I’m looking for advice or suggestions for a problem I have almost every night, that is, my blood sugar jumps in the period between 8:30 pm (2 hours after bolusing and eating) and 10:00 pm (bedtime).
Every night, I go for a walk after supper. When I get back from my walk (approx 2 hours after my last bolus), my BG is generally normal, sometimes even hypoglycemic. But, when I test my BG at bedtime (10pm) it’s a lot higher, on average 4.5 mmol/l (81 mg/dl) higher. I take a correction bolus before bed, but it’s not always effective.
I don’t eat anything in that period, so I know it’s what I ate at supper that’s causing the increase, but I don’t know what to do. I don’t eat more than 65 g of carbs at supper time, and I take what I believe to be the right amount of insulin for that amount of carb. As I said, I sometimes have low blood sugar after my walk, which makes me believe that taking a larger supper bolus wouldn’t help. Also, I sometimes don’t treat the low that I get after walking–I feel no symptoms and my blood sugar rises on its own. (I know that’s not good, but I’m saying it for the sake of providing a full description of my problem).
The only thing that seems to work is to eat a smaller supper with fewer carbs, but I’d like to be able to eat a more normal sized meal and not face a huge spike in my BG every night.
I would appreciate any help anyone can give me. I have no idea how to solve this problem.
Have you ever done any basal testing at that time of day? Maybe you have a natural rise at that time and your basal rate will need to be adjusted for that? It could also be your body recovering from the low. Sometimes my sugar will rise on it’s own after a low because the liver is producing a bit of glucagon to try to fight the low. Maybe change your walk to before dinner rather than after?? You might be using the insulin much more efficiently while exercising and after you stop it might not continue to work as well? Strange problem but with a little experimentation i have no doubt you can figure it out. Good luck
Are you certain your basals are correct? Have you done basal testing? It’s too hard to correctly bolus if the basals are not set right so you might want to check those first. Especially if your blood sugar comes down after your walk then dramatically rises before bedtime. That sounds like you need more basal for that time period.
As for dinner, for me, I can’t accurately bolus for anything over about 50 carbs. If a smaller meal with fewer carbs works, you might want to experiment with foods you like that are less carbs but you find satisfying, so that you can have less spikes. We all have ideas about what a “normal” meal is, but what is normal for us is what works. If your spike is coming as late as 3 1/2 hours after your meal, you might be combining high carb and high fat which takes longer to digest.
I agree that basal testing is a good idea. I have tested my overnight, morning and afternoon rates, but not supper time/evening. I’m pretty sure I do have higher insulin needs at night, and I have a higher basal rate at night, but maybe it’s not high enough.
(I have to walk after I eat–no time and no energy to do it beforehand).
It’s interesting to hear that you can’t accurately bolus for anything above 50 carbs. I feel the same way myself (after about 65 carbs). I definitely do better when I eat 50 carbs or less, but not all my meals are that low carb.
I will think about fat and carb content of my supper, as well—that’s a point worth considering.
Maybe its what carbs you are eating. I know if I eat pizza, pasta, chips, white potatoes my levels will not stay low. I think because those carbs eventually turn into sugar its like a double hit. Your BG may come down due to the exercising but then hours later it may increase again when the carbs turns into sugar. I would also look into changing the types of carbs you are eating at night and see if that makes a difference.
It is possibly an over reaction from the hypos… Physiologically it is the perfect situation… You bolus… eat… walk… then you are normal or hypo because your muscles have taken up all they glucose when you were exercising, then you become hyper… Your liver is reacting to your hypos and producing more glucose… to balance it out… but because you haven’t taken any more insulin… you stay hyper…
I totally agree with Rye. If I don’t really eat carbs at dinner time, My BG’s are right on through the night. If I do eat carbs, and am not super careful about what carbs they are, and don’t extend the bolus appropriately, I have a huge spike hours later.
Evening can be when digestion is slowest as our bodies slow down. Also usually the heaviest meal of the day with the most protein/fat. If this is a consistent pattern, consider taking your bolus a bit later than you normally would to cover the later spike. Or, you can take a split dose with part of the insulin at the usual time & some at 1.5 hours after eating.
This might be gastroparesis (delayed stomach emptying), which tends to be most apparent in the evening. Going low after eating & highs hours later is a sign of gastroparesis. Hope it’s not this.
Your basal would need to be way off to have that much of an increase, so I question if it’s your basal dose.
I doubt it’s gastroparesis, but you might be on to something about either taking my insulin later or doing a combo bolus. Since I end up taking a correction every night before bed, anyway, I might try taking it when my BG is normal (2 hrs after eating) and seeing if it prevents the spike.
Thanks to everyone for the great suggestions. Keep 'em coming!
I have the SAME problem!! I believe it is the delayed absorption of my protein and fat at night. I will have a perfect 2 hour pp, I also ride stationary bike at night and then by my 4-5 hour bg check before bed I will be in high 100s
For you Lili Mama, thats it. I have to use TAG to get low carb meals correct due to the long digestion of fat / protein. The more fat the longer I need to extend the bolus for. Thats on a pump, I think on MDI, you may need to do 2 shots or like you said more exercise. Also the combo of the insulin / exercise maybe giving your that great PP, but when the exercise is over the glucose keeps on working to bring you up.
HFXNS, when I used to eat sushi with white rice, I would have to do long extended boluses to cover the carbs. For some reason it just took a long time to process. What it sounds like is happening is that you are correcting well for the dinner, but the insulin / exercise is just running out and the digestion is lasting beyond that.
If your on MDI, what time does your basal run out? Possibly, that could be a factor as well. What happens when you cut out the exercise? Also, have you tried changing the carbs your eating? Possibly rice takes longer to break down than pasta, etc.
Thanks for the wonderful suggestions onesaint! I have considered doing multiple injections but I am so new at all of this that I get nervous about splitting it up so I just do one. I have read some in the TAGGERS but most of the posts are for pumpers. And yes I do believe my basal is worn off by dinnertime but the weird thing is the higher I am when I go to bed the more I drop during the night for example, last night I went to bed at 170 and woke up at 110. The night before I went to bed at 95 and woke up at 110…weird how it always works like that.
I have never tried cutting out exercising, I bike for at LEAST an hour a day everyday. I only eat low glycemic and low carb. I never eat more than 20 carbs at a time and I eat a total of 30-40 carbs per day, I do however eat a lot of fat and protein. About 80 grams protein and 100 grams fat a day.
Im with you, I eat the same way. The fat/protein can take hours to break down. Thats the one reason I havent tossed the pump. Try cutting some protein at dinner and adding some fat. Possibly add that protein in at lunch for the daily total, but that should help reduce the high in the evening.
Looking at the trends on my CGM, usually the breakdown of the proteins lasts 4-6 hours. If its a high protein meal that means more glucose. I can toss a full 3u at it and my BG wont budge until digestion is done.
You might check with your doc or in the published lit, but I think he’ll tell you that exercise can and does frequently cause blood sugars to rise. You might try checking your bg just before and just after exercising to measure this phenomena for your situation. IIRC, the bg rise with exercise is more pronounced at higher bg levels, which might correspond to your situation after eating a meal. I believe our bodies store glycogen (a form of starch) in muscles (and the liver) that is then pumped out during exercise. I think it takes one to two hours of exercise to deplete the glycogen stored in muscles. (all of this is fragmented knowledge from various literature and way beyond my paygrade )
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