Unexplained overnight BGL Rises

[leather_ferret]

Hi folks,

I suffer from Chronic Pancreatitis and I am recently diagnosed with diabetes. Metformin & glicazide failed to make any difference to my +20 BGLs and I was put on Lantus and Novorapid.

I have noticed that I have a pattern of high readings when I wake in the morning. I always have a small snack to help me sleep, but not large enough to account for the rise in Blood sugars.
For example, I had a test last night of 8.9 before having a cup-a-soup and a small slice of wholemeal bread. I wake up to a reading of 20.1 !
I would have thought that the Lantus should have been able to cope with such a snack over 7 hours

I have always been one for a late supper and wonder if it is possible that my liver is just used to dumping glucose into the bloodstream over night ??

Any ideas ??

Dave

 

[SophiaW]

You need to do a few overnight BG tests to see what's happening. It will mean waking two or three times to test. A high morning reading could mean not enough insulin to cover you overnight, or it could be that you're going hypo without realising and your liver is dumping glucose to bring you out of that hypo. Without testing it would be very difficult to know what the reason is.

 

[Celtic.Piskie]

A cup-a soup can have 14g of carbs in it, and with the bread (22g) that could be 36g of carbs. something which i'd certainly have to have some short acting insulin with.
Lantus isn't meant to cover snacks, it's meant to provide a backgrouns insulin, it can't cope with the spikes from food.

Test during the night, and after your snack. You may be going hypo, or you may need to cut down on the carbs or take some meds for them.
Testing is the only way you'll know.

 

[leather_ferret]

Hi, and thanks for the replies,

My problem is that, with the pancreatitis, I can eat no fat and only very limited proteins so my diet has to be almost exclusively carbs - not ideal for diabetes :shock: eg if I ate a small piece of cheese I would be in agony inside 10 mins and would need 30 or 40 mg Morphine to even out the pain spike - ain't life fun :?

Early days really as I only started on Insulin yesterday and it will take a while to get the doses sorted out and learn how the food and insulin interact. The diabetes nurse just phoned to check up on me and said not to worry about the morning readings for now. She said that these morning highs are apparantly due to something called the 'dawn effect' where the liver dumps glucose overnight. Have to read up on that one.

Cheers

Dave

 

[cugila]

Hi Dave.
Bit of light reading for you.........

DAWN PHENOMENON
Everyone, diabetic or not, exhibits some Dawn Phenomenon. It is a natural part of our bodies' circadian rhythms. Some have said it is the way our ancestors had the strength to rise and slay a wooly behemoth for breakfast.

Since most of us fast while sleeping, with teenagers a possible exception, our bodies use stored energy during sleep. The body uses all three macro-nutrients (carbohydrates, proteins, and fats) to store energy.

The most easily used is the storage medium of carbohydrates, called glycogen. Glycogen is made from glucose, and is stored in the liver and muscles. Since it is basically nothing more than a complex matrix of glucose, it is easy for the body to store and use, something the body does all day long. The technical term for the act of creating and storing glycogen is glycogenesis. When the body calls for the conversion of glycogen back to glucose it is called glycogenolysis.

Another macro-nutrient that is available to be converted to glucose is protein. Most of us think of our protein as being stored in muscle, but the body has protective mechanisms to make muscle wasting its last choice. One of the most useful and readily available sources of protein storage is in blood components, i.e., albumin (plasma). The body uses a process performed in the liver to convert amino acids, the building blocks of proteins, into glucose. The name for this process is gluconeogenesis, literally "the creation of new glucose".

So, what does all this have to do with a high fasting BG? Overnight, usually between 4am and 11am, your body releases some hormones. These are Growth Hormone (GH) from the anterior pituitary gland, cortisol from the adrenal cortex, glucagon from your pancreatic alpha-cells, and epinephrine (adrenalin). These hormones cause an increase in insulin resistance, raising your BG. In addition, these hormones trigger glycogenolysis and gluconeogenesis, adding stored or new glucose to your bloodstream.