Unexplanied night time highs - Advice plz

[O_DP_T1]

Hi all,

Hope you're well and staying safe. Haven't posted here in a while.

I’ve been having some real problems with overnight levels for the past 3-4 weeks, I get a sudden rise around 11pm-12am.
Levels shoot up to around 10-13 from say 4-6, then I end up taking 3-4 unit’s of rapid and it does not seem to bring it down most days.

Please see attached graph, these numbers are not normal for me. It feels like some random liver glucose dump etc.

So far I have tried:

• Increasing my evening Levimer by 2 units - No luck
• Taking 3-4 units correction dose at midnight - No luck
• Taking another correction does at 3am - Again no luck
• All the above together - Again no luck

At the moment I seem to be injecting every 3 hours in order to keep things under 12, I'm not ill or feeling off or anything like that.

My evening meals have always been around 8pm and they don’t contain heavy fats/proteins that could be causing issues later in the evening.

Any ideas would be welcome as this is really getting me down.

 

[porl69]

What are you eating for your evening meals at around 8pm?

 

[O_DP_T1]

What are you eating for your evening meals at around 8pm?

Usually some thing like sweet potatoes or brown rice with grilled chicken or salmon and some green veggies.

My marcos are about 45gCarbs 15gFats and 40gProtiens. So nothing that will spike me hours later, thing is I've been eating like this for ages an it's been fine until recently.

 

[porl69]

Usually some thing like sweet potatoes or brown rice with grilled chicken or salmon and some green veggies.

My marcos are about 45gCarbs 15gFats and 40gProtiens. So nothing that will spike me hours later, thing is I've been eating like this for ages an it's been fine until recently.

I do find that any rice no matter what the colour effects me after 3 - 4 hours. Luckily I am on a pump and can spread my bolus out over a few hours. Was you eating similar things before the spikes started happening?

 

[O_DP_T1]

I do find that any rice no matter what the colour effects me after 3 - 4 hours. Luckily I am on a pump and can spread my bolus out over a few hours. Was you eating similar things before the spikes started happening?

Yep nothing has changed.

 

[porl69]

Yep nothing has changed.

My motto - "Oh the joys of T1D" Which is of no help whatsoever to you.
You mentioned that you take 3-4 units of NovoRapid and nothing happens. Does your graph show a movement at around the 3-4 hour mark after you 3-4 units?

 

[O_DP_T1]

My motto - "Oh the joys of T1D" Which is of no help whatsoever to you.
You mentioned that you take 3-4 units of NovoRapid and nothing happens. Does your graph show a movement at around the 3-4 hour mark after you 3-4 units?

Nope it stays the same so then 3am I'm taking another 3-4 units and again no luck

 

[kev-w]

Have you tried the/a correction bolus earlier say around 9pm?

If that was me (it's not and I've never used levemeir or a split basal) I'd correct at 9 and probably up my basal by a couple of units but run like that for a week to settle.

 

[porl69]

Could it may that maybe your bolus ratio is out for your evening meal?

 

[Vplum]

It's the dawn phenomenon apparently. I have the same. Makes no difference what I have eaten i frequently go up to 14 (used to be 20+). Hoping this will get me a pump! 20 years I have had it and no one has managed to help me resolve it yet

 

[MarkMunday]

Looks to me like you may be running out of basal in the evening, before evening Levemir gets up to speed. Have you tried splitting your Levemir between morning and evening shots?

 

[O_DP_T1]

Thanks all. Quick update.

So last night I got a a new Rapid and Levimer pen out.
Took my usual 8pm meal and dose, then at 9:30 took my levimer as usual. After dinner I was 5.5 and stable then boom at 11pm shot up to 9, i took 3 units and then at 3am still 11 so took another 4 units.

 

[MarkMunday]

So it isn't the pens. You could try splitting the Levemir between evening and morning shots. You could also switch to Lantus. Lantus has longer action than Levemir. Tresiba would be another option.

 

[O_DP_T1]

My levimer is already split. I tried another experiment last night which was to completely skip dinner so the last meal I has was 2pm, and guess what no 11pm rise. Woke up this morning as a 4.2 and STARVING!!!!

 

[MarkMunday]

Do you think you aren't bolusing enough? Maybe you need an extended bolus for that evening meal. Using Regular instead of Novorapid in the evening would have that effect. You could also try just eating low-carb in the evening.

 

[EllieM]

Do you think you aren't bolusing enough? Maybe you need an extended bolus for that evening meal. Using Regular instead of Novorapid in the evening would have that effect. You could also try just eating low-carb in the evening.

I've got to think MarkMunday is onto something here. 11pm is only 3 hours after your evening meal so maybe you just aren't absorbing the carbs as fast as you used to. Either go low carb or up the bolus and/or split it. Any weight gain/lifestyle changes that might have increased your insulin resistance? (T2 family history?)

I find that if my levels are higher than my correction ratio goes up. (And recently I was panicking because no matter how much humalog I injected my levels weren't coming down - then I found that 2 cartridges in my latest insulin packet in the fridge were cracked - I just hadn't been managing to inject more than a fraction of the insulin I'd dialled up... .)