Morning help required

Hi Mitch,

We might be able to offer some suggestions, but some extra info would be useful first:
Are you type 1 or 2?
Which other medications are you taking?
What are your typical blood sugar levels at other times of the day?
What sort of foods do you eat?
What are your eating patterns, mealtimes etc.?
Do you have any other conditions?

All the best,

fergus

Hi
With High Morning Sugar's common with many type 1 Diabetics!
The idiots Guide is Increase, increase Insulin (DON'T DON'T do it unless you are sure)
instead try something silly have a couple of biscuits or extra Carb before bed?
Many of us Hypo or Coma in the Night and wake feeling rough.
Reason is simple before Bed say 12.7mml 2-3am 2.9mml 8am 16.3mml.
The higher the insulin Injection higher the Sugar?
Some Nights if I have around 6mml I have to EAT around 30 -50 Carb extra next morning
very LOW Sugar Try It lets know how you get on!
One lot of high sugar is beter than no Sleep?

Fergus asks a lot of (relevant) questions, can I add a couple more?. The timing of your lantus dose, the timing of your evening meal and at about what time do you wake up with high BG ?

Basically if your lantus is properly adjusted and your dinner time apidra has finished working, your BG at bedtime should not change (within reason) overnight.
If you take your lantus in the morning, your higher bg may coincide with the lantus running out (it often doesn't last 24 hours)
Your BG might also rise because your lantus is not high enough for you overnight (some people need a different rate at night to during the day) or for the opposite reason, too much insulin (as Insulinman mentions) with BG falling and the liver kicking in some glucose to compensate.

I find that Apidra has a very fast onset. What can happen with an evening meal containing a relatively high level of fat and carbs or a very low GI is that the peak of the insulin action happens before the food is digested, resulting in a later rise in BS. When I was on MDI (using novorapid which I think was a bit slower in onset) I got around this by doing 2 injections, about 50% at the start of the meal and 50% an hour later.

Now I'm worried for you...

The high morning levels would seem to come from a liver dump due to you going too low over night, taking alcohol on Saturday night paralyses the liver and stops this happening- so you BG stays low on Sunday morning.

But this is dangerous, if you go into a coma the liver can not help by dumping glucose to raise your BG again.

Insulinman is probably right in his assumptions, although if you can get a copy of Bernsteins Diabetes Solution and read about the 'beauty of low numbers'. Reduce carbs, reduce insulin and any swings will not be anywhere near as big and hopefully not life threatening.

Being a type 2 I have no experience of the details of insulin management but I would ask you please to take advise from those with experience because - as you suspected I am sure -you do need to get control of this.

Mitch said:

Can anyone help for the past 6 months I have been awoken by high blood sugars between 15-20 and cant get a decent night's sleep!

have told my specialist and the diabetes nurses, but nothing seems to work. I take Lantus and have recently been put on Apidra. My blood sugars the rest of the day ten to be fine Any suggestions would be gratefully received as wuld a good night's sleep!!

Click to expand...

When you say nothing seams to work, have you tried increasing the Lantus ?
This is what i would do if i was having highs during the early hours :Increase lantus by 2 units each night for 3 nights... if the sugars start dropping before then STOP increasing. If they stay high, keep it at the + 6 for at least a week before you start increasing again.

Do you use the prefilled pens for Lantus ? If so did you know there "apparently" has been a problem with these in the past, that it has been noted that they can be faulty and not give the correct dose. My diabetic nurse changed me to levimir because i told her i thought my lantus was not working properly, thats how it felt to me, like it wasnt having the proper effect. I feel much happier with Levimir, and I dont have the random blood sugar readings i got when i was on Lantus.

I wonder why you are taking a snack with a BS level of 6.7mmol. It may be because you have previously had having hypos overnight, or it may be a habit from a previous insulin regime and be contributing to your morning BS.
When I was diagnosed, I was one of the first patients to use lantus at the hospital , my own doctor said to take a bedtime snack at 6.7. The consultant butted in reminding her that this was not necessary with lantus, and said to not to if the level was above 5mmol. Now I don't snack above 4.5mmol and will correct if above 7mmol BUT I know that my BS doesn't tend to go down overnight unless I've exercised during the early evening.

The normal way to find out if your BS is actually rising or falling then rising is to test during the night at about 2am and 4am I know its not fun but it does help.
This article (sorry its from an American forum, I hope its alowed)) explains better than I can how to perform basal testing on MDIhttp://www.diabetesdaily.com/forum/articles/16675-basal-testing-multiple-daily-injections

A second way is that it might be possible to use a CGMS dor a few days to help identify whats happening. You would have to ask your doctor if thats possible.

There are 2 books that really help with MDI, Using Insulin by John Walsh and Think like a Pancreas by Gary Scheiner