Hello all. First off, I am new here and I’m happy to be part of such a community!
My issue I’m having is as follows. I went to bed last night and my glucose level was 134. I had a few pepperonis and mozzarella sticks as a snack, and since there are no carbs in either of these, I didn’t take insulin.
When I woke up this morning, I checked my sugar and it said 475. This has happened to me a few times and I’m just wondering if this happens to anyone else? And if anyone know what may be causing this?
Thanks in advance, and I look forward to hearing from some of you!
Hi Rusty; welcome to the community! A couple thoughts: If I was 134 at bedtime I would correct. Also did someone tell you that you need a snack at bedtime or are you just hungry. Personally I wouldn't eat at bedtime even if it was low carb or carb free, it's just putting something else in the mix.
But most importantly, if this happens regularly, it's really clear your basal is too low. I see you are on the Ping. You can adjust your basals for different "time zones". I would do some night time testing and see when it starts to rise, and then slowly start raising your basal up for the period two hours before the rise.
But first, that is quite a rise,so I would question whether it was a pattern (happens most of the time) or just a now and then thing. If it was now and then, rather than change basal I would first change sets and see if that helps. Perhaps try another kind of set. I had lots of problems with bent canulas and now use the metal ones (they're way easier to insert than I'd thought). Good luck, don't let your blood sugar stay that high too long!
Your post leads me to say, "more information, please".
What did you eat for dinner last night (or on a typical night where you have a high fasting BG the next morning)?
How long was it between dinner and bedtime?
What does your basal rate look like overnight? Has it recently changed?
Do you ever have fasting BGs in the 100 mg/dl (5.6 mmol) range?
How many pepperonis and mozzarella sticks (in grams of protein and fat)?
Also, ditto on what Zoe said. I also would have corrected if I was 3+ hours after eating. I wouldn't have that type of snack at bedtime without an extended bolus, plus an alarm to wake me for a test @ 3AM, so I could correct if needed.
My dinner was homemade vegetable soup, which I ate at around 8:30. My sugar was 114 before dinner, and the only thing in the soup with carbs was the broth and potatoes. My current basal rate is 1.6 units an hour. Perhaps I’ll have to bump that up a little bit during my bedtime hours.
I am a pig. I get hungry all the time. I’ve been trying to get away from eating after a certain time at night. I will try that (not eating) tonight and let you know what I find.
If I missed anything to respond to, let me know. Thanks again everyone for all your advice!
Even though I replied, here's more info for you Mike.
Dinner was the vegetable soup last night.
I ate dinner at around 8:30, and I had my snack at around 11:00.
Regarding the fasting BG's, are you referring to in the morning time?
I had 3 mozzarella sticks (7 grams of protein, 3 grams of fat [both per stick]) and about 20 or so pepperonis (0 grams of protein, 1 gram of fat [per slice]).
I am going to take your (and Kristina's) advice and start waking up in the morning to check it.
The reason I didn't correct from 134 (I did give myself insulin to cover the meal) is because my "target range" is 110 - 140. And no, the snack at bedtime wasn't a recommendation. Just me being a piggy. :P
It's definitely not a pattern. In the past two weeks (I must embarrassingly say that I haven't been the most responsible diabetic up until the 14th of September), I've had about 3 morning highs like this (usually only in the low 200's, then the whopper of the 475). I talked to my doctor, and he recommended I not eat so close to bedtime (unless it's necessary) and to check it early in the morning for the next few nights, then if the problem persists, he wants me to increase my basal rate overnight.
I have the bent canulas and occlusion issues quite a bit, and it's such a nuisance. I didn't realize they had metal ones now! I'll have to look into those.
One of the drivers might be the seasonal change from summer to autumn. A drop by 10°C (~20°F) is always challenging for me. I need to increase my basal and so forth. I often joke that my body goes from cooling to warming mode in this time of the year.
The great thing is you are working to figure it out, as opposed to just throwing up your hands and saying - WHAT????
Thanks for giving more info.
Yes, Fasting BGs are your morning readings.
With a reading of 134 within 2.5 hours of eating, I might not have corrected that either, since there would be a bit of insulin left to kick in.
