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Freestyle Libre - Being high in the night

RobertJ

Well-Known Member
Messages
260
Location
Cambridgeshire, United Kingdom
Type of diabetes
Type 1
Treatment type
Pump
I've been giving the same amount of Levemir before bed for about a year now. I've had a Freestyle Libre since May 2016.

There have been periods of a week or so when most nights have been in target. When that happens I think I've finally cracked it.

Every now and again though, I just go off the rails. I still often get a horizontal line on the graph, it's just a horizontal line that's out of target.

Last night my blood test kit said 8.9 before bed. The Libre said 9.3. I gave 1 unit of Novorapid to get it down and back into target and gave the normal amount of Levemir. When I woke up the next morning it was 11.5 and the line was above the target range all night. Has anyone experienced similar trends where it just seems baffling as to why it won't go down at bed time?
 
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Hi @RobertJ might I suggest reposting this in the Type 1 forum, or asking a mod to move it for you, where more people will see it? Since this is really more about your sugar levels themselves than monitoring specifically.

I think every diabetic probably has times when it just won't go down. Did you have a particularly fatty meal last night? Or was it colder than it has been? Did you struggle to get to sleep/wake up more frequently? Those are all things that can keep me higher.

It is really great that you are looking for answers - I have a tendency to just complain about it! However, I think sometimes this disease does things like that just for fun, for no real rhyme and reason - as you say, just when you think you've got it to behave itself for a good thirty or forty seconds!
 
Have you done a basal test? If your usually getting flat lines through the night it sounds like your basal is probably right, but it might be worth checking.

If your basals right the the rises must be something to do with food, bolus, activity/stress. If you've had a "pizza effect" type meal that might cause highs later on in the evening, or even in the middle of the night, so if it's starting to climb because the carbs only start working, breaking through the fat, as you go to bed your usual correction might not be enough because you also need to cover the carbs that are now released.
 
Hi both. Thanks for your answers.

I've had the condition since 2003 but it was only in the last year or so that anyone told me stress could be a factor. Do you know how this affects things exactly?

I guess it was a fairly fatty meal, maybe. How do you know how much of a correction to give when this happens, @catapillar?
 
Stress usually sends blood sugar up.

No one can tell you how much of a correction to give. It's just got to be trial and error based on what you've eaten. Lots of people will split bolus for a fatty meal, so give half the bolus when eating half later. But a high fat meal can require more insulin than normal I think because the fat makes you resistant.
 
I thought I'd revisit this thread as this problem is still happening. I thought I'd solved the problem about two weeks ago with three nights "in target" in a row but in the past seven days all nights but one have been above target. It's very frustrating and upsetting.

Last night my blood test kit said 7.1 and the Libre said 6.7. I gave the usual dose of background and it was then high over the whole night. It was about 11.5 when I woke up.

This kind of thing is happening all the time. It's so weird. How fatty does a meal have to be to exhibit the pizza effect?
 
Hi Robert, in order for us to give you some assistance, you're going to need to provide a few more details.

What does your last six hours before taking your levemir look like? When do you eat? What do you eat? When do you exercise? etc. All of these things can have an effect and without getting into the nitty gritty of timing, it's often hard to provide advice!
 
How late did you eat? When I go to bed feeling happy with myself at 5.5mmol and a straight line and then wake up the next morning and realise from my CGM trace that I spent the whole night at 10mmol+ it's usually because I ate later than usual and/or had a particularly high-fat/high-carb meal and the BG rises didn't start until after I'd fallen alseep.
 
Thanks, @tim2000s and @pinewood. In the last six hours before taking Levemir I did a few things. As it happens I walked to a pub, had one pint of beer, then walked back. I injected five units when I got to the pub as I'd had an Royal Gala apple earlier and it was going up a bit and I beer always makes me go really high if unchecked.

I had a meal at about 7:30 in the evening and gave 12 units of Novorapid to cover this, injecting before the meal. My reading went up a bit, obviously, then by about 9pm was stabilising to around 7.0.

At 10pm it was 6.7 on the Libre and 7.1 on the blood test kit. I gave 11 units of Levemir thinking that finally a night spent in the target range was on the cards. Obviously this was wrong.

