS5]

I find that my supposed fast acting insulin seems not to do the job too! My hba1c hovers mid 50s but pump was justified by my high exercise levels.
Like all of us you are anxious about complications etc. but I think it would also be detrimental to your mental and physical health to get up in the middle of the night to bolus!
I wish you luck with the basal regime but in the meantime perhaps you can up the protein/bolus ratio then split the dose between mealtime and bedtime to account for the delayed absorption.

Yes I think this approach may work better.Thanks for the advice.