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Unexplained highs in the late evening

M

michael_n

Member
Hello everybody!

I'm 26 and have been diabetic for almost 14. The first 12 years were easy as pie: my HbA1c s was between 5.6% and 6.4% and I was checking my blood sugar only 4 times a day. I was on NovoRapid and Lantus the entire time. I had bad days/weeks when I just couldn't lower my BG, but they were pretty rare.

Things took a turn for the worse in 2016. I admit it was a pretty stressful year with one of the toughest exams of my life and my first job. On top of that, I got a couple of Lantus lows which got me scared as I was living alone and was very anxious so I switched to Levemir. It wasn't that great, but it (kinda) did the job. My HbA1c s in 2017 were between 6.6% and 6.85%. I know it isn't that bad, but it isn't great either and bear in mind that for the past year and a half I've been testing at least 10 times a day.

In the past two months, the issue got out of hand. My blood sugar rises inexplicably between 10 pm and 3 am and is virtually non-responsive to insulin. I have to inject a very high dose to lower it, which I'm scared to do. If I wake up during the night, I inject two smaller doses which can do the job. That takes its toll on my sleep which already isn't good because of the high BG. This happened a few times while I was on Lantus too, but I can't tell if it would happen that often as I switched to Levemir. These unexplained spikes happen during the day, but that usually lasts for a few days at is somehow easier to deal with.

I have to mentions, my diet is almost exactly the same for the past 14 years and my insulin doses are the same for the past 10 years or so. My doctor is clueless and doesn't seem too concerned as my HbA1C is decent enough. I'm really worried and for the first time I feel I'm losing control over my disease so any pieced of advice will be much appreciated. Thank you!
 
when and how much levemir do you inject? Do you split it? Also what is your BMI (if you don't mind me asking ;))
 
OK I was thinking you maybe doing just one basal injection and it was running out of an evening. scrap that idea then!

Although your dosages may need tweaking, have you thought of doing a basal test?

It could also be your evening bolus Insulin to carb ration may have 'drifted'?
 
The weird thing is this spike isn't dependent on meals and insulin dose. Even if I eat less or earlier, my BG will increase after 10 pm. I've though about it being because of a liver dump and tried eating later. Sometimes the increase comes a little bit later, sometimes not.

As for the basal test, I haven't done that. I know for a fact that Levemir, at least at the dosage I'm taking, isn't as effective as Lantus because of higher morning readings, but it used to be decent half a year ago.
 
I'd consider switching to Toujeo for your basal. Sounds like whatever you're taking isn't lasting through the night to me. I haven't used it myself, Lantus still works (I take it in the morning, 25 units). But my friend's daughter is doing way better on it and her control has been pretty spotty for years (she's about 30).
 
Are you doing any kind of activity/ exercise after dinner? I typically will rise before bed but wake up low even if I just vacuum a room hahah. But true
 
@slip: Around 7:30 in the morning and 22:00 in the evening. I thought about the morning dose not lasting until the evening one kicks in but I always took it like this and it hasn't been bad in the beginning.

@Kristin251: I usually don't do anything after dinner, but there have been a few times when I went to the gym in the evening. My BG still rose, only a couple of hours later.
 
michael_n said:
@slip: Around 7:30 in the morning and 22:00 in the evening. I thought about the morning dose not lasting until the evening one kicks in but I always took it like this and it hasn't been bad in the beginning.

@Kristin251: I usually don't do anything after dinner, but there have been a few times when I went to the gym in the evening. My BG still rose, only a couple of hours later.
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Yup. Mine raises too but then I’m usually a tad low by morning. Exercise is a tough one to figure out. I pretty much gave it up as I don’t like all those random fluctuations.

I take 2-3 units of lantus at 10pm and it’s long gone by morning.
 
@TheBigNewt : I'm willing to try anything as long as it doesn't have a significant hypo risk. I'm thinking of going back on Lantus which I know for a fact is effective but the two severe hypos I had because of it scared the s**t out of me.
 
Update: Switched to Lantus for the past 5 or 6 days and nothing changed.

Here's an example from last night: 96 mg/dl before dinner at 7 pm; I could feel it going slightly low around 8:30 to 9 pm but decided to wait as I clearly wasn't hypo. Then at 21:30 it was 179 mg/dl. I injected 2u of NovoRapid and 22u of Lantus. Two hours later - 191 mg/dl. I injected 2u of NovoRapid and go to sleep. At 6:15 in the morning it was 280 mg/dl. I know for a fact I'm not going hypo overnight as I've checked my blood glucose at different times in the past year.

The problem is this sometimes extends well into the morning, sometimes even until lunch and I inject high doses of insulin without it being effective at all. This doesn't happen all that often, but it's definitely more often than it was 4 or 5 years ago.
 
I inject in the morning when I first wake up. Wait 20 min and eat a small bf. If I don’t eat I keep rising. No fasting for me. Then an hour later I test and inject to stop the morning rise. I have to do this all morning every hour or hour and a half to stop the rise until noonish. I only eat with the first injection and I eat the same thing every morning. A lettuce wrap with turkey/ chicken and some avocado smashed in. Nothing carby and not a lot of protein.
 
I usually inject the Lantus at least 3 or 4 hours after dinner. If I do have a snack after taking it, it's usually something pretty small.

I can completely relate to your morning rise. It happens to me pretty often, but not as often as the evening one.

I noticed that on days like these, my BG is good only after meals, even I don't inject a big dose of insulin. Yesterday was a perfect example: I struggled all morning to get it under 200, then I had lunch and it was 155 about two hours after, which is decent enough on days like these. It rose again before dinner. One hour after dinner it was 168, I went to the cinema to see a film (2 mile walk) and it was 117 when I arrived there. Sat through the entire movie without snacking and at the end of it - 256. Injected 3u of NovoRapid and walked the 2 miles back home, but came back with 231. Should I try eating something more consist in the evening and taking 1 or 2u of NovoRapid with it?
 
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And there was me thinking '2 mile walk' was a new film! :D

michael_n said:
I struggled all morning to get it under 200, then I had lunch and it was 155 about two hours after
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Did the lunchtime bolus include a correction?

Was the 2 mile walk above and beyond normal activity for you?
 
It did include a correction.

It wasn't, it's just that I haven't had any activity after dinner lately. I usually take a walk or hit the gym right after lunch or before dinner.
 
There are several things that could be going on but I feel your frustration. I eat the same macros at the same time everyday. This is the only way I don’t rollercoaster and I know my doses for each meal at each time of day. Random eating never worked for me

In the absence of carbs, protein can turn to bg
A high fat meal delays the rise for hour. If I eat a very high fat meal I need to split my bolus
A high protein meal raises ME but not everyone
Of course a high carb meal will raise us

Do you preboiks or split boluses? It’s typically about 20 min before insulin starts working. I always wait 20 min even with a vlc meal. Getting insulin and food to get there at the sameness time and marry can be very difficult. That’s why I have my routine meals.

Exercise ( your walk) can either raise or lower me. And I never know which way it’s going to go. Or it can go one way and an hour later the other way. I gave up. I’m not auggesting you do.
 
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