Insulin/pump not effective at night ?

[Diamattic]

This may seem silly, but i do have to ask - Is it possible that given a certain location of your infusion set and the way someone sleeps that an insulin pump may fail to get the insulin into a persons body at night while they are asleep ?

The reason I ask is obviously due to my own experiences lol I have noticed recently that my sugars will be great all day long, no issues with basal or bolus. Then i go to be and they seem as if they just go up and up all night - even with correction boluses!

Last night i went to bed with a 7.8, gave a correction and went to sleep. At around 3am i found my sugars up around 10 so i gave a correction AND set a temp basal of +30%, went to bed. woke up 3.5 hours later and my sugars were even higher so i gave another correction and another temp basal of +30%, then when i woke this morning 3 hours later my sugars were still 11.6 so i gave a correction again and almost immediately saw them dropping.

It could very easily be something I ate before bed, but i want to know if its possible that delivery of insulin could be prevented ot disturbed - Am I sleeping in a way that's stopping the infusion set from working ?

I use the 6mm Animas set, and its usually placed somewhere on my rear lol I have had this issue before but i wanted to ask to be sure.

Thank you all!

 

[Italie]

I asked my consultant this on Tuesday actually! I've had a few occasions where I've easten nothing since dinner, been 6-7 before bed then wake up at 19!! He seems to think it's the way I'm lying on the pump. It is SUPPOSED to be anti-kink tubing but if you catch it at a certain angle then it does stop delivery but wont alarm. Think I need to stop sleeping on my stomach!

 

[paulliljeros]

Hi @Diamattic, have you checked to see if you have had a hypo in the preceding 24 hours? I have noticed that correction doses have minimal affect for me in this period after a hypo, due to the liver dumping glycogen. Something that I was completely unaware of until the DSN pointed it on my CGM.

 

[noblehead]

This may seem silly, but i do have to ask - Is it possible that given a certain location of your infusion set and the way someone sleeps that an insulin pump may fail to get the insulin into a persons body at night while they are asleep ?

No question is silly.

A couple of suggestions, you could try putting some pillars against your body to stop you rolling on the side where your infusion set is placed and see what results you get, alternatively (if at all possible) stay up one night and test your bg regularly to see if your bg still continues to climb regardless of sleep, if it does then you need to adjust your basal rates or look at the meals your eating on a evening.

Good luck and hope you find the cause @Diamattic

 

[Diamattic]

Hi @Diamattic, have you checked to see if you have had a hypo in the preceding 24 hours? I have noticed that correction doses have minimal affect for me in this period after a hypo, due to the liver dumping glycogen. Something that I was completely unaware of until the DSN pointed it on my CGM.

Actually yes - I had a low just before dinner. I pre-bloused and I guess waited too long and it took a nose dive lol So I lovingly crammed my dinner into my face and chugged a juice box lol My sugars stayed under 8mmol/L for the next 4-5 hours through the evening and then as soon as I went to bed they just crept up all night. When i woke up this morning and got out of bed they fell back down to 5s within the first 2 hours and have leveled off here.

@noblehead - I have stayed up super late (not all night) and I find that as long as I am moving around my sugars stay in control. But when i look back on my dexcom graph it shows that about 1 hours after going to bed they always creep up.

I get that it could be a glycogen dump, but is it normal for it to dump 5-6 hours after the low rather then directly afterwards?

Could it be because my infusion set is on the side of my butt cheek so when i sleep on my side it compresses the set and prevents delivery ?

 

[CarbsRok]

Just sounds to me as if you need to do a night basal test. (hard luck)

 

[paulliljeros]

My sugars stayed under 8mmol/L for the next 4-5 hours through the evening and then as soon as I went to bed they just crept up all night. When i woke up this morning and got out of bed they fell back down to 5s within the first 2 hours and have leveled off here.

It usually peaks for me somewhere between 8-12 hours after the hypo, and can last for 12 hours after that, and then suddenly start to drop again when the liver starts to reclaim the spent glycogen. I'm guessing its not a hard and fast rule, but seems quite consistent for me. Not a brilliant example, but have attached an example where I was hypo from 6-8am, and then running high through day ( after slight over correction), and then sudden surge at 18:00 despite bolusing for food / corrections 8 times through the day. Even the correction at 20:37 had minimal affect till well after midnight.

 

[Diamattic]

Just sounds to me as if you need to do a night basal test. (hard luck)

I will give it a shot, but I doubt it is the problem here. This is not an every night thing. Most nights I can sleep and wake with no movement in my sugars. However every now and again it feels like the insulin just ins't working - if it was a basal issue the correction doses would affect me at some point but they don't until I am out of bed.

