I need advice!

All of a sudden, I have had unexplainable high BGs overnight and into the morning. Here is an example: ate at 5:00. Took 4 units and was 102. At 9:00 I was 90. Then overnight the BG goes up and up! 143 at midnight, 166 at 2:00, 194 at 4:00 (took a correction bolus of 1.5, Actual BG reading was 189.), Woke up at 6:00 with a 114.

Left for work. at 8:00. I was 195 with no food, no coffee, nothing. Another correction bolus of 1.5.

If this was happening everyday, I would know that I need to raise by basals, but it doesn’t. What I eat seems to make no difference. I can have pizza and be fine or a salad and have this happen. So I am afraid to raise the basals for the times I am fine.

Saturday night I went to a wedding. I took 4 units for 40 carbs. Ate two tablespoons of rice, which is a lot less than 40 carbs, and one bite of cake. The meal was a salad, salmon with the rice. Had the same kind of overnight highs.

Any thoughts on this? I did have pasta last night, but as I said, food does not seem to be the cause of this.

Do you take your basal in the morning or at night?

From the pattern you show it doesn’t look like dawn phenomenon. And it doesn’t look like your basal is out of whack either.

Meals with proteins and/or fats and/or creamy sauces cause a rise in bg up in the 6-9 hours after the meal. Not only that but they also delay the absorption of carbs from the carby parts of meals. Understanding this and taking advantage of it has been very very useful for me.

Lots will tell you that carbs are the only things that count but they’re oversimplifying. That might be true in the most easily controlled types of diabetes (maybe what we used to call “glucose intolerance”) but I know it’s not true for me.

You may have underestimated the carbs in some of your meals. Also, I know you say this is not food related, but pasta is EVIL for me and will cause high BGs many hours after I’ve eaten it (because it digests more slowly). Same thing with rice. Also, the food you had at the wedding might have had some hidden sugar in it (was there sauce on the salmon? dressing on the salad?) Those are just the things for me that come to mind.

Also, assuming it’s not food related, did you have more stress on the days where, the following day, you ended up high? While your numbers are a bit high, I guess for me they would not be anything terribly alarming, especially if they are not happening every day. How often are they happening? Is there any pattern you can discern at all (again, not necessarily with regard to food, but related to stress, amount of sleep you get, etc)?

To Lil Mama: I am on a pump, so I take basal all day.

To Time 37: The meal last night (pasta) could be the culprit, but it was whole wheat with homemade pesto as a dressing, so no protein, creamy sauces, and the only fat would be the olive oil in the pesto.

To My Busted Pancreas: I doubt I underestimated the carbs. As I said, I had very few carbs with the meal at the wedding, and took enough insulin for 40 carbs. I also did that meal as a square wave, and was fine at midnight (5 hours after eating) when I went to sleep. There was nothing high fat, creamy (no sauces), etc.

It happens a couple of times per week. I generally freak out if my BG gets above 130. I am known to correct at 110. A high BG near of over 200 is a major stresser for me. But it is already hugh, so the stress is coming after the BG raises.

I will have to think of the patterns. If this had not occured several times pre-wedding, I would have thought it was just the wedding, but now I think something else is going on.

Oh, and for pizza and pasta–I make my own. I know what goes in, I can accurately count the carbs, etc. It really helps. I usually have no problems with homemade.

Oh, now I see a little more, it only came down to 114 at 6AM because you had taken a correction before morning came.

In which case it starts to sound more like dawn phenomenon. Which could have something to do with what you ate (or didn’t eat) the night before but is probably about as clear as mud.

Oh, BTW, Iowa reference: I’m originally from Muscatine and spent my early years making checkup trips to the U of Iowa hospitals.
A lot of folks on the pump take advantage of basal rate vs time of day and bump up the basal rate overnight and have great results. I’d like to figure out how to do this well myself but am not quite there yet.

How did you pick up the Iowa reference? I was born in the Quad Cities, moved to Cedar Rapids in junior high and graduated from the U of I.

I change the basal rates often. But I am so concerned about overnight. Last Thursday, my husband moved to the spare room because my CGM alarmed me all night. It kept saying I was low, but I woke up at 195. It was low from about midnight to 3AM. I drank juice, but knew not to do too much. It started going up about 3AM.

Just when I think that I’m getting a hang of DM (dx in sept, pump since jan), I have a day or two like this. One weird workout the day before can make my BS go low. Also a tiny illness or stress can make my BS go up.

