Hi everyone For about two weeks I've had consistently high fasting numbers. I don't mean 130 or 140 which I am used to having on occasion, but up into the 200s and even 300s! In the last week my lowest was 234! That's nuts for me! The couple times I hit the 300s I assumed it was a pump problem and changed my set. I did in fact have some tubing/no delivery problems during that time and through my communication with Animas ended up getting a completely new pump (because the date reverted when I changed the battery!). So I've had a completely new pump since 6/13.
When I correct these highs it does come down and I'm usually fine after breakfast, so the insulin is fine. My numbers the rest of the day are within my normal range so it's just the fasting.
So of course, I've been raising basals. I'm not big on basal testing and have always done fine on just tweaking the relevant time period. I'm always fine when I go to bed then I wake up with those ridiculous numbers. The other day I went to bed at midnight at 130 and woke up at 6AM at 234! I always raise just one time zone at a time but I've started raising two. I'm seeing no response at all. I've done 12 raises in the last month. My rates were all around .550 or .575 and now are .600 or .625. I know that's not an enormous difference but I've always seen good responses to small changes.
Yeah, I know I should start setting alarms and narrowing it down to the exact point where it climbs, but I think that 12-6 time frame is pretty narrow! I've raised my 10PM time zone, my Midnight time zone, my 3AM time zone and my 5AM time zone. What do you think? Any other reasons it could go high at night? Would you just keep raising it gradually? It's weird I'm seeing no response at all, like someone hit the "snooze button" on my pump!
I do a pretty good job by just getting up early and eating something/taking insulin to "nip it in the bud". If I don't eat something at dawn... my bg can easily go up by 200, 300 in just a few hours without eating anything. And sometimes I wake up and I'm already at 200 or 300. Hate it, but it happens, and when it does happen, it tends to happen in stretches sort of like you.
What you're doing, raising basal overnight, is very feasible with pump, but you're only doing a slight bump in rates. Many folks use a much bigger bump in overnight basal rates and report excellent success.
When I am having morning highs and raising my dawn phenomenon basal rates a notch or two doesn't fix it, my first thought is whether I'm going low at night and rebounding.
That would make sense, Tim, but I've never had DP before. Not in the whole 6 years since diagnosis! These numbers are a dramatic change from previous numbers. The previous two weeks the numbers range from 70-134 which is about normal for me.
I've never had that experience (that I know of), Jen,and sort of doubt it, but if that were the case than raising my basals would make it worse! Sounds like I should be setting those alarms!
In my experience raising basal rates won't necessarily make it worse, just not better. But testing in the middle of the night is usually one of the first things I try doing if I start waking up high. I think this would be MUCH easier if you have (or have access to) a CGM.
A few weeks ago I started waking up in the high 200s and 300s and turns out I just had to raise my dawn phenomenon basal coverage (which I think I had lowered a few weeks earlier when I was waking up low). Now, I'm waking up low some mornings but high others ... Seems mornings are one of the most challenging times for me to "get right" for some reason.
No DP and definitely no CGM, but I think it would definitely help to wake up and test so I can see exactly what is happening and target my basal changes to the exact time needed. This is just going on too long! Thanks.
You have only had diabetes for six years. I'm sure that seems like a long time to you, but from my viewpoint that is still a newbie. And you have LADA, which is characterized by slow-onset and increasing doses. And you eat low carb, which tends to increase the proportion of basal you take.
Yet your basal was only 13.5 units per day before you started to increase it. Now its about 14.5 units. For comparison, I've had juvenile T1 for close to 40 years, do not eat a low carb diet, and currently take 38 units per day of basal insulin. Of course I'm significantly larger than you at 6'5", but my point is that you probably just need more basal, probably because of progression of your LADA.
Also, don't be afraid to increase your insulin. My basal needs can change seasonally by more than 20% (for comparison that would change your 13.5 to over 16). And because I inject rather than pump, I need to change all my time zones at once, and it works fine. I am simply more insulin sensitive in the summer than I am in the winter - and I'm more sensitive throughout the day. Don't be afraid to adjust all your time zones - if your body has changed its more likely that the change is universal and not limited to certain times of the day. Just go with it.
Has your dinner changed at all? I know you are not big on basal testing but I think it's time to do it. 130 is already high for my own liking so I'd not go to bed with it. And while 234 for fasting is bad enough...if you were rocking that high all night then yikes! I hope you find the cause and can resolve it.
I did a correction for the 130 at bedtime, Karen. I forgot to mention I also tweaked my nighttime ISF a tad just in case I wasn't getting enough correction. No real change in my dinners. Most about the same level of carbs.
You may be right, Jag, thanks for the input. I was only at a .38 c-peptide when it was tested in 2009 so I figured I'm pretty well done with LADA changes, but who knows. I know you're used to thinking in long-acting insulin terms, and there would be no reason to change all the time zones when this only occurs overnight. But otherwise I think your feedback is right on. I get this message over and over, "don't worry so much about why your insulin needs change, just respond to those needs". Thanks.
Well, I did not suggest a correction necessarily, I would just check it again before I went to sleep to be certain it was not climbing. Is there any change in your diet? I wonder because if I add a big hunk of protein to my meal then I am going to experience a rise in bg hours later. Once the bg starts to climb, it continues unless corrected, so finding the onset of the rise is the first thing to do.
That 130 was before I went to sleep. But I have gotten kind of lazy about testing at night; I often test when I get in bed to read and then either correct or not depending on the number, but then don't test again before sleeping. My basals as well as my ISF had been pretty reliable so I counted on staying relatively steady. But I need to be more on it now. No changes in my diet. I think twice during that two week period I ate a high carb/high fat meal (and blamed that for the high) but it's been consistently high the rest of the time too. I'm a vegetarian so don't eat large amounts of protein; I get more protein at breakfast and lunch than dinner actually. Thanks.
Hi Zoe - I thought when I was having so much trouble with my pump and numbers we had stopped twinning. Alas, that doesn't seem to be the case...
I really think you need to set an alarm (or drink a lot of water before bed) and force yourself to get up and check in the middle of your sleep cycle. Not only will you get a better idea about when you're starting to spike, you'll also be able to take a correction which will give you real information about how much basal you may need. If you're at 200 and correct back to 100 and still wake up at 200 a few hours later, you know that your basal plus the correction was the amount of insulin you need to hold more or less steady.
When I'm having trouble I use percentage temporary basals rather than resetting the Time Zones. With all your changes, you've only bumped up your dose by maybe 15%. When I was having trouble, 20% was the minimum that did any good and 40-60% was often required to drive the numbers down.
I hope you can get a handle on this soon. I'm sure you're frustrated and feel like hell in the morning.
Yep, we definitely have to limit this twinning to good things! Yes, I think you are right, Maurie about checking during the night. Maybe that is part of why I posted because I knew everyone would reinforce that! That's very useful about the correction plus basal "formula"; I'll keep that in mind. I'm going to test and be a bit more aggressive. Part of the downside of doing all my own dosing and not basal testing is it's too darn slow.
I'm not always sure that the correction dose is the amount needed to be rolled into basal. Insulin suppresses DP, but once DP get's going it has a mind of it's own.
Another thing to consider is that it is possible that other factors are causing a problem. For instance, you might have an infection or inflammation that is causing a marked increase in basal requirement. Or if you are suffering from a sleep disturbance, that can cause stress and an exaggerated DP.
I have a slight DP problem. I find that if I take one unit of Apidra by 7:00 AM, my blood glucose stays stable. If I don't take that shot by 7:00, I have to take corrections. Maybe once your basal is correct, some strategy like this might help you; that is, if you've developed a DP problem.
