Suddenly crazy high night time levels

[eabhamurphy]

Hi
I started a pump on 15 June so pretty new to it still. My night time readings were high at beginning so adjusted up my rates at night to highest at 12-3am and then lowest during the day 0.975 to 0.5 and then ratios between these at other times.
This had me waking with blood sugars of 5-7 which I would have liked lower but have a history of hypos so wanted to eliminate hypos from the day before tightening my waking target.
Anyways I'm now suddenly waking with readings of 12-14. I did a temporary basal of 110% then I did 125% to little effect. In fact this morning was 14.5. changed my set regularly and have good control during the day.
Should I try a 40% increase from 12-6am?. I used to always have my insulin resistance at 12-3am but looking at my libre I'm suddenly getting highest readings at 3-6am.
Or should I do fasting tests and increase basal more gradually? If my bloods are high between 12-7 then is increasing the rate during 12-6 a good idea or do I need to start earlier? I have a very active job so increasing beyond 6am risks a morning hypo I fear and my daytime readings are good.
Just waking up with double digits despite increasing basal is frustrating and making me feel guilty! Bizarrely!
Other changes have been: missing a pill and having a heavy period, massive stress at work, not sleeping properly with my child waking in the night and increasing dose of fluoxetine from 20mg to 40mg (the later I don't believe does affect it but who knows!)
Anyone else experience this random resistance?


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[Juicyj]

Hello @eabhamurphy The other factors such as stress and lack of sleep will affect you insulin requirements so do take these into account, however the only way to know for sure is to do your fasting tests and measure your overnight levels, however best to try over a few nights to see a pattern rather than just off the back of one test, try to see the double digits as a blip and don't beat yourself up over it, you've recognised that you need to review so that's fine, it will come back again into single figures. Another thought as your on the pump is to perhaps review the basal settings and add another setting say from 3am to 6am and add an increase here which will cover the liver dump ? I added one into mine as was waking high and it has helped me.

 

[himtoo]

I would say that as you have only been pumping for just over 2 months you need to sort of slow down and look at it in the bigger picture

I would definitely not resort to to TBR's to sort out an overnight problem --- I would instead go back to some overnight basal testing to establish where the changes are occurring

( my basals do not stay the same ALL the time ) I regularly need to revisit and make adjustments based on patterns I see in my overnight and morning BG's

hope this helps !!!

 

[paulliljeros]

This had me waking with blood sugars of 5-7 which I would have liked lower

Not sure if I'm reading this out of context, but waking between 5-7 is pretty good, and I personally wouldn't want to be aiming too much lower than that? Also, One possible thing to check, at times when you have had the unexpected raised BG's, have you had any hypos in thee preceding 36 hours?

 

[azure]

Being woken at night by children can put your BS up, I've found. Stress can also have a surprising effect and cause highs at particular times rather than all day.

My final thought is that it's a site problem. For me, waking high is usually a sign of a 'bad' set/site @eabhamurphy

 

[eabhamurphy]

Thanks so much guys! This information has been really useful.

My most common time now for hypos is after dinner as I find this meal the hardest to regulate particularly if my husband cooks and have on occasion overestimated carbs. This did happen on one of the high nights in question.

The canula site tends to be slightly swollen around the insertion point and red and raw around it from the adhesive so need to look at changing site every two days rather than every one. The discomfort of this is tolerable and sometimes it worse than others!

The DSN has suggested an increase 25% 10-1, 35% 1-4 then back to original rates. Probably sounds quite aggressive but explained that the results were already on a TBR of 25%. She also agreed that a fasting test would be more useful than a temporary basal rate result but that it did obviously need to increase so that I was to do that straight away and then any further adjustments were to be done from fasting tests. It did work, 5.5 this morning but a bit steep climb (4-7.5) between 12-3 and then drops and flat the rest of the way so need to do fasting tests from tonight to get right adjustments.

I don't know why I thought this wouldnt change much, it's kind of obvious now that it would! I suppose my lantus dose had been similar from diagnosis to starting pump ~ 10 years but then I was having hypos so much and could only avoid them by going way to high at other times that inflexibility in dose was a real issue, hence the pump! So it makes sense now that it would be subject to change.

Thanks again!
*Off she goes to do fasting tests*


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[himtoo]

hi there
if you are getting swelling and red raw patches around your cannula site -- perhaps you could try a barrier spray before inserting cannula.

I use Cavilon -- you can get it on prescription