Flatline glucose curve at 50

Typically when I eat I see a spike in my glucose within 10-15 minutes. However I’ve had a few instances lately at night where even after eating/drinking 50-70 carbs I’m stuck at a 50 or 60 level for 1/2 hr to over an hour. Then of course I spike to plus 300! I try to limit carbs in these cases however it’s hard when the wife is freaking out thinking of calling 911. Any advise or comments greatly appreciated. With season change and possibly change in insulin requirements I’ve had a few of these lately.

Your description matches too much insulin (basal and/or bolus) during the leadup to the 50-60 mg/dL (2.8-3.3) time pre- and immediate post-dinner period. The 300 (16.7) post-meal number seems more like a garden variety meal spike often the result of too little pre-bolus time or not enough bolus insulin or some combination of the two.

I’ve noticed in me that longer times (30-60 minutes) spent in the 50-60 range will often provoke a counter-regulatory hormone response that protects the person from too much insulin. For me, this counter-regulatory response lasts 3-5 hours. Insulin resistance characterizes this event. So, the low period can amplify the high BG period.

I’ve written about his here before but discovered recently that this counter-regulatory event, also know as the Somogyi effect, is scientifically controversial.

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Is it possible that an extended bolus would help you? I also tend to go low during my meal and then will spike 3+ hours later, especially for dinner. I started experimenting with the extended bolus after reading how it has helped others here on this forum and it is helping me. For example, instead of taking the full 2U for dinner, I will only take 1U upfront (pre-bolus time) and extend the remaining 1U over 3-4 hours. It also depends on the BG that I am starting at. If I am already high, I may not extend any of the bolus. I think to do an extended bolus though you need to be on a pump. If you’re not on a pump, you could mimic the extended bolus by taking multiple bolus injections though.

Thanks Terry, it makes perfect sense.

Thank you, I have been on a pump for a few months and have not tried an extended bolus yet. My main concern/ question is how or why I was stuck at the 50-60 range for so long… my units on board was at 0 when this happened. Maybe to much physical activity that day?

You may have been driven too low by a higher than needed basal rate.

Are you eating fast acting carbs? Do you possibly have delayed emptying or absorption from your stomach, which is common after many years with diabetes ?

Terry - here is Bernstein’s thoughts on the Somogyi effect he calls a myth
" https://www.youtube.com/watch?v=Ys6TAqByjF0&index=18&list=PLs_TA02I6IvV-0SdUwE82Iw7iCCgbkJje

As far as LadaDudes I agree he has a dosing issue. Maybe with the nice weather he is exercising more taking him into the 50 range??? Then too many carbs and boom. At that point he could use some of your afrezza.

I started using a CGM in 2009. I have witnessed many events (dozens!) where my blood glucose would skyrocket after a hypo event while sleeping. Typically this hypo would last more than 20 minutes and would often range down to < 55 mg/dL. I learned after repeated episodes to go very lightly with my hypo treatments. If this happened near the end of my sleep, I would have to skip breakfast or face hyperglycemia well into the afternoon.

If I treated with, say 4 glucose tabs or 16 grams of carbohydrates, my BG would often rise to 250 or 300 mg/dL. This BG rise largely exceeded what I knew my body would normally produce absent a hypo event. I found through trial and error, if I limited the treatment to two glucose tabs, then my BG rise would likely top out around 240 mg/dL. Not only would I get a significant rise but it would stay high and resist any insulin corrections to bring it down.

Now I don’t know the full story of this Somogyi effect controversy but I’m here to tell you that my body, when exposed to a sustained (>20 minutes) hypo at less than 55 mg/dL, produces a counter-regulatory response that includes epinephrine from the adrenal gland (increased pulse, sweating) as well as the stress hormone cortisol. I’ve read that cortisol increases insulin resistance, a symptom consistent with my observations.

When my BG counter regulatory hormones engage, they also involve my liver. I then know that I am in for many hours of untreatable hyperglycemia.

Yet I’ve also read reports from other posting here, who I trust, like @Jen. She said her body does not do this. After reading her account, I started to suspect that I am an outlier in this phenomena.

Interesting - I would ask Bernstein directly on his online University and see what he says.

Do you see this effect with afrezza? One thought is the “stress situation” you are describing and your liver is dumping glucose to counter the low and continues to do so. In theory, the big insulin hit from afrezza should turn off the glucose dump. What does the CGM say?

Temporary insulin resistance over 180 is pretty well documented with a fast glucose rise.

Terry,

I can vouch for the Somogyi effect - happens to me at least once a week.