High Sugars thoughout the night

[scw33]

Hello, I am a 28 year old male Type 1 Diabetic with an A1C of 108/6.0, and am on 20 units of Lantus a day, and take a ratio of 5g carbs per 1 unit of NovoRapid.

I am at my wits end about how to control my sugar levels once I go to bed. Throughout the day my sugars are fine.   I used to be fussy about the "dawn phenomenon" and why my morning sugar levels were so high (ie. 180+), but now I realise that at midnight, 2am, 4am and when I wake in the morning I have very high numbers (180 to 320).  When I go to bed my levels are generally very good and I have supper every night between 5pm & 7pm).  Nights are a nightmare for me because I can't sleep due to having to go to the toilet all the time.

Usually, when I wake in the night and am very high I try and correct myself, but I find that my corrections do little to nothing; for example last night I was 270 and took 4 units of NovoRapid to get me down under 150 but I only marginally went lower to 234.  I often repeat this activity again and again during the same night (it seems like I am just wasting insulin).. Furthermore, I am not experiencing rebound highs as has been suggested to me in the past!

Some of the futile things that I have done to address this problem are: changing insulin (Lantus & Rapid - in case they have expired), exercise more often and more vigorously, omitting having supper, and having a glass of red wine before bed...  I have been told that eating a very low carb meal for supper is the best way to achieve a consistent night - but I have found that even plain garden salads do little to check my rise.

HOWEVER, last week I travelled to the UK for a conference and for the entire week I had healthy sugar levels.  My bedtime, midnight, 3am and morning levels were nearly all the same (90 - 126).....  I am so confused!

My endocrinologist has no solutions and he reckons my liver is behaving normally, so please if anybody can suggest/help me with this mystery I would be very very grateful and hopefully can enjoy a nights sleep without having to make half a dozen trips to the toilet.

Thank you and I eagerly anticipate your comments.

Stuart

[JDRF Volunteer SG]

You could try increasing the Lantus to see if this helps, but you need to be aware that it will increase the amount of insulin being released all day long, so you may need to lower the Rapid, or you may find that you need to nibble some throughout the day to keep the Lantus balanced. It really seems that the rapid-acting insulin would be the key: increasing it at dinner time. I don't have the problem you are writing about, and haven't really heard anyone else complain about this issue, but I do find that I do best eating a low-carb evening meal and making up missing calories with higher-carb breakfast and lunch meals and snacks. I guess this works best for me because there is less margin for error -- I require less insulin for a low-carb dinner, and so if I miscalculate, it isn't as big a deal.

[Kristin_wht]

Consider taking a nph insulin before bed.  That's what I take for my dawn phenomenon.  It peaks at a later time than rapid acting.  I take Humulin N

[bluarc1]

Have you tried very small meals, as in senior meals every 2 1/2 -3 hours.
No other changes. A friend of mine is doing very well with this and has even lost 20 lbs.

I myself am starting with this eating style. I do know that my B/S levels are better from the 90s - 145s. I have type II. Pryor to this my B/S in the 250s - 280s.

[Pacman25]

I'm a 25 year old Type 1 male diabetic.  For the first five years I used lantus and novalog.  Eventually I sucked it up and got the pump after I met an older guy (Diabetic) who really recommended it.  Generally I feel you have a lot more control at night with the pump that you do with lantus.  I HIGHLY recommend looking into that!

[davidspixx]

I find that for me Lantus lasts only 20 hours, not 24,so I split it morning and night (2/3 night/ 1/3 morning). Before I found this, the Lantus would run out around dinner, confusing the dinner numbers. I trim at 10 when I go to bed to correlate the dinner insulin.

[scw33]

Thanks again for the response and I don't have any allergies that I know of.

Funnily enough, for the last two days I have had a slight stomach bug and have therefore been unable to eat much.  Consequently, my sugar levels at night have been remarkably good - similar to my daytime sugars.  I did get a slight increase in my sugar levels this morning - but I suppose this is normal (dawn phenomenon).

What puzzles me, is that it takes a simple broth soup (total carbs - 5g) for supper to allow me to have good sugar levels at night.  At this rate I daren't even have a salad for supper because of the anticipated high I will probably get.

What I haven't considered revising is taking an increased dose of Lantus...  My endo hasn't suggested doing this, but perhaps this would allow me to eat a larger meal for supper and have decent night sugar levels??

[JDRF Volunteer SG]

Yup, if you are taking it at night, then it should be at its strongest while you sleep, so the Lantus shouldn't be the problem. Maybe the best solution for you is to increase your Novolog with the evening meal, and make sure you eat fairly early so you can catch any lows that happen if the Novolog peaks before the carbs in the meal digest. I personally find that I do much better with early dinner meals.

One more idea... do you have any food allergies or airborne allergies that might be kicking in at night while you sleep? Some people with allergies produce adrenalin when the allergins are present and this hormone acts as an insulin blocker. My twin has allergies that I don't have, and she finds that there is a direct effect of allergies on blood sugar levels. Just a thought. I am grasping at straws here.

[scw33]

Thanks for the suggestions.  I actually do take my Lantus at 9pm, but will consider splitting the doses to see if that will have an effect.  

As for high fat meals - the most fat I usually have with a meal derives from the actual meat (chicken, fish, beef) and from the olive oil that I use to cook...  

I find this daily pattern very strange, because it seems that as soon as I close my eyes my body (or specifically - my liver) mobilises and starts pumping-out sugar.  I am unclear if this is related to what I eat or as you possibly suggest because of Lantus...

[JDRF Volunteer SG]

You did not mention what time of the day you are taking your Lantus. If you are taking it at night, then it should be peaking (about 4 hours after injection) during the night, so the Lantus shouldn't be the problem). But if you take it in the morning, then a split dose of some in the morning and some at night may be a solution, for if taking it in the morning, it may be wearing off completely as you sleep.

I agree that low carb evening meals seem to be the best way for me to keep consistent glucose readings while sleeping. The thing to avoid is eating high fat, high carb evening meals which continue to digest long after you go to bed and after your NovoRapid wears off. Eating dinner earlier may help, too, so you have a better idea of whether your dinner quick-acting insulin was enough.