Random 3am spike

[TashT1]

I’ve been struggling more with control the past couple of weeks. I’ve gone from time spent in range 80% of the time to 50% this week. I’m adjusting my basal & trying to iron out my carb ratios to get things back in control but the one thing I don’t have a clue about is this random 3am spike.

Normally I enjoy lovely steady readings throughout the night. I could go to bed on 5 or 6’s, test in the night & be the same & still wake up on 6. It’s not uncommon for me to stir at 2/3am, scan & go back to sleep. But for the last 3 nights I’ve woken up at 3am, tested & it’s at 10.

I drink a couple of glasses of red wine most nights so I don’t know if this is suddenly having an impact, but I thought that would cause BG levels to go down rather than up. It’s been a stressful couple of weeks, my levels could be running high for 10 different reasons during the day.

With it being at night I’m thinking it’s a basal issue. I take 18u of Lantus at around 6am on a weekday, this ordinarily lasts the full 24hrs, but can that change overtime?

I’ve got a call in to my diabetes team so should hear from them on Monday. I plan to do a basal test tonight.

But any thoughts in the meantime?

 

[Jaylee]

Hi Tash,

If the only recent factor thrown in the mix is the wine? Wine doesn't technically lower BG. What it can do is keep the liver busy with the alcohol content & stunt the production of glycogen.
The carb content on a couple of late night glasses could be pushing you up at 3am?
At a guess.

 

[Antje77]

I take 18u of Lantus at around 6am on a weekday, this ordinarily lasts the full 24hrs, but can that change overtime?

Your rise perfectly coincides with the last 3 hours before taking your Lantus, so that would be my first suspicion. I think many people split their Lantus for this reason (or they use a longer acting insulin like Tresiba or toujeo).

There is also the Dawn Phenomenon which might be in play here.

In my experience anything in diabetes can change over time, especially in the beginning. I've had diabetes for 4 years now and I've found many things have changed during this time.

I wouldn't think it's the wine.

 

[TashT1]

Thanks both for your thoughts.
The evening wine is a habit of at least 10yrs. I’ve been keeping an eye out for it affecting things but it hasn’t so far. Sometimes there’s occasion to drink more & sometimes I drink less. But it is one of the reasons I don’t inject at night. I like to know I’ve had my last bolus at tea time & can have the evening ‘off’.

I’ll keep an eye on that though, it may be the case that a longer acting basal suits my lifestyle better.

If it happens again tonight it will be interesting to see if it’s later in the night. Weekends I don’t rise until 8-8.30am. Even though it spikes to 10 some insulin kicks in & I wake up on 8 or 9mmol so it’s not at 10 for a long time.

 

[MarkMunday]

... it may be the case that a longer acting basal suits my lifestyle better.
...

Looks like a shorter acting basal would suit better. Then, in addition to the morning shot, as much as needed can injected at night. Doing this with Lantus may also work. Longer acting basal does not provide this flexibility. The 24 hour action profile of the insulin can not be changed.

As for insulin requirements changing over time, it comes with the territory. I used Lantus successfully for many years but I am now having to change to the shorter acting Levemir.

 

[Antje77]

Looks like a shorter acting basal would suit better.

Longer acting basal does not provide this flexibility.

Sounds like this is your experience, which is of course perfectly valid.
However, for others, like me, the longer acting basal (Tresiba in my case) works in a very nice way, providing me with more flexibility than Levemir would, because I can vary the timing of my long acting over at least 6 hours (I inject roughly between 10PM and 4AM) without noticing a difference, which wouldn't work well at all on Levemir.

It's always better to share what works for you than to advice people on what medication would be best for them.

 

[MarkMunday]

... It's always better to share what works for you than to advice people on what medication would be best for them.

I didn't give any advice. Nowhere do I suggest action. Yes, I made an assertion. This is how ideas develop and arguments are built. Another issue with Lantus is greater intraday variability than other modern analogue basal insulins. This can make getting good consistent control more difficult. These are also assertions, without advice. If you have a problem with this type of input, perhaps I shouldn't be giving it here.

 

[Jaylee]

Thanks both for your thoughts.
The evening wine is a habit of at least 10yrs. I’ve been keeping an eye out for it affecting things but it hasn’t so far. Sometimes there’s occasion to drink more & sometimes I drink less. But it is one of the reasons I don’t inject at night. I like to know I’ve had my last bolus at tea time & can have the evening ‘off’.

I’ll keep an eye on that though, it may be the case that a longer acting basal suits my lifestyle better.

If it happens again tonight it will be interesting to see if it’s later in the night. Weekends I don’t rise until 8-8.30am. Even though it spikes to 10 some insulin kicks in & I wake up on 8 or 9mmol so it’s not at 10 for a long time.

Hi,

I'm no temperance merchant myself. I feel you're wise making sure you have as little fast acting insulin on board when you do consume alcohol.
Could you have changed the wine you normally consume to a brand with a little more carbs lately?

The lantus maybe tailing off around the 3am mark if you jab 6am the prevous morning?
Some have reported Lantus don't quite go the boasted 24 hours.
If you happen to work weekdays? How are you finding the days off in the morning waking later? Focusing on Saturday morning 8/8.30 & back to work on Monday injecting at 6am?

What I used to find on work days (I was up at 4am.) was even though I didn't eat till late morning at break on a shift.
My blood would rise after the morning routine by as much as 3mmol? & needed correction. Liver dump.
I do inject my Lantus in the evening around 10pm.

Good luck with the call from your team on Monday.

 

[TashT1]

I cycle between 4 or 5 brands so it could have been that. I drank the same brand all 3 nights. Finding out carb counts for wine is next to impossible. But this something to look out for.

I usually don’t see a change between weekday & weekend readings even though I take my Lantus later. My morning readings are usually the most predictable. For example wake up on 6mmol, eat a low carb breakfast of 7g, no fast acting required. 2hrs later it’s either barely moved up or slightly
lower depending on activity. Test at lunchtime & I’m somewhere in the 5’s.

This was my pattern until 10 days ago & now those 5’s & 6’s are 7’s & 8’s. This coincided with a lot of stress so I’m hoping it will settle down soon.

I’m really not keen on injecting at night, I find it uncomfortable at the best of times & it’s not uncommon for me to fall asleep on the sofa before 10. I’d end up taking an evening dose at inconsistent times.

But at least I have some ideas for talking to my nurse, it’s never useful to start those conversations unprepared.

 

[Jaylee]

I cycle between 4 or 5 brands so it could have been that. I drank the same brand all 3 nights. Finding out carb counts for wine is next to impossible. But this something to look out for.

I usually don’t see a change between weekday & weekend readings even though I take my Lantus later. My morning readings are usually the most predictable. For example wake up on 6mmol, eat a low carb breakfast of 7g, no fast acting required. 2hrs later it’s either barely moved up or slightly
lower depending on activity. Test at lunchtime & I’m somewhere in the 5’s.

This was my pattern until 10 days ago & now those 5’s & 6’s are 7’s & 8’s. This coincided with a lot of stress so I’m hoping it will settle down soon.

I’m really not keen on injecting at night, I find it uncomfortable at the best of times & it’s not uncommon for me to fall asleep on the sofa before 10. I’d end up taking an evening dose at inconsistent times.

But at least I have some ideas for talking to my nurse, it’s never useful to start those conversations unprepared.

Hey, slow down. You don't get "judged" here.

Stuff somtimes gets skewed? (Different factors.)

If it was all "textbook." We wouldn't be here on a forum asking what went down & swapping experiences..... Lol, it would just be a case of "jab & go."

Others may have a different perspective. Most of us feel it's a "plate spinning act."