Type 1 Highs at 4am?

[sleepster]

Hello, I need some help!
I'm type 1, diagnosed 21 years ago, use novorapid in a pump since 2012 which I met the criteria for because I lost hypo awareness and was having fits from night time hypos.
Anyway lately my body clock has been very messed up, typically I am going to bed at 4am and getting up in the afternoon (the joys of being unemployed ), that's all good and well but I have noticed since Christmas I am going very high at bedtime, like 20+ high, which usually means staying awake until 6.30 or later doing blood tests and bolusing (usually temp basal as well) until it gets low enough for me to go to sleep. Most days when I wake up I am around 4.5-6
When my body clock wasn't quite so messed up I noticed the 4am highs after having a takeaway a few times so put the recent highs down to what I had been eating but now, with it being every night I just don't know.
Any suggestions please? I have an appointment at the diabetes clinic at my GPs on thursday, but I'm not massively confident they will be much good.
(For info today for tea (around 9pm) I had mince in gravy, mashed potato, carrots, peas, broccoli, cabbage and roast squash, tested about 3 hours after and I was 8.4 with 2 units of active insulin, stupidly I didn't test again until bed when I was 22 but in the mean time I ate nothing and didn't do much)

 

[kitedoc]

Hi @sleepster, As a fellow pumper, but not as professional advice or opinion:
There is a thing called sleep hygiene, which is about developing habits that help ensure a good night's sleep and how to help return one's sleeping habits back to a more appropriate day-night cycle. Your GP should be able to either do that or refer you to someone that can. And you are not needing to be on 'night shift' type cycle.
There are medical conditions which can also affect sleep cycles and require diagnosis, assessment and treatment.
When I was first put on my pump 7 years ago my pump's basal rate was 'sculpted' to allow for things such as a normal sleep cycle, the Dawn phenomenon and the usual lack of food intake overnight. If I had a night of being awake, such as supporting a relative who had been been to A&E, I knew that my BSLs would need watching as the usual routine had been disrupted.
So your change in sleeping habits is likely to upset the effects of the carefully prescribed basal rate of your pump.
And I know that if I had gravy and mashed potatoes that my BSLs would not fare well.
It sounds as though your meals are irregular as well and again, whilst basal insulin is not a big contributor to dealing with BSLs related to food, as compared with bolus doses, it still plays a part (at least in my experience).
Please be prepared to accept some possible criticism from your doctor and try to work with him or her to get your life back onto a more regular track.

 

[sleepster]

Thanks for your input @kitedoc, you make some good points.
I have had a look at sleep hygiene tips and aside from going to sleep and getting up at the wrong times I am doing everything else needed for good sleep hygiene, the highs are contributing to my body clock being off, as when I am tired (and high) I am having to stay awake an extra 2.5 or 3 hours to check my blood, bolus etc so then I get past the tiredness and am wide awake. It doesn't take me too long to get to sleep once I know my bloods are ok and I am getting enough sleep.
I have always gone to bed late as my husband works during the night, so I'm not sure it's as simple as my sleep routine being disrupted. It's not as though I used to go to bed at 10pm, it has always been early hours. I am trying to get into a better sleeping pattern but it's so difficult when you know, come 4am you're going to be as high as a kite!

 

[dancer]

@sleepster if you get back into your "normal" routine, eating your normal diet, and you still go high around 4am, obviously you'll need to increase your basal. I would suggest doing some basal testing to find out when the increase in BG begins, and increase your basal at the appropriate time(s).

If you are high before bed, why not give your correction and set the alarm for 2 hours later, to check your blood. This would mean you would be getting some sleep, rather than staying awake for hours and then getting past the tiredness.

 

[sleepster]

Thank you @dancer, I think that would be a sensible thing to do.

@sleepster
If you are high before bed, why not give your correction and set the alarm for 2 hours later, to check your blood. This would mean you would be getting some sleep, rather than staying awake for hours and then getting past the tiredness.

I must admit that's not something I had considered (seems a bit daft doesn't it?) I'm not sure how well I would sleep knowing I was high, but it's certainly worth a try

 

[EllieM]

Thank you @dancer, I think that would be a sensible thing to do.

I must admit that's not something I had considered (seems a bit daft doesn't it?) I'm not sure how well I would sleep knowing I was high, but it's certainly worth a try

Has your weight or the amount of exercise you're taking changed? That could affect your bolus ratio? (I know my insulin to carb ratio would go down if I lost weight, just as it does when I take more exercise...) Plus if you're stressed then that is also going to have a similar effect....