Glucose rise falling asleep

Peyote

Newbie
Messages
4
Hey all

This is my first post here, so sorry if something is out of place. :)

I have been having a issue for a fairly long time now, that I have not been able to solve even with help from my diabetic team.

My problem is that I see a huge increase in my bloodsugar the first couple of hours after I fall asleep. My bloodsugar is pretty stable during the hours I am awake, and my h1abc have been around 7.0 mmol/l for the last couple of years.

I have a Libre so it is pretty clear to see that as soon as i fall asleep my bloodsugar starts to rise. just this night i went to bed with a bloodsugar on 5.8 mmol/l, woke up 2 hours later with it being 20.0 mmol/l. That is a typical pattern and the curve is fairly steep so it happens quite fast after I am sleeping. It ruins my sleep as I wake up due to the high bloodsugar and finds it hard to fall back to sleep again while the bloodsugar is still high. When i correct with Fiasp the bloodsugar will fall back to a normal level and not rise again during that night/morning.
Also if I take a nap during the day, there is no rise.

What I am thinking now is that there most be something in my body that triggers the glucose to be released as I fall asleep, but i have no idea on how to fix that. Anyone here who have been through something similar and found a solution that might be worth a try?

I am on 20 units of Tresiba and Fiasp per need - 1 unit will lower 2 mmol/l and carb ratio is 1:10g.
I have tried to take more/less Tresiba and also to take it at night/morning, but does not see any change other than my bloodsugar being too low during the day when i increase the Tresiba.
As it does not happen everyday and it changes a lot on how high my bloodsugar will go, I cannot correct it with Fiasp before i go to bed as there is a great risk of overdosing if the rise does not happen.

It does not seem to be directly food related, even if I haven't been eating for a while before going to bed or eat something just before, it still happens. And if I am eating low/high carb it is still the same.

Best
Kasper
 
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Antje77

Oracle
Retired Moderator
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I have a Libre
Do you use a Libre1 or Libre2? Seeing as it doesn't always happen, perhaps you could use it to alarm you when you start to rise and correct before you're very high?

I sometimes get a rise around 6 am, very much the middle of the night for me, and sometimes not. I use the alarm for this. If I put my Fiasp next to my bed, already primed with the dose I want to take should I rise, I need to be hardly awake to silence the alarm, grab the pen and inject, so minimal sleep disturbance.
It doesn't always work, but it does a lot of the time.
 

StewM

Well-Known Member
Messages
390
Type of diabetes
Type 1
Treatment type
Insulin
Hey all

This is my first post here, so sorry if something is out of place. :)

I have been having a issue for a fairly long time now, that I have not been able to solve even with help from my diabetic team.

My problem is that I see a huge increase in my bloodsugar the first couple of hours after I fall asleep. My bloodsugar is pretty stable during the hours I am awake, and my h1abc have been around 7.0 mmol/l for the last couple of years.

I have a Libre so it is pretty clear to see that as soon as i fall asleep my bloodsugar starts to rise. just this night i went to bed with a bloodsugar on 5.8 mmol/l, woke up 2 hours later with it being 20.0 mmol/l. That is a typical pattern and the curve is fairly steep so it happens quite fast after I am sleeping. It ruins my sleep as I wake up due to the high bloodsugar and finds it hard to fall back to sleep again while the bloodsugar is still high. When i correct with Fiasp the bloodsugar will fall back to a normal level and not rise again during that night/morning.
Also if I take a nap during the day, there is no rise.

What I am thinking now is that there most be something in my body that triggers the glucose to be released as I fall asleep, but i have no idea on how to fix that. Anyone here who have been through something similar and found a solution that might be worth a try?

I am on 20 units of Tresiba and Fiasp per need - 1 unit will lower 2 mmol/l and carb ratio is 1:10g.
I have tried to take more/less Tresiba and also to take it at night/morning, but does not see any change other than my bloodsugar being too low during the day when i increase the Tresiba.
As it does not happen everyday and it changes a lot on how high my bloodsugar will go, I cannot correct it with Fiasp before i go to bed as there is a great risk of overdosing if the rise does not happen.

It does not seem to be directly food related, even if I haven't been eating for a while before going to bed or eat something just before, it still happens. And if I am eating low/high carb it is still the same.

