Type 1: Spike in levels during night

[kellie lees]

Husband newly diagnosed.
Before bed his level was 6.7 (which we didn't think was too bad!) he'd had a few pints in the day but not a lot and eaten a carb loaded meal at the end of the day.

Checked level at 3am and it was at 18

Checked when woke up and down to 8.

Any ideas? Concerned as this will give a high glucose reading over time won't it and affect his average readings?

 

[azure]

When you say he ate a meal "at the end of the day", what time exactly @kellie lees ?

 

[kellie lees]

When you say he ate a meal "at the end of the day", what time exactly @kellie lees ?

Erm about 7:30/8pm and he takes his long lasting at 9pm. He checked his levels at 10:30pm before bed and it was at 6.7 but then at 3am his levels were high at 18!

 

[azure]

Erm about 7:30/8pm and he takes his long lasting at 9pm. He checked his levels at 10:30pm before bed and it was at 6.7 but then at 3am his levels were high at 18!

Ok - next question: what did he eat?

If it something that caused a slow rise, it could be that his BS was on the way up still when he went to bed. I find eating 6/6.30pm means I can spot slow rises easier.

Another possibility is that his basal may be slightly wrong, but if this doesn't usually happen, that would seem less likely.

 

[kellie lees]

Ok - next question: what did he eat?

If it something that caused a slow rise, it could be that his BS was on the way up still when he went to bed. I find eating 6/6.30pm means I can spot slow rises easier.

Another possibility is that his basal may be slightly wrong, but if this doesn't usually happen, that would seem less likely.

He had a pizza - i know this is bad but he'd had a few drinks in the day so had thought to carb up? We are so new to this but in the day he can manage his levels - the highest he is going is 10 which I know is too high but come down a lot since he was diagnosed. But the 18 at 3am concerned us!
Thank you

 

[azure]

He had a pizza - i know this is bad but he'd had a few drinks in the day so had thought to carb up? We are so new to this but in the day he can manage his levels - the highest he is going is 10 which I know is too high but come down a lot since he was diagnosed. But the 18 at 3am concerned us!
Thank you

Ah, that will be the answer then - the 'pizza effect'! Pizza will often cause a delayed rise due to the fat.

Perhaps eat it earlier (or even for lunch) and set alarms to do a night test. I find keeping my portion moderate helps too.

Yes, alcohol can cause lows sometimes but they can usually be dealt with by eating a small carb snack eg nibbling a few crisps with your wine or whatever. Extra tests are sensible too. If the alcohol was beer, then that has carbs in so is slightly different.

 

[azure]

Oh, and a pizza isn't bad - it just needs more planning Personally, I like to keep my portions small to minimise the effect but others have different methods to deal with pizza eg splitting the bolus or using an extended bolus if they have a pump.

 

[DunePlodder]

I agree with Azure about the post pizza high, but it is strange that it came down to 8 by morning. All his bolus insulin would have been out of his system by 3 o'clock so in theory it would have stayed steady at around 18. This assumes his basal dose is reasonably good. Did he give himself a correction dose at 3:00 a.m.?

Don't worry about his long term average for the moment, he is newly diagnosed. As you get to understand & improve problems like this one the averages will improve.

 

[kellie lees]

Oh, and a pizza isn't bad - it just needs more planning Personally, I like to keep my portions small to minimise the effect but others have different methods to deal with pizza eg splitting the bolus or using an extended bolus if they have a pump.

So do you think the 18 was due to the pizza? I can't believe it could have such a dramatic effect?! Lots to learn. We feel like it's very trial and error which is scary when it's your health is this normal?

 

[kellie lees]

I agree with Azure about the post pizza high, but it is strange that it came down to 8 by morning. All his bolus insulin would have been out of his system by 3 o'clock so in theory it would have stayed steady at around 18. This assumes his basal dose is reasonably good. Did he give himself a correction dose at 3:00 a.m.?

Don't worry about his long term average for the moment, he is newly diagnosed. As you get to understand & improve problems like this one the averages will improve.

No he didn't give himself a correction dose at 3am - he didn't do anything.
But the fact that he was back down to 8 in the morning shows his long lasting is probably at the right level at the moment yes?
It's the fact that the sugar rise has been so spiky- surely this isn't good?

 

[azure]

So do you think the 18 was due to the pizza? I can't believe it could have such a dramatic effect?! Lots to learn. We feel like it's very trial and error which is scary when it's your health is this normal?

Certainly I think that was probably a large part of it. Regarding the improvement in levels by the morning, that could have been helped by him still being able to contribute a little of his own insulin.

Up and down levels aren't abnormal during the honeymoon and early diagnosis - there's an awful lot to learn with Type 1! Some things can only really be learned by experience.

I've probably mentioned this before, but my top tips are to buy Think Like A Pancreas, push to be shown carb counting or teach yourself the basics if you have to wait for education, test lots, and keep good records. That way he'll learn that a certain meal generally needs X amount of insulin, that the best size serving of pasta for him is X grams, that a pizza needs a second bolus at X hours after, etc, etc.

I promise you it does get easier

 

[DunePlodder]

Your situation is complicated by the fact that he is probably in the "honeymoon" phase & as Azure says he may well have produced enough of his own insulin to bring his reading down. I'm still surprised it came down so much.

For people who've had type 1 for a few years, the basal ("long lasting") dose should keep blood sugars steady when there is no other insulin or food in the system. So in that situation, once up to 18 his blood sugars would theoretically stay at around 18 until a bolus was given.

Have a chat to your diabetes specialist nurse about basal testing.