Since you’re on the pump, I would start with the infusion set, tubing, etc. My highs lately have usually been infusion site issues… I bend the plastic tube during insertion a lot! eeps!

If that isn’t the case, I would perform the tedious task of fasting hourly testing to see what’s going on and definitely rule out food.

Maybe set temp higher basal rates and see if those work also?

Good luck!

I saw you’re from Davenport by clicking on the picture and finding your page here at TuDiabetes :-).

I was diagnosed in Muscatine at age 14, sent to U of Iowa hospitals where I spent two weeks recovering from DKA and learning the ropes in the pediatrics department, and for the next 8 years saw the docs at UI. Also lived in Iowa City 4 years as an undergrad :-).

Did you ever visit the U of Iowa pediatric endocrinology section? Did you overlap with Nurse Rose? (Don’t know her last name she was always just called “Nurse Rose” and seemed to be a permanent fixture!)

The increased basal rates used by pumpers to deal with dawn phenomenon seem to be mostly in the 3-6AM hours and although I’m no expert in pumps that seems to match my dawn phenomenon pretty well.

I was diagnosed in Davenport, and had local endos, so I never went to U of I endo.

I think I will raise my basals from 3 to 6 tonight and see what happens! Give it a whirl!

My DP can do exactly what you are describing. I have my basals set so that 75% of the time (on a good week) my CGM is flatlining between 85 and 120. On bad nights my CGM will be vibrating quite a bit. I have my basals set on the low side, so that if my DP does not act up I will usually go high. I have not been able to figure out any great relationships that cause my BGs to fluctuate from night to night (besides exercise and alcohol and excess protein in evening snack).

It is really frustrating to get woken up by my CGM for a high and taking a bolus just to be woken up 120 minutes later and have my BG go up. I am assuming this is an overactive and changing DP. I feel your frustration. I find a far worse night is when my CGM is alarming for lows every 20 minutes because my DP did not show up that night. That makes for a long night of not restful sleep.

I do not really have a solution unfortunately. I change my basals frequently (especially on bad weeks) and try to keep myself from going hypo at night. Besides that I wake up and take corrections as needed.

An update: Last night I made a tomato pie for dinner (tomato, herbs, cheese, onions baked in a pie shell). 1/6 of the pie was 35 carbs, and I square wave bolused for that. Went to bed with a reading of 70, and ate a peach to bring it up a bit.

I reset my overnight basal to .6, up .2 from the previous setting. Woke up at 6 am at 83. No beeps all night. By 9 am BG had reached 148, with no food or coffee.

As far as correction, my pump is set to always aim toward a BG of 100. So, if I am 110, it will add .1 to the bolus for the correction. My pump beeps for high at 200 and low at 70. I am pretty anal about all this and have an A1C of 5.6. My endo loves my numbers and encourages them. I used to have an A1C of 5.1, but have loosen up a little bit.

If I flatline for any amount of time, it might be 10 hours. I am very sensitive to insulin, and food, so flatline is difficult to maintain unless I stop eating. I have had D for almost 50 years, and feel that the more tightly controlled I am the better and longer I will last!

I am glad you had nice BGs overnight and a nice night’s sleep. I hope your increased basals continue to work well for you. You sound very insulin sensitive with an overnight basal of 0.6 (mine is 2-3 times that). Almost 50 years of T1 is amazing and something I find inspirational and motivating. My CGM rode “Steady Eddy” in the 90s and 100s all night which led to a great night’s sleep. I eneded up doing a temprorary basal reduction of 8% for the entire night due to all the mild lows I have had in the past 48 hours.

I hope tonight is another restful success for you.

If you’re correcting at 110 and freak out when blood sugars top 130, the seemingly unexplainable and unexpected highs may result from the Somogyi Phenomenon (named after its discoverer). When you drop below 70 (and I know you have a CGM, but I’ve found it doesn’t take long for good ol’ Somogyi to take effect) the body secretes hormones that raise you blood sugar in the morning all without your knowing. And if you give more basal insulin to counteract it, it can get worse, not better. (There’s a little debate over whether you should give more or not so see what works for you.) However, that may explain why you’re waking with highs and not being able to do anything about it. Until effects of the Somogyi Phenomenon leave your body, it will say to all corrections, etc., TOUGH! I’M NOT MOVING UNTIL I’M GOOD AND READY AND YOU’LL JUST HAVE TO WAIT. But it does go away - eventually.