Best
Kasper
When you say it starts when you go to sleep, is it always triggered by sleep itself? I.e. if you stayed away an hour later, the spike would be delayed to by an hour?
 

ert

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fasting
Have you tried testing your basal by skipping dinner (or eating a carb-free meal)?
 

Peyote

Newbie
Messages
4
@Antje77 i am sadly still on libre 1 and not that easy to change due to regulations in my country. otherwise that would have been a good start.

@StewM yes it is always by sleep, if I go to bed at 9 one day and 12 the other, it will only happen during sleep and not in-between if I am awake

@ert yes I did this numerous times as I suspected that it could be the case in the beginning. But always return to 20 units as this is the most stable

I also tried to split the dose of tresiba morning/evening per request of my doctor but this had no effect.
 

Antje77

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Retired Moderator
Messages
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Type of diabetes
LADA
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@Antje77 i am sadly still on libre 1 and not that easy to change due to regulations in my country. otherwise that would have been a good start.
Depending on how much benefit you'd expect from having alarms, you could invest in a MiaoMiao, basically turning the Libre1 into a CGM.
 

StewM

Well-Known Member
Messages
390
Type of diabetes
Type 1
Treatment type
Insulin
@Antje77 i am sadly still on libre 1 and not that easy to change due to regulations in my country. otherwise that would have been a good start.

@StewM yes it is always by sleep, if I go to bed at 9 one day and 12 the other, it will only happen during sleep and not in-between if I am awake

@ert yes I did this numerous times as I suspected that it could be the case in the beginning. But always return to 20 units as this is the most stable

I also tried to split the dose of tresiba morning/evening per request of my doctor but this had no effect.
"As it does not happen everyday and it changes a lot on how high my bloodsugar will go,"

How frequently does it occur roughly? What's the variability in Blood Sugar peaks?

"But always return to 20 units as this is the most stable"

What happens when you increase your Basal?
 

Peyote

Newbie
Messages
4
"As it does not happen everyday and it changes a lot on how high my bloodsugar will go,"

How frequently does it occur roughly? What's the variability in Blood Sugar peaks?

"But always return to 20 units as this is the most stable"

What happens when you increase your Basal?

It happens 3-4 times a week, no pattern in days with or without going to work. Usually it peaks within 15-20 mmol/l. Never goes much over 20 and the "trending arrow" on the libre never shows an increase when it hits the 20's

Tried to increase Basal slowly to 25 over a period recently, but this gave too many lows and a jumpy blood sugar where i took little Bolus because it would go low after eating even without the Bolus. Still had the peaks 3-4 times a week but now the rest of the days i had lows in the early morning.
With 20 units on the days where there is no peak, it is completely stable during night, even at 19 units it starts to rise very little during the "good" nights and a need for more Bolus when eating.
 

StewM

Well-Known Member
Messages
390
Type of diabetes
Type 1
Treatment type
Insulin
It happens 3-4 times a week, no pattern in days with or without going to work. Usually it peaks within 15-20 mmol/l. Never goes much over 20 and the "trending arrow" on the libre never shows an increase when it hits the 20's

Tried to increase Basal slowly to 25 over a period recently, but this gave too many lows and a jumpy blood sugar where i took little Bolus because it would go low after eating even without the Bolus. Still had the peaks 3-4 times a week but now the rest of the days i had lows in the early morning.
With 20 units on the days where there is no peak, it is completely stable during night, even at 19 units it starts to rise very little during the "good" nights and a need for more Bolus when eating.
I would expect a reaction like that from raising your dose by 25%. 22 units would seem like a better place to start.

The fact the peaks persist on even a clearly too high Basal Dosage suggests that the Bolus might be where the problems lie. An appropriate dose Tresiba doesn’t respond well to an inappropriate dose of Bolus. Due to the late nature of the Peak, have you tried pushing your Bolus later, splitting or just simply taking a higher dose. You may need to do some combination of the three to get rid of the peak.
 

Richard F

Well-Known Member
Messages
222
Type of diabetes
Type 1
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Insulin
I have a similar situation, often but not always starts to rise 22.00-23.00. I'm on a pump I've increased my basal for late evening.

