Do you bolus at night if you're high?

In the past if I woke at night and I was high (like over 16mmol/288mL) I would always bolus to get it down. The main reason being of course that I wasn’t able to sleep, being very restless, and with very high BG. in the morning when I woke I was frequently low, or most times would be in an acceptable range, at least a decent number to get my day started.

Recently though, after starting with a new nurse and she realized I was doing this, she FREAKED out, bigtime, and made me swear that I would never do it, and gave me a medical reasoning about the body is resting and shouldn’t be processing glucose and that it basically goes against your body’s pattern. Or something like that.

Thankfully I have been hard at work at control and have not had a high during the night for quite some time, and can proudly say I have not bolused at night for a high - until last night.

Thats when the delicious hot Indian curry and Naan bread decided to give me a late onset rush of glucose and resulting high. I awoke at 3am with a BG of 16mmol/288mL and was tossing and turning, and I sheepishly decided I need to bolus. My bolus wizard calculated a 3.5u bolus but I decided to rather go for 2.2u, keeping in mind my nurse’s words.

I awoke with a 7mmol/126mL reading and was quite chuffed, so what I basically want to ask is - DO YOU BOLUS AT NIGHT if you’re high?

Do you rather not due to risk of hypo, or rather up your basal to treat the high? What is your action plan if you wake with a high?

Naan bread has been the source of some nighttime highs for me too! It digests very slowly…

I have never heard your nurse’s advice. Yes, I bolus at night.

Last night I woke up at 12.5 mmol/L (225 mg/dl) and I bolused and also woke up at at 7 mmol/L (126 mg/dl). On my pump, my doctor set my insulin sensitivity factor (ISF) so that I get a smaller correction bolus during the night than I would during the day to prevent overcorrecting. During the day, my ISF is set that one unit of insulin decreases my blood sugar by 3.9 mmol/L (70 mg/dl). During the night it is set to 4.4 mmol/L (80 mg/dl).

I will be curious if others know a reason that we should not be correcting. I don’t want to stay high ALL night!

I know how you feel. If I have a high BG at night I usually bolus, but then lower my basal rates for the next few hours so as to not get a low BG. I’m pretty paranoid about checking my BG so I normally check it sometime in the middle of the night to make sure that all is well. But my doctor recently told me that if you bolus and you already have active insulin in your system to not override your pump, bc that will lead to a low BG. She told me that studies are coming out now that Dr.'s would rather patients have slightly higher BG than low ones bc a lot of low BG over time is worse than high BG and can eventually hurt you mentally. Hope this helped. I know what you are going through.

Of course I will bolus at night. A healthy person will always have a BG in the lower range in the morning. If this healthy person has eaten a high carb menu or juice at midnight the amount of produced insulin will match the carbs. The body will not care for the sleeping pattern in his tight glucose control.

This lady is driven by the fear of you going low at night. She should not invent arguments but tell that in the first place. To bolus at night without going low can be challenging. Instead of freaking out she should work with you on a good strategy. How high is the risk of going low? Would it help to work with different settings for the insulin sensitivity: one unit will bring you down 40 instead of 30 at night (assuming a higher sensitivity of 10 points). Thus the calculated dosage for the bolus would be lower (just as an example).

This would be constructive and positive for you. Instead she pushes you to have a high BG for several hours. That is just laughable.

I would bolus with a reading of 16 at 3am no doubt about that,its such a headach and messes you up.
The nurse is worried about hypos so thats why she does not want you to bolus but she does not honestly know the distress a high reading causes.
Good luck

yes i do. i’m lucky in that my numbers are pretty good, but if it’s midnight or 1 am and i’m getting ready to sleep i routinely bolus if my BG is 160 or 170. i’ve never had a problem; never had a seizure or bad low. i have no complications after 50 years. but … i’m determined to have good - even a bit low - numbers in the morning because it sets the tone for the rest of the day. so i will always bolus to wake up happy.

Thank you for all the replies, makes me feel much better and I think I will confidently bolus if high from now on!

I correct highs during the night & also correct if I’m high before going to bed.

The nurse’s advice makes little sense. If non-diabetics eat late at night, doesn’t their pancreas produce insulin:) Good advice for diabetics & non-diabetics not to go to bed with a lot of food to digest because the body should be in a resting mode, but high BG is not something to ignore.

As Holger said, medical people are always wary about overnight lows & tend to go a bit overboard.

Yes. If I am high at bedtime I will bolus. If I have had a very light dinner or none, I reduce my correction factor. I will check BS 4 hrs after correction, if I am still high I will bolus again. I have had some hypo’s from this…BUT, usually my own fault from not eating dinner and a very late lunch.

Yes. If I’m over 165 at bedtime,I’ll bolus. If I’m high in the middle of the night, I’ll bolus.

I’ve never heard that advice that your nurse gave. I don’t see any sense in it. It’s not as if ‘processing glucose’ requires any physical exertion. Isn’t the body capable of doing more than one thing at a time?


Yes, I bolus during the night & at bedtime, but as others said not as aggressively, but I will bolus for a 180mg/dl or higher, I set tatget of 110 rather than my daytime 95.

Yes I bolus at night if I need to. But I dent to take a bit less, much like you did, for safety. I also become insomniac if my sugars are too high at night, so I usually just stay up and watch some tv or read a book until I’m able to test a couple of hours after bolsing. Then I hit the hay.

I don’t bolus at night because doc said I’m so sensitive to Insulin that I would go too low. Based on 288 at noc and 90 in the morning without a bolus.

Dumbest logic I ever heard. You sure she’s a nurse?

If your blood sugar is high, take insulin. It is against your “body’s pattern” to have high blood sugar in the first place! And you spend up to 1/3 of your day asleep, and that can dramatically raise your A1C in the long run. If you feel uncomfortable with your ability to wake from a low, then don’t lower your blood sugar quite as aggressively, but certainly lower it by some!

I bolus anytime I need to. If I am high I end up not sleeping. I do make sure that I am up for the testing 2 hours after I bolus.

It does sound stupid, doesn’t it. Cuz she said usually she does say to bolus but not with me.

Mark, I bolus at night all the time. Your nurses’ argument about the body resting and not processing glucose is simply nonsense from a physiology standpoint. Its not medical reasoning at all. However, from any viewpoint, you shouldn’t need to be doing correction boluses late or in the middle of the night. Ideally, your sugar would be where it needs to be before bed, but this is not reality for many of us.

The real DANGER from bolusing at night is hypoglycemia unawareness. When I bolus late at night, I usually make a point of waking two - three hours later to recheck my BG. A few times I have caught myself going way too low, so be careful.

“I don’t bolus at night because doc said I’m so sensitive to Insulin that I would go too low. Based on 288 at noc and 90 in the morning without a bolus.”

Kathyann, with those numbers, I too would tell you not to bolus overnight. If anything, you may need to increase your afternoon/evening insulin so that you’re not so high right before bed. Then, you may need to actually decrease your overnight insulin so you’re not so low in the A.M. Of course, this is all guessing based on the two numbers that you posted, but as a general rule you want to make the adjustment on the insulin dosage that is occurring before the BG numbers you’re trying to affect.

Yes. Usually half of the bolus wizard calculation.