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High BG readings before bedtime - help please

B

birchy66

Well-Known Member
Messages
143
Location
Essex, England
Type of diabetes
Type 1
Treatment type
Insulin
Can anyone help me please. I was diagnosed 6 months ago with Type 1. I am 66 years old :(. I take Novorapid based on carbs and Levemir before bed.
My problem is:-
I frequently get high BG readings just before bed, typically between 9 to 12 mmol/L. I've been in touch with my diabetic nurse who is really helpful. She has suggested that I add extra units of Novorapid (+4) to my evening meal carb bolus. This doesn't seem to help bring the readings down by itself and I usually have to resort to pounding the streets at night to have any effect on my BG. :crazy: I usually have a busy day and would really like to relax in the evening watching TV or doing what I'm doing now. Has anyone ever had this problem?
 
I normally give my daughter a correction dose if big over 12 which is normal half a unit of nova rapid .luckily her meter tells us how much insulin to give to correct her back to normal ,does your meter have this function if not maybe ask nurse about correction dose's x


Sent from the Diabetes Forum App
 
You can try increasing the late mealtime dose by an extra unit at a time to see how you get on ( after speaking to your nurse ). Alternatively, look at the type of meal you actually eat. Is it every meal or certain meals ? Can you eat less carbs on your evening meal ? Better than pounding the streets lol ! Good luck !
Mo
 
Shell1 said:
I normally give my daughter a correction dose if big over 12 which is normal half a unit of nova rapid .luckily her meter tells us how much insulin to give to correct her back to normal ,does your meter have this function if not maybe ask nurse about correction dose's x


Sent from the Diabetes Forum App
Click to expand...
Thanks for your help. My nurse has suggested adding 3 extra units of Novorapid which didn't seem to make a lot of difference. Now I have stepped it up to 4 units (as per nurse) on top of my meal carb bolus. This doesn't seem to make a difference either. But if I go for walk or just keep moving about round the house it goes down to anything between 7 and 9.
I guess I have the answer but not the one I want. Your meter sounds interesting, I'll look into that.
 
mo1905 said:
You can try increasing the late mealtime dose by an extra unit at a time to see how you get on ( after speaking to your nurse ). Alternatively, look at the type of meal you actually eat. Is it every meal or certain meals ? Can you eat less carbs on your evening meal ? Better than pounding the streets lol ! Good luck !
Mo
Click to expand...

As I replied to Shell1 I have added some extra units with my evening meal bolus but doesn't seem to make any difference unless I exercise. I keep very detailed records so I can look back at the different meals I have eaten. Even though different meals can be similar in terms of amount of carbs and type of carbs I can still get high readings. I have tried eating less carbs which means a smaller bolus and even added 4 extra units to the smaller bolus. Despite this I still get a high reading unless I exercise. I read that inactivity can cause insulin resistance so maybe this is what's happening. I will continue experimenting before I wear the pavements out!! Thanks for your help.
 
Hi. Yes, I wonder whether insulin resistance is playing a part in this? Are you overweight? How many NovoRapid units do you take before adding the +4? If overweight then I would try to keep the carbs down for a few weeks to see whether you can lose weight and the sugar should reduce. If your weight is normal then I'm afraid I can't think of anything to help. Certainly the exercise will be helping anyway.
 
Have you tried testing every hour after your evening meal to get a better idea of how its behaving? If your meal has a high fat content then your Novorapid might be running out before the carbs have been absorbed. If they're coming down and then rising it could be a sign of that.(Probably trying to teach you how to suck eggs) Are there 4/5 hours between your evening meal and bed? If high at night are they back down in the morning? Questions, questions eh? I had a similar problem a few months after diagnosis, I upped my evening meal bolus by 50% which worked for me and then a few months later it went back to the way it was (10g to 1 unit). No idea why though...................
 
Daibell said:
Hi. Yes, I wonder whether insulin resistance is playing a part in this? Are you overweight? How many NovoRapid units do you take before adding the +4? If overweight then I would try to keep the carbs down for a few weeks to see whether you can lose weight and the sugar should reduce. If your weight is normal then I'm afraid I can't think of anything to help. Certainly the exercise will be helping anyway.
Click to expand...

Hi, Thanks for your help. My BMI is 25.3 so yes I am technically overweight. My Novorapid dose varies for evening meal but usually around 7-8 units to which I am adding 4 extra units. I work on a 10 carbs to 1 unit basis and this seems to work for breakfast and lunch. Maybe as you suggest I will reduce the carbs a little. The diabetic nurses at hospital said I can eat pretty much what I want as the bolus will take care of the carbs (if calculated correctly!). My total carb intake daily is approx. 150 - 200g, which I think is OK?
I do try to avoid fatty foods in the evening as had trouble with this before.
 
