I've had T1DM since childhood and am now in my early 40s, although my control has always been reasonably good my blood glucose variation has been a bit erratic, so I make use of carb counting, Libre 2 alarms, tresiba and a very consistent lifestyle to keep things in check. Something I've found (especially since using tresiba as basal insulin in 2018) is that I periodically get randomly very high blood sugar levels (up in the teens and 20s) overnight and I can't work out why (not food, stress, alcohol activity change etc.) does anyone else find this? I can't really increase tresiba much further as this already sends things quite low during the day and this is inconsistent it's difficult to do a rapid acting insulin dose when I go to bed as sometimes the dose I choose is too much or too little. Anyone have any ideas?
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Overnight high glucose
- Thread starter Chill22
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Any chance you have any "lumps" that you inject into? The insulin might be absorbed more slowly? (That's assuming you inject the basal at night.)
Is it high before you go to bed or does it go up in the middle of the night?
Edited to add: And welcome to the forums.
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Marie 2
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There is something called DP or Dawn Phenomenon. It's a release of hormones getting ready for the day and causes the liver to dump some glucose. Usually about 5 am. Not always easy to stop. If it's just happening off and on, it could be a higher carb day and your liver just has more stored so it decides to dump some in the dawn hours.
Also type 1's for the most part are more likely to have BG levels go up at night because of not eating and your liver is more likely to try to help with extra glucose being released but that usually occurs at a more gentle increase each night and all night.
A pump is the best thing to handle it if it's consistent as you can have an increase in basal in the dawn hours. Otherwise you just give a correction dose when you wake up.
Also type 1's for the most part are more likely to have BG levels go up at night because of not eating and your liver is more likely to try to help with extra glucose being released but that usually occurs at a more gentle increase each night and all night.
A pump is the best thing to handle it if it's consistent as you can have an increase in basal in the dawn hours. Otherwise you just give a correction dose when you wake up.
ert
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I would start by testing my basal by dinner skipping or eating a carb free meal at night.
I doubt it, I check myself and have asked in clinic in the past and couldn't find anything. I try to keep to the same injection site for each time of day and am quite consistent with keeping bolus injection to 11pm (although with tresiba I don't think that should make a huge difference. I do find that my carbs to insulin ration is very different in the evenings and more variable than the start of the day, but glucose levels don't tend to go wild until between midnight and 3am (evening meal at 7pm), sometimes an insulin bolus will bring it down and sometimes it just keeps on rising.
Oh just noticed the other replies. DP sounds possible although I thought I was seeing this later in the day just around breakfast time but I'd thought that was about cortisol shift where you get insulin resistance from steroid hormones, am I confusing two different things? I suspect I get some of the difference from carbohydrate load but my evening insulin requirement for carbs seems change rather sporadically. I'm pretty sure my basal insulin is too high for the morning to late afternoon, but seems too low for evening and overnight. I find it easier to adjust for hypos in the middle of the day but difficult to sort high blood glucose as the dose requited changes a lot with time of day.
Marie 2
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There can be two different hormone releases, getting ready for the day. One is DP, dawn phenomenon that usually happens around 5 am. But I remember once I was getting large increases around 12-3 am for a few weeks. Who knows why sometimes our body does certain things? The problem becomes if our liver decides to release glucose we don’t have the normal insulin release to deal with it that a “normal” does.
There is a also FOTF foot on the floor. That happens when you first get up, sometimes when you first wake up, many times when your feet first hit the floor, or in my case it likes to hit 1-2 hours after my feet hit the floor.
You can get DP or FOTF or both. Either one also has a tendency to make you more insulin resistant for a few hours following. I’ve had a mix of them, right now for me it’s FOTF, 4 months ago it was both.
The body can be weird and DP or FOTF can be a day here or there, or weeks or months. But one of the theories of the off and on day is that it could be from higher carbs than normal the day before so your liver dumps more.
Some type 1’s still have a glucagon response to lows. If you drop too low or what it perceives as too low for a longer time your liver releases glucagon to help. Somogyi effect. It’s very possible your basal is too high if you are dropping too low at some point
My thyroid seems to play a large part with mine. When I take my thyroid supplements regularly my DP either goes away or really calms down.
I would do a basal test first. Your basal rate is solely for what your liver puts out without eating and should not cause you to go too low at any point. An MDI shot has to be a dose based on a full day without going too low, whereas a pump can be adjusted for a variable basal rate. With an MDI protocol you add a correction bolus as needed when you need extra. It’s hard to figure out your carb ratios if your basal is off.
Your carb ratio can vary during the day too and keep in mind most insulins can still work up to 6 hours. With me most of it works within 2 hours but I have a small kick at around 5-6 hours. In my case if I eat in the am I have a higher carb ratio because of FOTF.
https://www.medicalnewstoday.com/articles/317998#what-is-the-somogyi-effect
https://www.mysugr.com/en-us/blog/basal-rate-testing/
https://integrateddiabetes.com/basal-testing/?amp
There is a also FOTF foot on the floor. That happens when you first get up, sometimes when you first wake up, many times when your feet first hit the floor, or in my case it likes to hit 1-2 hours after my feet hit the floor.
You can get DP or FOTF or both. Either one also has a tendency to make you more insulin resistant for a few hours following. I’ve had a mix of them, right now for me it’s FOTF, 4 months ago it was both.
The body can be weird and DP or FOTF can be a day here or there, or weeks or months. But one of the theories of the off and on day is that it could be from higher carbs than normal the day before so your liver dumps more.
Some type 1’s still have a glucagon response to lows. If you drop too low or what it perceives as too low for a longer time your liver releases glucagon to help. Somogyi effect. It’s very possible your basal is too high if you are dropping too low at some point
My thyroid seems to play a large part with mine. When I take my thyroid supplements regularly my DP either goes away or really calms down.
I would do a basal test first. Your basal rate is solely for what your liver puts out without eating and should not cause you to go too low at any point. An MDI shot has to be a dose based on a full day without going too low, whereas a pump can be adjusted for a variable basal rate. With an MDI protocol you add a correction bolus as needed when you need extra. It’s hard to figure out your carb ratios if your basal is off.
Your carb ratio can vary during the day too and keep in mind most insulins can still work up to 6 hours. With me most of it works within 2 hours but I have a small kick at around 5-6 hours. In my case if I eat in the am I have a higher carb ratio because of FOTF.
https://www.medicalnewstoday.com/articles/317998#what-is-the-somogyi-effect
https://www.mysugr.com/en-us/blog/basal-rate-testing/
https://integrateddiabetes.com/basal-testing/?amp
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