Waking up with high readings. Advice needed please

[acm24]

Hi,

Any advice on the following would be welcomed.

I am a type 1 diabetic taking approx 16 units of nova rapid with meals and 12 units of levemir before I go to bed. I am also using the freestyle libre.

When I test before I go to bed, my readings are always in range between 7-9 however, this seems to start rising around 3am so I wake up to readings in the high teens!

Does anyone have any idea of what could be going on here? Or any suggestions of what I could do to stop this from happening?

I’ve recently had the letter to say I have back ground retinopathy following my eye screening so I want to take better control to avoid any complications.

Thanks for your help.

 

[In Response]

This sounds like Dawn Phenomenon. It happens to most of us - our livers dump a load of glucose into our blood to give us energy to start the day. A healthy pancreas will react by releasing insulin. Those of use with T1 are not so lucky.

There are many many threads about Dawn Phenomenon including ideas for minimising the affect. I recommend having a read around the forum.

On a positive note - isn't it great having the Libre so we can see this rise and know that it isn't a problem f too little basal?

 

[Juicyj]

Hello and welcome @acm24

It's worthwhile having a chat with your diabetes team about this, I know that if it's a regular occurrence then you have a good case for pump therapy, as you can create a basal pattern to manage the Dawn Phenomenon which will prevent the rise in the morning and enable you to manage this better, the libre is an excellent way of seeing patterns with this, but try and keep records to see how often it's happening.

 

[Jaylee]

Hi,

Any advice on the following would be welcomed.

I am a type 1 diabetic taking approx 16 units of nova rapid with meals and 12 units of levemir before I go to bed. I am also using the freestyle libre.

When I test before I go to bed, my readings are always in range between 7-9 however, this seems to start rising around 3am so I wake up to readings in the high teens!

Does anyone have any idea of what could be going on here? Or any suggestions of what I could do to stop this from happening?

I’ve recently had the letter to say I have back ground retinopathy following my eye screening so I want to take better control to avoid any complications.

Thanks for your help.

Hello,

Welcome to the forum.

When did you have your last meal prior to bed?
What are your Libre trends doing through the day? Are you finding a bit of a roller coaster effect.?

 

[acm24]

Hello,

Welcome to the forum.

When did you have your last meal prior to bed?
What are your Libre trends doing through the day? Are you finding a bit of a roller coaster effect.?

Hi!

Last meal is normally around 6:30/7ish and then I’ll have my levemir around 10:30.

Definitely have a bit of a roller coaster throughout the day. Once I’ve had breakfast/ nova rapid, my readings will go back into target range then spike again after lunch around 3ish. They’ll level off again and be fine the rest of the day until they start to rise at 3am and I wake up high.

 

[Jaylee]

Hi!

Last meal is normally around 6:30/7ish and then I’ll have my levemir around 10:30.

Definitely have a bit of a roller coaster throughout the day. Once I’ve had breakfast/ nova rapid, my readings will go back into target range then spike again after lunch around 3ish. They’ll level off again and be fine the rest of the day until they start to rise at 3am and I wake up high.

OK,

You would need to discuss with your doc or nurse. But at a guess it sounds like your Novorapid could be taking the "load" on what your basal should be doing? (which should be handling the background levels.)
Especially if you might be on a fixed dosage of Novo. Do you carb count, or are you more "Portion" advised with meals?

This is where you need to consult your HCP. Your Levemir may need a tweak?
This is a useful link on basal testing. It's great you have a libre, should make it a little easier.
https://www.mysugr.com/en/blog/basal-rate-testing/

 

[nickm2uk]

I had a similar issue and my specialist halved my levemir 1 injection at breakfast another 12 hours later after evening meal . It was working fine until lockdown. I'm going to bed very late and sleeping later so the 2nd injection appears to fade before I wake.

 

[Glucobabu]

Hi!

Last meal is normally around 6:30/7ish and then I’ll have my levemir around 10:30.

Definitely have a bit of a roller coaster throughout the day. Once I’ve had breakfast/ nova rapid, my readings will go back into target range then spike again after lunch around 3ish. They’ll level off again and be fine the rest of the day until they start to rise at 3am and I wake up high.

You could be talking about me! I have had the same issue for a long time. My DNS advised me to reduce my evening NovoRapid so that I don’t go low after dinner to necessitate a carb snack which would cause a rise later due to inactivity and dawn phenomenon. It worked to an extent but I still find BG creeping about 5am and wake up with 10+. I have found that the only solution that seems to work is taking about 3u of NovoRapid at around 5am. I wake up around 7.30 with BG between 5 and 7. I have a phone appointment with the DNS in a few days to see what she suggests.