Highs and Lows in the Middle of the Night

So, I've been trying (unsuccessfully) to get my MDI PM levemir dose correct. I've also been on the pump and am noticing the same thing happening, we're still working on basal rates but the POD didn't work for me so I'm now (again..ugh!) gonna retry Revel tomorrow. I'm OK at bed and it seems, via my CGM and finger checks, every night around 12am - 1am I'll have a drop (not a true 'low' but just a drop) and then a very quick rise. The other morning, 3am I woke up to 245, last night 3:30am 180. I cannot figure out what is going on, if I'm taking too much basal and having rebound highs or not taking enough and going up as the night turns into early morning. It's starting to really effect me. Does anyone else have this issue? I thought, initially, it was my levemir peaking but it's doing it on the pump too so I think it's just my body in general.


We all have different basal patterns and times where we need more or less basal insulin. That's why a pump is so effective. if we have a drop such as you describe between 12 and 1AM then we can lower the basal rate for the period two hours earlier like 10PM and then raise it for the period when we need more insulin. I don't worry so much about why things happen, but just tweak my basal based on results and my own personal patterns.

First we need to know how your levemir injections are scheduled: times and units.

A good reason to get on to your Revel ASAP! I would use Occam's Razor (the simplest answer is usually the right one)and assume it is not enough basal during those time periods. When you get onto your pump since you already know the offending time period you can set it a tad higher for the period two hours before you begin to drop. Then see how it goes for a bit until you tweak it a bit more. it takes awhile to get basals in line but pumps are wonderful tools for that!

thanks, started Revel pump this morning, waking up at another 180 at 4am. So, I'm crossing my fingers and will make adjustments as we go along, pump nurse gave me some basal adjustments rates to use. This feels a bit better - the Revel, safer, i guess, compared to the Pods.

Congratulations on your new Revel. I've heard good things about them. My process is to just increase by the smallest amount possible and see how that goes for awhile. I also think it's important to break down your basal rates into as many different "time zones" as you need for your differing needs. I have 9 different time zones which were very varied but lately have all started converging. But I'll keep the time zones in case things change. I actually like fine tuning basals, once you get comfortable to do so it's satisfying to see it all come into "just right" territory.(until it changes again, of course!) So much easier to do with the small increments and hourly adjustments on the pump then the long acting 1 unit increments.

I had some similar issues not long ago. Key is understanding the variables and adjusting one at a time. When are you injecting and how much? Also, what are you eating and when? I moved my nighttime Levemir injection up to 9PM and found if I have my dinner earlier rather than later (ideally around 6PM) with no post dinner snacks I can achieve flat basal rates through the night.

thanks, zoe. OK, like I already had to change my infusion site/set..What the #@$#??? It was bleeding thru cannula so I guess i hit a capilary, and my pump nurse didn't instruct me on how to wrap the sure-t so it doesn't bend - kink. oh, crap...I was 191 at lunch and going up. I hope this one works. I'm getting so frustrated. Pump nurse seems to be worthless, gonna figure this out and see someone else. This seems like so much work but it's either this or MDI, which I was already doing 2 doses and couldn't get right or maybe just not enough. THANKS for all your help and support. :)

Zoe, or anyone using a pump, when you take out your infusion sets is it OK (normal) if they bleed, are they supposed to bleed? THANKS!

No, they are not "supposed" to bleed, but sometimes they do and it is usually indicative of, as you say, a problem. I use the Inset 30s which I like because you can see the canula through a clear window and see if there is a drop of blood which lets me know I'm probably (but not always) going to have blood sugar problems. Wait till you have your first gusher, those are such fun, especially if you are wearing white!

I had a lot of set problems in the beginning but now most of the time they last for 3-4 days. I seem to have problems in clusters, like none for quite awhile then a couple in a row.

Yes, pumps have their own hassles. But 1) they get less with time as you figure out the variables and 2) it's still easier/better than shots for most of us once we get past the learning curve.

I've had a few bleeders with infusion sets and CGM needles, not for a while. I've had a few as well where I stick it in and if I go for a run, it seems to tear the edges up a bit so it bleeds. I don't usually worry about it if the BG is ok. I have the opsite flexfix tape I use to hold the CGM's on to cover it up if there's a problem too.

I'm not sure what to make about Levimir plus a pump. I think that part of the deal w/ a pump is that it gets sort of irritated when you stick them in but that it goes away when you use it and the basal is a big part of that. I think you'll be better off with pumping everything. I wouldn't expect a lot from the pump nurse. Their goal is to get you started and, once you are "done" with that, so are they.

I didn't get the impression she was using both at the same time, AR. Just that she started on the Omnipod and it didn't work out so went back to shots for awhile and then just got her new Revel today. I could be misunderstanding

no, not both at the same time, just pump now - novolog. so, is it OK for the tubing to be curled up, like when it comes out of the package, the pump pressures up the insulin from the reservior, correct? we don't have to 'straighten out' the tubing? if i keep this pump on through the weekend, it will be a miracle..ha! I get so frustrated and just end up wanting to give or give a shot(s), or resort back to what I was doing.

You are correct; it doesn't matter if the tubing is curled up. I always just stuff mine below my waistband. I like the longer tubing because I can move around much easier, get dressed, etc.

You'll get there. I'm the world's most unmechanical person and if I can get good at inserting sets anyone can. I recently discovered the manual steel sets I'd been so leery of are a piece of cake and eliminate the problem of kinking, so live and learn.

thanks so much, that's what i'm using too, the manual steel sets, they don't bend so that's a good think. thanks much. have a nice weekend!