Mid-afternoon spike with no carbs.

[Jasmin2000]

There are a couple of threads on the unexpected BG spike in the afternoon, but most deal with the type of food eaten at lunch.

I get this BG rise from 5-9 mmol/L over 3 hours from 4-7 pm or thereabouts, but I don't eat carbs at lunch and sometimes don't have lunch at all.
I guess the glucose is coming from glycogen or fat metabolism, or even protein, but why in the afternoon? Should I increase insulin despite not eating any carbs?

Thanks for any help.
Jasmin

 

[Fairygodmother]

Maybe the spike is due to you not eating carbs at lunch and your body releasing glucose from your liver to compensate, to ensure you have an energy source?

 

[Jasmin2000]

Thanks @Fairygodmother - yes that would make sense. You would think that the body would stop at 6-7 but it keeps rising to over 9 - maybe it;s expecting to see insulin to counteract it's own response to low glucose?

 

[Fairygodmother]

In a person with a ‘normal’ pancreas, yes.
Are you following a ketogenic diet diet?

 

[Antje77]

There are a couple of threads on the unexpected BG spike in the afternoon, but most deal with the type of food eaten at lunch.

I get this BG rise from 5-9 mmol/L over 3 hours from 4-7 pm or thereabouts, but I don't eat carbs at lunch and sometimes don't have lunch at all.
I guess the glucose is coming from glycogen or fat metabolism, or even protein, but why in the afternoon? Should I increase insulin despite not eating any carbs?

Thanks for any help.
Jasmin

What basal are you on and at what time do you take it?

I get this BG rise from 5-9 mmol/L over 3 hours from 4-7 pm or thereabouts, but I don't eat carbs at lunch and sometimes don't have lunch at all.
I guess the glucose is coming from glycogen or fat metabolism, or even protein, but why in the afternoon? Should I increase insulin despite not eating any carbs?

We can't advice on dosing, but I usually take a top up of insulin when I see a slow and steady rise, depending on expected activity. I'm more cautious if I know I'll be driving in the next couple of hours, or if I expect do do physical activity.

 

[Jasmin2000]

In a person with a ‘normal’ pancreas, yes.
Are you following a ketogenic diet diet?

Yes - a normal person's insulin would be released to balance the glucagon that is trying to provide glucose. In theory I need to find the level of insulin that a normal person would release and inject it.

I am not wholly keto but eat very low carbs most of the time so it does make sense that this happens - thanks again.

 

[Jasmin2000]

What basal are you on and at what time do you take it?

Lantus, 12 units in the morning and 12 units before bed.
Actrapid, unit by unit when my BG goes up.

We can't advice on dosing, but I usually take a top up of insulin when I see a slow and steady rise, depending on expected activity. I'm more cautious if I know I'll be driving in the next couple of hours, or if I expect do do physical activity.

"slow and steady rise, depending on expected activity" That hits the nail on the head - seems I'm getting the slow and steady rise from a semi-keto diet and moderate exercise. Thanks @Antje77.

 

[Antje77]

Lantus, 12 units in the morning and 12 units before bed.
Actrapid, unit by unit when my BG goes up.

So your morning dose of Lantus should be in full action by the time you see the rise, but the before bed dose (depending on what time you go to bed) might be starting to wear off.
Have you considered the possibility that your basal needs aren't the same at night as during the day? I know many people don't do an even split if they split basal.
(No personal experience with splitting basal, I'm on Tresiba once a day, no need to split, and top the basal up with Levemir on days my insulin needs are higher.)

 

[Jasmin2000]

So your morning dose of Lantus should be in full action by the time you see the rise, but the before bed dose (depending on what time you go to bed) might be starting to wear off.
Have you considered the possibility that your basal needs aren't the same at night as during the day? I know many people don't do an even split if they split basal.
(No personal experience with splitting basal, I'm on Tresiba once a day, no need to split, and top the basal up with Levemir on days my insulin needs are higher.)

Good point. Not sure about a Lantus single dose - my GP gave me a split does plan a decade ago and I've kept it assuming it was more flexible. I've recently shifted my late dose from 10 pm to 8 pm in the hope of reducing pre-bedtime BG levels. It worked and fasting BG is now constant at 5-6 (no more dawn phenomenon either).

So the morning dose could be increased to take care of the afternoon spike - I'll give that a try.

 

[Antje77]

Good point. Not sure about a Lantus single dose - my GP gave me a split does plan a decade ago and I've kept it assuming it was more flexible. I've recently shifted my late dose from 10 pm to 8 pm in the hope of reducing pre-bedtime BG levels. It worked and fasting BG is now constant at 5-6 (no more dawn phenomenon either).

So the morning dose could be increased to take care of the afternoon spike - I'll give that a try.

Let us know if you solve the puzzle, and how you did it!