The last four nights I have alarmed for high BG at 3AM. This is nine hours after dinner, five hours since meal dosage is done. I don’t eat much at dinner.
Night one was a salad with avocado, blue cheese and egg…oil and vinegar. Bedtime BG was 121. 3am, 263
Night two was a 2 slices of baked pork tenderloin with a few roasted potatoes. Bedtime 93. 3am 232.
Night three was leg and thigh. Of baked Cornish hen with roasted carrots. Bedtime 123. 3am 243.
Last night was 1/3 Stouffers small size Lasagne. Package said 30 carbs, BG was 103.(I get that pasta is evil) 3am 233.
Increased my midnight and 2am basal. Starts to climb at midnight. No help. This is a new one.
When is bedtime? When is dinner? I’ve found that if I haven’t fully digested my food before I go to bed, my body seems to go into digestion overdrive as soon as I go to sleep (as per my cgm).
All of the dinners you listed contain a decent amount of protein and fat. Maybe you could try eating a meal with no protein/fat and with faster-acting carbs tonight to see if your dinner digesting late might be the culprit.
If you’re not eating enough carbs with protein, then your body will convert the protein into carbs. Since protein and fat take much longer to digest, you may not see the results until hours later. I see the results of eating pizza for 12-15 hours because of all the fat and protein.
Alternatively, it could be you need to increase your basal rate. Maybe weight gain or temperature change or nightmares ? Might be good to double check the dinner first.
Hi there, bet you wake up feeling pretty rotten too… if it starts to rise at midnight I would say that it’s the late evening basal which needs to rise, say 9-10pm to account for a midnight rise. Just raise by tiny amounts at first. If you start going low later into the night, you would need to reverse any increase you’ve already made to the basal rates around midnight.
Good luck and stay safe!
First of all, are you confident that your current infusion site is absorbing consistently and well? Are you otherwise feeling well, no impending illness or infection?
Otherwise I agree with the advice that your basal rates may need to be increased, even more than you already have. I usually increase the basal segment that starts two hours before the observed rise.
If your basal rates are in the 0.5-1.5/units per hour range, I would increase in 0.1 unit steps. I think basal increases need to be a significant step up and if you’re using the smallest basal increments allowed by the pump, it may take a long series of increases before you see BG improvements. Don’t be overly timid with increasing your basal rates.
I’ve been through this scenario many times and have often found that after making the needed basal increase that normalized blood glucose, I then start to go low and ultimately return my basal rates close to where they originally started. I view insulin pump settings as subject to change at any time. I let my glucose levels inform me about needed changes. The “set-it and forget-it” tactic can lull you into holding onto insufficient or too generous settings for much too long.
You are so right Terry4 - the amount of times I’ve got it right then it’s all gone back to how it was! It’s is the most frustrating condition. I sometimes wonder what I’d think about if I wasn’t type 1 …
I am super sensitive to insulin, after 55 years as a T1. Basal is currently a 7.425 for 24 hours. I only raise basal at .025 per hour. This includes an increase of over .5 units per day. Really scares me.
Fine the rest of the day.
It’s all gonna come tumblin’ down when whatever is going on is over…
Yeah, 3 hours before the rise is a long time (9 PM bedtime vs 12 AM rise starts). Sorry this has been such a nightmare. I hope you’re able to tweak the basal so you’re not dealing with this! I agree with others that increasing it a bit before midnight might be best- maybe around 11?
I agree that your insulin sensitivity makes a 0.1 unit/hour basal step increases too much of a jump. You’ve tried 0.025, however, and didn’t get much improvement. What about another increase of 0.025 to bump it up to a 0.050 cumulative increase?
When I worked with Gary Scheiner several years ago to get my basal set well, he made a point of making basal rate changes in significant enough increments. That’s when I adopted 0.1 units/hour for my basal adjustments. But I take 13.7 units basal/24 hours, almost twice what you take.
I wouldn’t be afraid to set an alarm to get you up to respond to any possible night-time hypo. At least until things settle down some.
Since it was for the past four nights I would change your set and see if that cures the problem. If i have a bad site location I will get high bgs .
Don
We make basal rate changes on a percentage basis. A typical adjustment for us would be in the 10% ~ 20% depending on how much of a change we thought was warranted. We would then let this sit for at least half a week and hopefully longer to monitor and decide if further adjustments are appropriate.
Our percentage seems to fit right in the ballpark with the absolute numbers that @Terry4 mentions above considering his total daily basal usage.
it sounds like the protein and fat from your meal is taking longer to digest than the insulin you take to cover it is lasting. I am also very sensitive to insulin just as you are and I find I need to use a combo bolus with a higher percentage delivered over a longer period of time when I have a higher protein or fat diet. It could be that your digestion is slowing down so you may want to add some digestive enzymes with your meal that include good lipase and protease levels. That may speed up your metabolism somewhat. My pump also allows me to increase in increments of .025 or by 10% for temporary increases to basal rates. On the occasional times I miss on the amount of bolus insulin to allow to extend over several hours after a meal, I have found increasing my basal by 10% for 3 or 4 hours at bedtime helps cover that later protein and fat digestion.
Here’s some Dawn Phenomenon (DP) basal adjustments I did in Feb. Just to give some hard numbers on % of basal increase. Note: I am still pretty insulin resistant in the AM (which is common for me when I’m running periods of DP). So, I try not to eat until late in the day. DP just kinda pops up for some months with me. Then, it goes away. Then, it might pop up again a year later. This increase in basal was adjusted a tiny amount every day, just incase it went away suddenly. Took me about ten days to find this sweet spot.
? Might be good to double check the dinner first.