Type 1 High blood sugar during the night.

[chrisbug]

Hi, up until the last 3 weeks my overnight results were excellent, normally a level 6.5mmol/L.
I'm using Libre 1 with XDrip via MM.
Now I'm having high readings at 01:30 to 02:30 AM. Typically reaching 12 mmol/L.
If I catch it early enough (9mmol/L) I take a correction dose only and my BS comes down nicely within 1.5 hours.
If I miss that sweet spot, I'll be taking correction dose and on my bike trainer over a 2 hour period and really fighting with it.
My carbs remain constant, and nothing else has really changed. I do have unplanned bursts of activity at work, which I treat any impending or occurring low blood sugars successfully and things seem to level out well.
I've never really suffered from dawn phenomenon (apart from struggling to pronounce it)!
I'm using Humalog and Tresiba.
I can't increase my evening meal dose as that will cause low BS right before bed, I don't want to even attempt a basal test currently (or turn off my XDrip alarms) as I fear without my overnight corrections I'll be very high when I wake and it would be for a prolonged period.

So I'm finding it absolutely exhausting, I've emailed my DN and awaiting a response.
And I don't really know how to tackle what to adjust to come up with a solution.
And what has suddenly changed to cause this?

I would greatly appreciate any suggestions that I could try...

Thanks

 

[ert]

I would start by skipping dinner to check my basal dose. If my basal is correct I would consider changing some variables such as: what time you were eating? How much fat is in your meal? Higher fat content can meal there is a delay in breaking down the carbohydrate in a meal. If these weren't issues then I would also try cutting back on the carbohydrate in my night meal or consider walking for 20 minutes before bedtime.

 

[NicoleC1971]

You could run the experiment of not correcting to see if the tresiba smooths things out. I suppose the fact that you are no bouncing into a low after correcting suggests this won't happen but wondered if the stress of waking to correct might even be enough to push you up . Thanks to cortisol + glucagon push.
You could experiment with Tresiba timing. I am a pump user but I've previously tried dose splitting to even out delivery. I know it is a good insulin but all of them have some kind of peak affect.
You haven't changed what you ate but is that just the carbs or have you added something like extra fat/protein that would slow digestion down into the wee small hours? If you can keep your food to at least 4 hours before bed maybe that will help clarify if this food, stress or delayed digestion (gastroparesis).
I know it is frustrating but I do think you need to get some sleep and turn off that alarm then see if this pattern is still happening once your energy levels are up and stress is down. Hope the DSN can offer some useful tips.
This happens to me in the day but with pump I can tweak hourly basals to get ahead of it. Once its gotten high as you say, it is hard to manage. TSlim Basal IQ + Dexcom G6 which autocorrects for slight highs should be my salvation!

 

[Daibell]

One point ref Tresiba. As you don't split it, it's not as easy to adjust for overnight use as it is with Levemir which is normally split. You may want to consider moving to Levemir Basal?

 

[chrisbug]

Hi,
Thanks for your replies.
So skipping dinner is something I really worry about, I've greatly reduced my carb/food intake, and I'm continuously hungry, I immediately finished my lunch today and was still hungry! but I aim to have my evening meal at around 4 hours before bed, and tends to be sweet potatoes,
or reheated brown pasta, with fish or chicken, vegetables, that kind of thing. Gone are the days of pizza!
I'd considered the liver dump with the stress of waking, but I have been woken with a rising BS. Also I've once completely slept through a load of alarms and my BS has just carried on climbing from when the first alarm went off.
So I would generally say that the stress of waking is adding to the problem, not causing it.
I think light exercise before bed would, without adjusting my mealtime dose drop my BS by about 2 mmol/L? Which would send me low, but I'll explore adjusting my mealtime dose, and see what happens with a walk, or time on the bike trainer.
I like the idea of splitting my tresiba, I don't really want to do this without running it past my DN, as it stands now, I always inject tresiba just before bed and fear that I may forget to take an earlier dose.
I guess that overnight it's harder for me to lower my BS than in the day?
I'll definitely act on your suggestions (that I'm comfortable with) and report back here!
Thanks again

 

[chrisbug]

One point ref Tresiba. As you don't split it, it's not as easy to adjust for overnight use as it is with Levemir which is normally split. You may want to consider moving to Levemir Basal?

Oh, can't it be taken by splitting the dose?

I'd suggested to my DN that because It feels like I'm continously injecting bolus (split mealtime doses, correction doses overnight) I may as well be on a pump!

I kind of thought that altering the timing wouldn't make too much difference as tresiba is so forgiving?

 

[chrisbug]

I would start by skipping dinner to check my basal dose. If my basal is correct I would consider changing some variables such as: what time you were eating? How much fat is in your meal? Higher fat content can meal there is a delay in breaking down the carbohydrate in a meal. If these weren't issues then I would also try cutting back on the carbohydrate in my night meal or consider walking for 20 minutes before bedtime.

Hi ert,
majority of my evening meals are about 60g of carbs. And I avoid food that spike my BS, I also try to avoid too protein much in one hit.
I'm not a real foody type of person.
If my family are having pizza, I'll just have cod roe on wholemeal seeded (Lidl) toast (45g CHO), which has never caused me a problem.
I will try and have my evening meal earlier.

 

[KK123]

Hi ert,
majority of my evening meals are about 60g of carbs. And I avoid food that spike my BS, I also try to avoid too protein much in one hit.
I'm not a real foody type of person.
If my family are having pizza, I'll just have cod roe on wholemeal seeded (Lidl) toast (45g CHO), which has never caused me a problem.
I will try and have my evening meal earlier.

Hi there, you could also try a much lower carb dinner just to test it, maybe around 10/20 carbs for example. Once you've tried a few variables it may give you a better understanding as to what's going on...or it may not of course with this fickle mistress!

 

[chrisbug]

Last night I had my evening meal at 18:30, quite carby (79g reheated ravioli and wholemeal bread) with a split dose.
Basal dose and bed at 23:30.
A nice level night. I'll see if I can repeat it tonight?