 

[Diamattic]

It usually peaks for me somewhere between 8-12 hours after the hypo, and can last for 12 hours after that, and then suddenly start to drop again when the liver starts to reclaim the spent glycogen. I'm guessing its not a hard and fast rule, but seems quite consistent for me. Not a brilliant example, but have attached an example where I was hypo from 6-8am, and then running high through day ( after slight over correction), and then sudden surge at 18:00 despite bolusing for food / corrections 8 times through the day. Even the correction at 20:37 had minimal affect till well after midnight.

Thanks Paul!

It could be this... I will have to start my journal again and try to track these events better and read some journal articles on the topic if I can find any.

Thanks everyone!

 

[iHs]

My bg changes during the night at times so I just tweak the basal rate according to what I see on the cgm. Most of time, it's just temporary but could do with a few more time slots to fine tune it a bit better. I don't lie directly on my sets and I try to make sure that the tube from the pump to set is not bent at a U bend where the luer connection is as that might result in slower delivery.

 

[noblehead]

Could it be because my infusion set is on the side of my butt cheek so when i sleep on my side it compresses the set and prevents delivery ?

A good question to ask your pump team or pump company.

As you've said the high's don't occur every-night it might be down to the food you eat later in the day (sorry I don't know what sort of diet you follow), I find if I eat too much fat or protein with my evening meal it can effect my bg levels for several hours after.

 

[tim2000s]

I was chatting to Dr Thomas at Guys art my last appointment in relation to the glucagon reaction to hypos, and he mentioned that we release it for up to 24 hours after a hypo...


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[MushyPeaBrain]

I have this issue too! I'm on Animas Vibe with 6mm insets and in certain areas my BG will just rise and rise in the night. After staying up all night, basal testing etc etc I realised that it happens when my sets are in an area I might sleep on slightly or where the fat thins out as I lie down which seems to affect absorption for me. My current set is doing exactly this as it's on my back. I have trained myself as best I can to sleep on one side which least means lying on my set and also when I find a site does this I have to put massive overnight temp basal on until my next set change. No corrections work for me either. Luckily doesn't happen too often but is still annoying!

 

[CarbsRok]

I have this issue too! I'm on Animas Vibe with 6mm insets and in certain areas my BG will just rise and rise in the night.

If that were me I would use an angled set as it would solve the problem.

 

[MushyPeaBrain]

If that were me I would use an angled set as it would solve the problem.

I have tried the inset 30 but I couldn't manage it. My sight isn;t great (blind in one eye and reduced in other) so I couldn;t see if the feet were in the correct place. It all looked fine and it did insert but I got lumps where I used it so DSN thought I might be getting angle wrong. Inset normal is foolproof for me even with sight issues so I'm sticking with that at the moment. Shame because I think the 30s could have been good for me in slim areas. Would be interesting to see if they would solve the problem for @Diamattic

 

[donnellysdogs]

From my experience...

1) it depends if you are going by libre or cgm readings as these are more likely to be affected than the pump...by being in bed...best if you are to check on blood meter.

2) could well be the food you ate previously....

Diabetics can start to get slower digestion (not necessarily as slow/non stop as mine)... But it could still be certain foods....

I

 

[Diamattic]

Still a mystery... I think I am learning towards the fatty/slow digestion issue. But i honestly think it could be a combination of the two, or perhaps its a combination of everything mentioned above all happening when the other is not so it it seems random, but really just 3 causes giving the same problem...

However, the weirdest part is that I correct all night, i check with my glucometer first, and nothing seems to work when I am laying down, but as soon as I get out of bed and start walking around and getting ready in the morning my CGM shows the down trend arrow and my sugars really start to drop, that has me leaning towards poor absorption.. oh well lol .

 

[noblehead]

Still a mystery... I think I am learning towards the fatty/slow digestion issue.

Have a look at the meals you consume on the night when you have these constant high's, certainly if a meal contains a high levels of fat/protein it can effect bg levels throughout the night, I know this to be the case from my own experience both on MDI and using a pump.

 

[yingtong]

Have a look at the meals you consume on the night when you have these constant high's, certainly if a meal contains a high levels of fat/protein it can effect bg levels throughout the night, I know this to be the case from my own experience both on MDI and using a pump.

Totally agree with noblehead I had the same experience and confirmed this with my C G M

 

[donnellysdogs]

With slow digestion though it doesn't matter what you eat!!
Certainly worthwhile having a good look at foods tho..