Perhaps the beer-drinking aspect of this makes it a bad example. Over last week, I've had a few nights where it's been around 9 at the time I want to go to bed and whether I give 1 or even 2 units it just doesn't do anything. I still end up being high all night.
 
Hi @RobertJ - I guess the question overnight is then, what were you eating? And secondly, have you done a basal test?

Levemir is notorious for not lasting 24 hours and is best used in two doses, so it's quite likely that from late afternoon until about midnight, you don't have any basal insulin on board and are covering the gap with the boluses you take. The 10pm levemir injection will take up to two hours to kick in. I think it's definitely worth redoing a fasted basal test.
 

Hi @tim2000s. At the moment I do do two basal injections: one at about 6-7am and the other at 10-11pm. It's 4.5 units in the morning and 11 in the evening. Do you think even doing it this way the morning one is wearing off by the evening and therefore creating a gap where there's nothing at all?
 
There probably will be a gap in the evening where your AM levemir is done.....

I done the same as you, taking my PM levemir closer to bed time to help with the Dawn Phenomenon...

I didn't observe a huge rise post evening meal but I lost any deficit in my meal time bolus....

the assistance in the morning was crucial for me, even though in the end it wasn't enough....hence the pump.....

so the way your doing it has some positives....

have you noticed any dawn rise....?
 
So what about if I did the basal injection at, say, 9pm? Would that be a sensible idea in the sense that it would kick in earlier?

Given that I wake up quite early most of the time (and then do another basal injection), I don't see how there would be a problem with it dropping off at the other end.
 
It wouldn't be an issue no.....

you should carry out a basal test from evening meal till bed.....see if it is in fact running out....the libre would make this easy...

do you take a reading right before bed?
 
Yes I do check right before bed. The readings I was referring to were very much before bed.

This might be a really, really stupid question but what's a basal test?
 
You are focusing on the high BG. Do you have a low BG before that which you sleep through?
If you do not treat a hypo, eventually, your body may react by releasing lots of glucogen which will lead to a high. As you are using a Libre, this should be easy to check.
 

No, I don't have hypos in the night. It tends to go up shortly after I go to sleep and then stay high (albeit level) all night. A similar problem is when it's around 9ish before bed and 1 or 2 units of Novorapid has seemingly no effect.
 
Last night was another disaster. It was 4.4 about an hour before bed so I had an oatcake. Then at the time I wanted to go to bed it was 8.6 so I have 1 unit of Novorapid. I'd done by basal injection at about 9:30 and was wanting to go to sleep by 10:30.

When I woke up it was 13.9 and had been high for the entire time I'd been asleep.

I've had Type 1 since 2003 and it's probably the case that 99+ percent of that time I've had high blood sugar levels during the night. It's only since I got the Libre that I learned how bad this whole thing was.

As you can see in my original post, I don't think my background is wrong as I have gone through three, four, five days in a row where the nights are under control. At the moment, though, it's totally off the rails.
 
RobertJ said:
This might be a really, really stupid question but what's a basal test?
Click to expand...

Its not silly at all...

A basal test is a test of your long acting [basal insulin]....

This insulin is meant to hold your blood sugar steady in the absence of digesting food and/or active quick acting [bolus] insulin...

So to test you need have no digesting food or bolus on board.....

overnight is usually the easiest and first place you should start....

so let your dinner food and insulin deplete and test before bed, you wouldn't correct either unless you really have to, in which case abandon the test...

the libre can map out your blood sugar throughout the night and show you if the dose your taking at bed is right....

And its right if your blood sugar doesn't go up or down by more than 2mmol....I personally use 1.7 for the pump
 
I tend to take the view that if I run high 2 nights in a row and am pretty certain that my food/insulin has run out before bed that it's my basal which needs adjusting.

Running high can be for various reasons, so exercise, stress, adrenaline, hormones, illness/infection or simply because the insulin has gone off, if you've changed your basal pen for a new one and it's still running high then you will need to look at your dose. The libre has done the same for me, so pinpointed when it's rising and shown me where I need to adjust. I will be honest I don't take it as a given that my basal dose is constant either, it changes throughout the year, more in winter, less in Summer etc, there's many reasons why you need to increase/decrease but it's seeing a pattern and knowing when to adjust.
 
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