If you do some testing @ 3AM over a few nights, that might give you some idea of if you have Dawn Phenomenon (aka DP) that typically starts adding glucose into the bloodstream 2 - 3 hours before you wake up.
i'm not sure it's 'healthy' to suggest T1's correct a 130 at bed...this again makes me nervous when this is suggested on this site all the time. many T1's fall in the middle of the night, etc...and they know better if they should be correcting or not. same thing with suggesting not to correct (with glucose) unless 60's for many t1's that is far too low to even consider.
does your endo have a trial CGM they could use...to allow them (you) to see what may be happening in the middle of the night? Can you get a CGM, they're incredibly on-point and reliable. You may have had a low because that's a huge rise. Protein can indeed raise blood sugars (i typically bolus for protein if it's the majority of what I eat for a meal/snack). Plus you're not digesting food as well when sleeping. But that's a HUGE spike so it think it may suggest a rebound high from a possible low. Doesn't even have to be a true low, if it's low enough to support any type of liver dump release, you could rebound high. Did you come down easily when you woke up, nothing wrong with your site, etc..?
There's a group on here called the "flatliners", which I aspire to, but have a long way to go :-)
They are relentless in accounting for protein and fat as well as carbs when figuring insulin. Basically, the protocol is to dual-wave bolus -- impulse for the carb content of the meal, then extended flat delivery over 2-4 hours for the protein and fat content.
As a formula to determine insulin, use grams of each divided by 2. So, for example a snack/meal with 10g carb, 12g protein, 10g fat, I:C 1:5 (me, T2): Bolus 10/5 + (12/2 + 10/2)/5 = 4.2U. Bolus 2U immediately, extend the other 2.2U over 3 hours.
Def sounds like a pump site issue, I've had my fair share of those lately. I however do not have to worry about the bent cannulas and wear the sure ts. I'd also suggest raising your nighttime basal.
I see you have a Ping, Rusty. On Pings it is called "Combo Bolus" You go to Combo bolus rather than Carb Bolus or Normal Bolus. Set the length of time you want to spread it over and put the percentages. So if you want 4 units 2 now and 2 over 3 hours, you would set it for 3 hours, put 4 units for total and put the percentages at 50/50. (Or whatever). However, not all of us do this - bolusing for protein and fat. For me if the carb count called for 2.2 and I bolused 4.2 I would go very low. People who routinely bolus for fat and protein have I:C ratios that account for this. Imho it is a lot simpler to just set your I:C ratio for carbs and count only carbs. The only time I use a combo bolus and raise my insulin amount (but not double!) is when I eat a high fat and high carb combo like pizza - not vegetable soup! But some people swear by Tagging - that is what it is called when you bolus for fat and protein and there is a group on here. If you decide to do that please check out that group and learn more. Don't just randomly double your insulin doses without learning more!
So here's my update. First off, sorry I didn't get back to you guys sooner. My sister had her 30th birthday this weekend and we threw her a big party, so I was a bit tied up with that!
Anyway, my sugar levels in the morning haven't been as high as the 475 that I had last week. However, they've still been a bit high, and a bit random. These are my "wake-up readings" from this past weekend (at around 8-8:30am):
-Stopped eating Thursday night at 9:30pm, had no carbs the rest of the night. Friday bg level: 227
-Stopped eating Friday night at 10:30pm, had no carbs the rest of the night. Saturday bg level: 172
-Stopped eating Saturday night at 9pm, but was drinking whiskey and pepsi until about midnight-1am. Sunday bg level: 102
-Stopped eating Sunday night at 10pm, no carbs the rest of the night. Monday bg level(this morning): 224
My bolus level from midnight until 8am is 2 units per hour. The rest of the day, it is 1.6 per hour.
I'm a bit confused. Let me know if any more info is needed!
Also, at my sister's birthday party, I met her friend's fiancee, and found out we are pump buddies! :D
Like you, I found that drinking at night kept my liver busy metabolizing the alcohol and suppressed my DP. Unfortunately, the idea of drinking a couple glasses of wine right before bed isn't really workable.
Also you might try not eating so late at night. You are just throwing a monkey wrench in the works. If you don't eat after dinner and test a few times during the night you will get a better idea of what your blood sugar is doing and whether you need more basal and if so when.
Once you get that straightened out so you are more or less stable , then if you are really hungry at night you can begin to try eating with and without a bolus and see how it alters your morning numbers
If you finish eating at 10:30 and you've eaten a fair amount of fat and protein as part of your meal, you may see a late spike in the middle of the night. I often have that experience on Friday nights when my wife and I have a more formal dinner.
You might consider waking up in the middle of the night to see where you are at 3 or 4 AM. That might not stop the spike but you'll spend a few hours less at high levels.
You might also skip dinner (or finish eating at 6PM or so) so that you can test your overnight basal. If you start going high in the middle of the night and wake up around 170-200, you'll have strong evidence that you should bump up your basal.
