Overnight highs

[pinewood]

Hi everyone,

After 3 years of very tight control (and feeling very grateful at how lucky I have been with the ease of control) in the past few weeks I have been really struggling.

I currently take 10 units of Tresiba before bed at around 10pm and my I:C ratio is now about 1 unit per 10g (used to be more like 1:20)

A typical day goes like this:

- I wake up @ 6-8mmol / inject 3 units for breakfast / have a small spike to 9mmol or so and then remain nice and steady at 5-7mmol until lunch
- Take 3 units for a low carb lunch / stay steady at 4-7mmol all afternoon
- Units for dinner vary, but even if I have a low carb meal and bolus with very high accuracy this is what happens:
* Inject 30-45 mins before eating to restrict spike;
* Assuming I carb counted and bolused correctly, I'll stay steady in the 5-8mmol range from eating dinner at c. 8pm until going to bed at 11pm (occasionally I will split-bolus or add an additional bolus depending on what I am eating and if my Dexcom shows me creeping up)
* I'll go to bed at 11pm-ish with my Dexcom showing me nice and steady at 5-6mmol
* My Dexcom alarm will then go off between 12am to 3am and I'm suddenly at 11-14mmol???!??!
* I'll bolus but still end up spending the whole night higher than I would like (e.g. 8-11mmol); sometimes my alarm will sound again at 4/5am because I'm still high despite the middle of the night bolus, so I'll take yet another bolus but still be in the 6-8+mmol range on waking.

Previously, I've had perfectly stable overnight sugars and would almost always wake up in the 4-5mmol range. The only time I'd have highs in the middle of the night is if I had a high fat/high carb meal (e.g. pizza/pasta) and the delayed digestion, understandably, spiked me. But now it's happening regardless of what I have dinner, even if it's a salad or low carb option.

Any ideas what's going on here or tips for things I can try?

I always thought our bodies needed LESS insulin at night but I seem to need more.

I'm reticent to increase my Tresiba given my daytime levels seem okay but maybe that's the first thing to try?

 

[vic hill]

CAN I ASK WHY A SLOW ACTING INSULIN . and are you on a pump have you lookedat the side affets of this insulin
think back to when you when you were more stable
diffrent food also life style something not correct .
unable to help look at all the points i have asked to see if you can nail down i have no idea how long this insulin act try to lift up basel/bolus if on pump to knock the highs down very slow does it over a week
sorry cannott help
vic 61 years on insulin

 

[Levy]

I made a similar post a few months ago because I was experiencing the same. Went to bed at a decent level and then seemed to spike pretty soon after falling asleep.
I can't help as I never found out what caused it, but it did stop eventually!

 

[pinewood]

Thanks both. I increased my Tresiba to 12 units and it seems to be helping somewhat, but daytimes are a bit more challenging now as I am prone to more hypos.

@vic hill - nothing has changed in terms of lifestyle compared to when my overnight levels were stable. Not sure what you mean by "why a slow acting insulin"? I am not on a pump, I use Tresiba for long/slow acting and NovoRapid for fast acting.

@Levy - thanks! I'm hoping it will be the same for me! I have been pretty stressed/anxious lately so maybe it's a stress response (hopefully temporary). Also wondered if maybe I'm coming down with something, but I don't feel unwell so not sure that can be it.

 

[novorapidboi26]

Looks to just be one of these times were the basal needs just differ too much for a single long acting dose....

you will always need to compensate in either the day or night with a single dose.....

see how you get on with the current situation then maybe consider a split maybe...

 

[vic hill]

thanks PINEWOOD for reply
had a senior moment ,i thought the mention of dexcom may have been a pump but its you b/sugar meter
when i was on 2 insulins before pump
i had the sogmire affect weeks of going low at about 2/3/4 pm at night took ages to get of it.
but that was many years back
now i have like today 2 high bloods sugars have to change needle sites ref the insulin being takeing in to my body
but like you ,we get by with trying things that peaple try on this forum
keep well regards vic 61 years on inslin

 

[emiliano]

Hi everyone,

After 3 years of very tight control (and feeling very grateful at how lucky I have been with the ease of control) in the past few weeks I have been really struggling.

Hi Pinewood,
that's *exactly* what happens to me as well.

I'm on Lantus and Tresiba + Eversense CGM. I've tried tweaking Tresiba but to no avail. The only thing that works for me is to fast for two-three days then start again with my normal routine.

The explanation I give myself (which might be totally wrong...) is the following: by fasting (without interrupting my normal exercise - 10K running almost every day on average) i deplete my glicogen stores so when the liver tries its infamous nightime dump (admitting it is a liver dump what happens during the night, which I'm not sure of) there's not much to dump. Then the glicogen store builds gradually up and the process begins again.

As I said this explanation might be completely off target, but seems to me to make sense. And it works...

Anyway, and this is always true, the lighter the dinners the better is my BG during the night.

 

[pinewood]

Still struggling with my levels rising overnight. So weird. It seems to start at around 1-3am, so presumably too early for it to be "dawn phenomenon"?

My fasting levels are steady during the day. I've upped Tresiba 30% from 10 units to 13 units to no avail. If I go any higher I'll struggle with daytime control.

Is it worth me trying to move my Tresiba injection from evening to morning? Or would that likely make it worse given Tresiba's profile?

 

[LooperCat]

Still struggling with my levels rising overnight. So weird. It seems to start at around 1-3am, so presumably too early for it to be "dawn phenomenon"?

My fasting levels are steady during the day. I've upped Tresiba 30% from 10 units to 13 units to no avail. If I go any higher I'll struggle with daytime control.

Is it worth me trying to move my Tresiba injection from evening to morning? Or would that likely make it worse given Tresiba's profile?

