High BG at bedtime

[birchy66]

Ever since being diagnosed Type 1 last April I have had trouble getting my pre-bedtime BG level down. My DSN put me on a 1:10 bolus ratio which works OK during the day but not at evening meal. I get a good BG reading if I move about in the evening or exercise before bed, which at 66 years of age is not always welcome. Don't get me wrong I am pretty active but enjoy a rest in the evening.

My DSN suggested taking a couple of extra units of Novorapid on top of my 1:10 bolus, which made no difference. I have recently self-adjusted my evening meal bolus to 1:6 and this has made no difference either. I visited the consultant doctor at the diabetic centre at hospital who advised me not to mess around with the 1:10 ratio.

If I don't exercise then my pre-bedtime BG can be as high as 13mmol/L but falls to around 6mmol/L by morning. Low carb evening meal doesn't seem to make a difference either. The doctor said don't worry too much about this as my HbA1c a week ago was down to 7% (53) which he said is were it should be. He also said that a higher BG reading at bedtime is just my body preparing for the night and also helps to avoid nighttime hypos.

I was encouraged but not completely reassured and still worried. Any comments anyone?

 

[hale710]

If you're dropping from 13 to 6 overnight then it would suggest your background insulin could be too high, or that you are still experiencing a honeymoon period.

Has anyone mentioned a DAFNE course to you? I was diagnosed last February and completed DAFNE in November. It really helps with getting your ratios correct


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[birchy66]

If you're dropping from 13 to 6 overnight then it would suggest your background insulin could be too high, or that you are still experiencing a honeymoon period.

Has anyone mentioned a DAFNE course to you? I was diagnosed last February and completed DAFNE in November. It really helps with getting your ratios correct


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Thanks hale, I think DAFNE would be a great idea. I've got lots to learn.

 

[Daibell]

An HBa1C of 7% is bit on the high side? I would aim for it to be nearer 6.5% if you can. Could you reduce your evening meal carbs a bit; perhaps you already have.

 

[G2ADY]

Hi, Birchy66

From what you've said, if you're dropping from 13 to 6 during the night then I'd agree with Hale710 that your Basal is too high. It may be worth dropping your Basal by a couple of units and monitoring it. Whenever I've had a shift in insulin needs I've tried to fast and miss breakfast and lunch to see what effect the Basal is having on my Blood sugars. If you plan on doing this then test and record your BS when getting out of bed and then every two hours. Try not to do too much exercise during this test. I used to take 26 units of Basal a few months ago. Suddenly I changed almost over night and was spending most of my time defending hypos. I managed over a couple of days to get to grips with it. Now I only use 12 units of Basal on average per day.

Once you've found a stable level then you may need to crank up your Bolus a little. This should prevent your BS going up to 13.

Don't get me wrong, I'm still new to all this but I've thrown myself into carb counting quite heavily. This free online course was a great help http://www.bdec-e-learning.com I'm also attending a DAFNE course this month to see if I can pick up any more tips.

Good luck

Steve

 

[birchy66]

Hi, Birchy66

From what you've said, if you're dropping from 13 to 6 during the night then I'd agree with Hale710 that your Basal is too high. It may be worth dropping your Basal by a couple of units and monitoring it. Whenever I've had a shift in insulin needs I've tried to fast and miss breakfast and lunch to see what effect the Basal is having on my Blood sugars. If you plan on doing this then test and record your BS when getting out of bed and then every two hours. Try not to do too much exercise during this test. I used to take 26 units of Basal a few months ago. Suddenly I changed almost over night and was spending most of my time defending hypos. I managed over a couple of days to get to grips with it. Now I only use 12 units of Basal on average per day.

Once you've found a stable level then you may need to crank up your Bolus a little. This should prevent your BS going up to 13.

Don't get me wrong, I'm still new to all this but I've thrown myself into carb counting quite heavily. This free online course was a great help http://www.bdec-e-learning.com I'm also attending a DAFNE course this month to see if I can pick up any more tips.

Good luck

Steve

Thanks G2ADY,
Lots to think about. Dropping from 13 to 6 doesn't always happen, like last night I was 9.5 and 8.3 this morning. Not great I know but would this point to my basal of 16 units being OK?