If it's an evening where the rise appears to be happening I take a 1-2u correction before I go to sleep. Not an exact science though.
 

StewM

Well-Known Member
Messages
390
Type of diabetes
Type 1
Treatment type
Insulin
Oh sorry there’s a fourth option changing the timing of your Tresiba injection. I find Tresiba not as flat as advertised and the timing of the injection can massively effect any peaks or troughs that occur.
 

sgm14

Well-Known Member
Messages
189
Not sure how quickly you would fall asleep if your blood sugar is not extremely high, but would it be possible to set an alarm to wake you up say an hour after you go to sleep. That way, if your blood sugar has not started rising, you can just go back to sleep, but if it is rising you may be able to take a correction dose before it gets too high that stops you from getting back to sleep. You would obviously need to be careful about the size of the correction dose.

It would also be interesting to know if your blood sugar continued to rise after you woke up or stopped rising and whether it rises again when you go back to sleep.

I have heard of diabetics who have sleep disorders which causes them problems with their control, so is it possible this is some sort of undiagnosed sleep disorder? You could try cutting out caffeine to see if this has any effect and maybe reading up on what else can cause sleep issues.

I would consider having BS levels around 20 for most of the night (or not being able to sleep) to be a pretty serious issue, so maybe ask your diabetic team if it is worthwhile being referred to a sleep specialist. At the very least they would probably know if I am talking rubbish or whether this is possible.
 

Peyote

Newbie
Messages
4
Thanks a lot for all your suggestions and ideas on this, it is really helpful :)

@StewM When you say pushing the bolus to later, would you then suggest waiting for my blood sugar to respond after eating and/or splitting the dose to limit the steep rise/fall? It sounds possible that the wrong dose of bolus could have that effect and with a mix of a little higer basal combined with more patience with the bolus could solve the issue. I will definitely give that a go.

Richard F - I do the same thing if I can see a rise before falling a sleep, but my issue is that it is so hard to tell how much correction I will need that I often end up with the high anyway.

Sgm14 - I have done some of that, but like mentioned above, I often find that the correction dose that I feel confident to take at the given measurement will often not be enough to correct the rise very much.
I also tried cutting out things that I thought could have an impact like caffeine, certain types of carbs/foods etc. but never found it to make a difference and seeing that it happens in the same pattern when basal testing I do not think it is where the issue is at the moment.
I have addressed this issue many times with my diabetic team but they kinda brushes it off as nothing since the rest of my values are within the range. They look at the h1abc and the graphs that libreview creates, seeing the median is within the limits and does not care about the 25% peaking at 20 mmol/l... I gave up on them trying to solve the puzzle and turned to this forum which already provided me with more trials than they have done.
 

StewM

Well-Known Member
Messages
390
Type of diabetes
Type 1
Treatment type
Insulin
Thanks a lot for all your suggestions and ideas on this, it is really helpful :)

@StewM When you say pushing the bolus to later, would you then suggest waiting for my blood sugar to respond after eating and/or splitting the dose to limit the steep rise/fall? It sounds possible that the wrong dose of bolus could have that effect and with a mix of a little higer basal combined with more patience with the bolus could solve the issue. I will definitely give that a go.

Richard F - I do the same thing if I can see a rise before falling a sleep, but my issue is that it is so hard to tell how much correction I will need that I often end up with the high anyway.

Sgm14 - I have done some of that, but like mentioned above, I often find that the correction dose that I feel confident to take at the given measurement will often not be enough to correct the rise very much.
I also tried cutting out things that I thought could have an impact like caffeine, certain types of carbs/foods etc. but never found it to make a difference and seeing that it happens in the same pattern when basal testing I do not think it is where the issue is at the moment.
I have addressed this issue many times with my diabetic team but they kinda brushes it off as nothing since the rest of my values are within the range. They look at the h1abc and the graphs that libreview creates, seeing the median is within the limits and does not care about the 25% peaking at 20 mmol/l... I gave up on them trying to solve the puzzle and turned to this forum which already provided me with more trials than they have done.
You could certainly do it that way. If it was me, I'd just move the timing back a couple of minutes at a time, so I could monitor the effects of the change, and base my decisions on what to do further based on the results I saw.