Mine starts to rise around then too, so I have to take a couple of units to correct, otherwise it’ll go through the roof! Maybe we’re on European time It’s always dawn somewhere...

 

[pinewood]

Mine starts to rise around then too, so I have to take a couple of units to correct, otherwise it’ll go through the roof! Maybe we’re on European time It’s always dawn somewhere...

Haha, maybe that's the case!

Has this always been the case for you? I'm just confused as to how and why my body could "suddenly" decide that it needs to release glucose in the early hours; surely DP is something your body does or doesn't do and I don't understand how it could just randomly start for me so out of the blue.

Maybe taking 2 units before I sleep each night will be the new norm. I am lucky to have Dexcom so at least I can try it out without too much worry.

 

[novorapidboi26]

My understanding is that the dawn phenomenon process always happens in everyone, it just happens in varying severities, which is connected to the amount of carbs you eat, your physical make up, the medications your on etc.....

the trick is being able to adapt to these almost inventible changes in life with the meds/diet etc....

 

[LooperCat]

Haha, maybe that's the case!

Has this always been the case for you? I'm just confused as to how and why my body could "suddenly" decide that it needs to release glucose in the early hours; surely DP is something your body does or doesn't do and I don't understand how it could just randomly start for me so out of the blue.

Maybe taking 2 units before I sleep each night will be the new norm. I am lucky to have Dexcom so at least I can try it out without too much worry.

I’ve only noticed it in the last few months, when I drastically dropped carbs as well as getting a Libre. But I just wake with a jolt at that time, sort of like an anti-hypo! Takes me an hour or so to get back to sleep, as I’m full of adrenalin. So I just read my kindle until I fall asleep again. Not ideal, but it is what it is.

 

[Brendon.Dean]

I'm pretty sure it has to do with your dinner meal timing vs carbs. I'll tell you what happens for me which may in turn help you figure out your problem.

If I have carbs at 8pm and sleep at 11, no matter what, during that last hour of which my insulin is finishing (from 11pm-12am) 9x out of 10 my blood sugar will spike from 4-6 mmol/L to 11-14 mmol/L.

If I eat carbs 4 hours before bed I hold steady around 5-7 mmol/L and closer to waking up it can go up to around 8 mmol/L. Sometimes if I'm still hungry i'll have some cottage cheese 1.5-2 hrs before bed and bolus 1unit of novarapid and my sugars hold steady.

If I have carbs anytime from bedtime to 2 hours before bedtime my blood sugars will still be around 4-8 mmol/L before sleeping and then bam at 2-3am my blood sugar will sky rocket to 15-20 mmol/L.

 

[Alison54321]

I switched, just yesterday, from Lantus to Levemir. The reason I did this was because at night my blood sugar just kept going up, and like you my day time blood sugars were quite low.

Last night I had a beautifully stable blood sugar. This has allowed me to develop an extremely dodgy theory, for which there is no research, and no evidence, beyond my blood sugars for last night. However, I won't let that stop me.

When I decided to stop taking Lantus I just felt as if the relationship had broken down, and it just wasn't working as well as it used to, for whatever reason. So I switched.

So my dodgy theory is that we should probably change basal insulin regularly. Just because............well, I don't know, but just because.

Is there any chance of switching to Toujeo? It's a different type of insulin, and maybe..............I don't know, maybe they just become less effective, or something, over time.

I have reservations about Toujeo, because you have to be careful with injection sites, because it's like Lantus, but as long as you do that ok, and you're aware of that, it should be ok.

 

[Wurst]

I get spikes in the night if I've been eating high fat/ high carb foods like pizza or doughnuts or certain 'heavy' cakes , the solution is not to eat them

Try low carbing and see if you still get the overnight issues.

 

[pinewood]

It’s not related to eating; I’ve tried having a low carb salad at 5pm, nothing else, bed at 11pm and still the steady increase occurs. I’m totally familiar with the delayed spikes from high carb/high fat meals but that isn’t the explanation here.

 

[Brendon.Dean]

It’s not related to eating; I’ve tried having a low carb salad at 5pm, nothing else, bed at 11pm and still the steady increase occurs. I’m totally familiar with the delayed spikes from high carb/high fat meals but that isn’t the explanation here.

Did you just try that one time and that is it? One thing about us type ones is you have to try something for an extended period of time before you can get an accurate gauge on if it works; our body takes time to adjust so 2-4 weeks of a trial period would be necessary.

Also I just realized you said you use your dexcom, that's not finger prick testing right? It's the one that measures interstitial fluid?

 

[annliggins]

Still struggling with my levels rising overnight. So weird. It seems to start at around 1-3am, so presumably too early for it to be "dawn phenomenon"?

My fasting levels are steady during the day. I've upped Tresiba 30% from 10 units to 13 units to no avail. If I go any higher I'll struggle with daytime control.

Is it worth me trying to move my Tresiba injection from evening to morning? Or would that likely make it worse given Tresiba's profile?

 

[annliggins]

I had the same problem ...on treseba perfect for 6 months and then i started to drift up through the night bgl 7 before bed 9 at 12 ,10 at 2 and so on so i changed my routine and had treseba dose at 10pm ish seems to have done the trick ( but if theres an 'r' in the month ) .....

 

[pinewood]

I had the same problem ...on treseba perfect for 6 months and then i started to drift up through the night bgl 7 before bed 9 at 12 ,10 at 2 and so on so i changed my routine and had treseba dose at 10pm ish seems to have done the trick ( but if theres an 'r' in the month ) .....

Thanks @annliggins - but I already take mine at about 10pm-11pm! Maybe I need to try taking it in the morning....