High blood sugars at NIGHT, low in the morning

[SimonX]

I am Type 2 diabetic and am suffering from high sugars at night (between 9 and 15) but they are normal in the mornings (between 4 and 7). I already use Levemir (a slow release insulin) twice a day taking 42 units in the morning (recently increased from 38 but with no effect on my evening sugars) and 12 units at night and have been using this for about 4 years with a slowly increasing dosage rate - four years ago when I started on Levemir I was taking 12 units in the morning only. I also take Metformin and Forxigra. My weight is the lowest it has been in the last 20 years (71kg) and I am 5ft 6 inches in height. I eat sugar free cereal in the morning a normal lunch and an early light supper (around 7pm) which is usually fish or cold meat and salad. I almost never snack between meals. I have had relatively good control for the last year or so and only in the last 3 months have my evening sugars gone out of control and I can think of nothing at all which i am doing differently. Has anyone any advise or suggestions to offer.

 

[GrantGam]

I am Type 2 diabetic and am suffering from high sugars at night (between 9 and 15) but they are normal in the mornings (between 4 and 7). I already use Levemir (a slow release insulin) twice a day taking 42 units in the morning (recently increased from 38 but with no effect on my evening sugars) and 12 units at night and have been using this for about 4 years with a slowly increasing dosage rate - four years ago when I started on Levemir I was taking 12 units in the morning only. I also take Metformin and Forxigra. My weight is the lowest it has been in the last 20 years (71kg) and I am 5ft 6 inches in height. I eat sugar free cereal in the morning a normal lunch and an early light supper (around 7pm) which is usually fish or cold meat and salad. I almost never snack between meals. I have had relatively good control for the last year or so and only in the last 3 months have my evening sugars gone out of control and I can think of nothing at all which i am doing differently. Has anyone any advise or suggestions to offer.

Your basal dose seems quite imbalanced in terms of the majority of insulin dependant diabetics.

Usually we take an even split of Levemir, or in a lot of cases - more insulin for the night time period rather than the day time. This is due to the body requiring more basal insulin during sleep, where we are both inactive and also fasting.

Exactly what time in the evening is your BG high? Is it the wee hours when you're usually sleeping?

 

[SimonX]

Your basal dose seems quite imbalanced in terms of the majority of insulin dependant diabetics.

Usually we take an even split of Levemir, or in a lot of cases - more insulin for the night time period rather than the day time. This is due to the body requiring more basal insulin during sleep, where we are both inactive and also fasting.

Exactly what time in the evening is your BG high? Is it the wee hours when you're usually sleeping?

I test in the morning when I wake (usually about 8am) and inject then and test at night before going to bed (usually around 11pm) and then inject. So my sugars are high at 11pm and low at 8am. I started on 12 units of Levemir in the mornings only but as I have had increasing difficulties in controlling evening sugars it was suggested that I split my doasges and have been slowly increasing my morning dosage ever since because of my evening difficulties. Over the last 4 years I have had good control and ir is only in the last 6 months that I have lost the ability to control my evening levels even with higher morning Levemir dosages.

 

[GrantGam]

I test in the morning when I wake (usually about 8am) and inject then and test at night before going to bed (usually around 11pm) and then inject. So my sugars are high at 11pm and low at 8am. I started on 12 units of Levemir in the mornings only but as I have had increasing difficulties in controlling evening sugars it was suggested that I split my doasges and have been slowly increasing my morning dosage ever since because of my evening difficulties. Over the last 4 years I have had good control and ir is only in the last 6 months that I have lost the ability to control my evening levels even with higher morning Levemir dosages.

Do you know the overall picture of your BG throughout the day? It's very difficult to gauge what may be happening with your BG from just two tests a day.

One thing you might want to try is splitting your Levemir 12hrs/12hrs instead of your current 15hrs/9hrs. That may give you better basal coverage for the evening time.

Again, because we have very little info regarding your BG readings, pre and post-prandial its very hard to say, but there's always the possibility that you may need to introduce a bolus insulin into your regime.

It's entirely possible that your high evening BG's are a combination of gradually increasing BG levels as a result of there not being enough insulin on board to deal with the carbohydrates in your diet.

Do you have any idea as to how many grams of carbs you're consuming daily on average?

I'd go for testing at the following times each day for a week whilst keeping a food diary:

-First thing when you wake
-Before breakfast
-2 hours after breakfast
-Before lunch
-2 hours after lunch
-Before dinner
-Two hours after dinner
-Before bed

It may seem excessive but it takes measures like this to build a usable picture of what is happening to your BG and why.

 

[catapillar]

Levemir lasts about 12 hours, so your 8am dose will have worn out by 11pm when you're seeing high sugars. You've got normal numbers at 8am because your levemir will have kicked in and brought you down. If it's bringing you down from 15 to 4 you might need to be a bit cautious with it if you go to bed with normal numbers.