Hi, Birchy66

From what you've said, if you're dropping from 13 to 6 during the night then I'd agree with Hale710 that your Basal is too high. It may be worth dropping your Basal by a couple of units and monitoring it. Whenever I've had a shift in insulin needs I've tried to fast and miss breakfast and lunch to see what effect the Basal is having on my Blood sugars. If you plan on doing this then test and record your BS when getting out of bed and then every two hours. Try not to do too much exercise during this test. I used to take 26 units of Basal a few months ago. Suddenly I changed almost over night and was spending most of my time defending hypos. I managed over a couple of days to get to grips with it. Now I only use 12 units of Basal on average per day.

Once you've found a stable level then you may need to crank up your Bolus a little. This should prevent your BS going up to 13.

Don't get me wrong, I'm still new to all this but I've thrown myself into carb counting quite heavily. This free online course was a great help http://www.bdec-e-learning.com I'm also attending a DAFNE course this month to see if I can pick up any more tips.

Good luck

Steve

 

[G2ADY]

Thanks G2ADY,
Lots to think about. Dropping from 13 to 6 doesn't always happen, like last night I was 9.5 and 8.3 this morning. Not great I know but would this point to my basal of 16 units being OK?

Yeah to be fair it would indicate that your basal is somewhere around being right. Have you analysed what causes the spikes? Is it a particular food or is it on an evening when you've had some alcohol perhaps?

Of course when carb counting it's always a guessing game as to how many carbs you're consuming, especially if eating out.

Take a look at the link I sent to the short online course at Bournemouth Uni. It's very helpful and may help you keep a tighter control. There's nothing more concerning that blood sugars fluctuating without you expecting it.

Steve

 

[hale710]

If it doesn't happen every night I would hazard a guess that you're in the honeymoon period. If I go to bed at 7 I wake up at 7. But if I go to bed at say 12, I'll also wake up at 7 lol it's a handy little party trick at times


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[birchy66]

Yeah to be fair it would indicate that your basal is somewhere around being right. Have you analysed what causes the spikes? Is it a particular food or is it on an evening when you've had some alcohol perhaps?

Of course when carb counting it's always a guessing game as to how many carbs you're consuming, especially if eating out.

Take a look at the link I sent to the short online course at Bournemouth Uni. It's very helpful and may help you keep a tighter control. There's nothing more concerning that blood sugars fluctuating without you expecting it.

Steve

Thanks again G2ADY,
I will have to spend more time testing my post meal BG. I do try to avoid high GI foods but not too strictly. I hardly ever touch alcohol as it messes with my blood pressure medications.

 

[birchy66]

If it doesn't happen every night I would hazard a guess that you're in the honeymoon period. If I go to bed at 7 I wake up at 7. But if I go to bed at say 12, I'll also wake up at 7 lol it's a handy little party trick at times


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So what you're saying is that my pancreas is still producing a little insulin that lowers my BG overnight. I always thought it was the basal that did this - as I said I have lots to learn.

 

[hale710]

It might not be... But it might be. Have you done any dating tests during the day to check it out?


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[birchy66]

It might not be... But it might be. Have you done any dating tests during the day to check it out?


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How do I do dating tests for my basal? Would this be along the lines that G2ADY suggested which involves daytime fasting?

 

[G2ADY]

How do I do dating tests for my basal? Would this be along the lines that G2ADY suggested which involves daytime fasting?

HI Birchy,

This will help. It's important to understand what you're trying to discover during the test. Remember to have some glucose tablets in stock before you do any testing in case you drop too low. http://www.nzms.co.nz/media/documents/ANIMAS Resources/Guidelines for Basal Rate Testing.pdf

 

[G2ADY]

Bear in mind however, that particular guide makes references to adjusting Basal rates during the day so it is aimed specifically at pump users. That said, you could still use the same testing method even if you are injecting Basal once daily.

 

[birchy66]

Bear in mind however, that particular guide makes references to adjusting Basal rates during the day so it is aimed specifically at pump users. That said, you could still use the same testing method even if you are injecting Basal once daily.

Thanks for your help G2ADY. This is a really helpful guide.