Rockape671 said:
Have you tried testing every hour after your evening meal to get a better idea of how its behaving? If your meal has a high fat content then your Novorapid might be running out before the carbs have been absorbed. If they're coming down and then rising it could be a sign of that.(Probably trying to teach you how to suck eggs) Are there 4/5 hours between your evening meal and bed? If high at night are they back down in the morning? Questions, questions eh? I had a similar problem a few months after diagnosis, I upped my evening meal bolus by 50% which worked for me and then a few months later it went back to the way it was (10g to 1 unit). No idea why though...................
Click to expand...

Thanks. I must admit I have never tried the hourly testing or any post meal testing probably because I fear the results. But I will try this to see what's happening. I try to avoid fat at evening meal as I've detected this problem before. There are always at least 4-5 hours between evening meal and bed. My fasting reading pre-breakfast is consistently 7 to 7.5. I take 16 units of Levemir at bedtime. Generally my pre meal readings during the day are pretty good, at least the diabetic nurses say so. They have only ever mentioned pre meal readings and the range they gave me was 5 to 9 mmol/l, probably to avoid hypos. My HbA1c first time round was 7.6 and next test is due in December.
 
Hi. You are only a little overweight and your carb intake is not too bad. I'm not sure I would totally go along with your DN. Yes, you can eat what you want and adjust your Bolus to match but that can be a good way of putting on weight. Even on insulin you need to control calorie/carb intake to avoid weight gain. I try to keep below 150gm/day. Your Bolus of 7-8 is not much above mine. Sounds like you are doing things pretty well but perhaps reducing the carbs a bit might help. Other than that the sugar rise does seem strange
 
Ref the testing after meals, don't be tempted to give a correction dose until 4/5 hours have passed as you're obviously going to get higher readings after eating. Aye, still hate the countdown on the meter! but every reading's just more information. Don't know about Levemir as I'm on Lantus. but another possibility is that your Basal isn't lasting the full 24hrs. Some split the dose every 12 hours to get better cover, but mine seems to last ok, but I'd get more advise on that one before trying it. I'm about 160g carb a day.
 
Daibell said:
Hi. You are only a little overweight and your carb intake is not too bad. I'm not sure I would totally go along with your DN. Yes, you can eat what you want and adjust your Bolus to match but that can be a good way of putting on weight. Even on insulin you need to control calorie/carb intake to avoid weight gain. I try to keep below 150gm/day. Your Bolus of 7-8 is not much above mine. Sounds like you are doing things pretty well but perhaps reducing the carbs a bit might help. Other than that the sugar rise does seem strange
Click to expand...

Thanks Daibell, your suggestions are really helpful. I must admit I was a little dubious about the DN's advice. I'll try the reduced daily carb route. Do you get hungry with less than 150g and does this include any snacks? Also I was told by the DN to bolus for carbs only, nothing else.
 
Rockape671 said:
Ref the testing after meals, don't be tempted to give a correction dose until 4/5 hours have passed as you're obviously going to get higher readings after eating. Aye, still hate the countdown on the meter! but every reading's just more information. Don't know about Levemir as I'm on Lantus. but another possibility is that your Basal isn't lasting the full 24hrs. Some split the dose every 12 hours to get better cover, but mine seems to last ok, but I'd get more advise on that one before trying it. I'm about 160g carb a day.
Click to expand...

The only times I have given a correction dose is when I have had a high pre-meal reading and then added it to the carb bolus. The DN never mentioned taking Novorapid at any times other than mealtimes. Can I correct just before taking my Levemir at around 10.00pm to 10.30pm as this is when I do my bedtime BG test?
 
Hi Birchy
I wouldn't give a correction dose until you've discovered what the reason for the high levels are. Unless your readings are really high and there are ketones present. Or unless you're confident of how much a unit of novorapid will drop your sugar by and that it won't cause a hypo during the night. Personally I'll have a correction dose at bedtime if I'm in double figures but only happens if I've eaten out and haven't guessed right!
 
Thanks Rockape, I agree it might be risky at this stage. never had a hypo in the night and would rather keep it that way. I've got plenty to keep me busy trying different ways of getting the readings down and it doesn't happen every evening anyway. I'm off for a plod to Asda, hopefully stress at the checkout won't raise my BG!
 
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