Insulin Resistance at night?

I am beyond frustrated and have tried everything you can imagine so I'm turning to my fellow diabetic friends for some advice.
During the day my blood sugar is good as gold usually runs 70-110. After dinner come 6pm my sugar spikes and does not come down. I exercise and continually take bolus after bolus. My blood sugar usually goes to 180-250 and does NOT come down until about 10am the following day where it CRASHES with no insulin on board and low hourly basal.
I go for my next A1C check and to a new endocrinologist that may be able to better help me in about 4 weeks and am super nervous my A1C usually runs in 6's but with these kind of numbers over past few months I'm more than sure I will cry over this upcoming A1C and assuming it will be about 9?
I am LADA and was diagnosed at age 23 placed on insulin within a year and have been on insulin for 4 years. HELP!! Any and all advice so greatly appreciated!I am so worried about the damage this is doing to my body and am exhausted.

I have shades of that insulin resistance in the morning 3 a.m.-noon. I see the endo on Friday and I'm thinking about asking about Metformin. As I understand it, it slows liver glycogen release. If I could keep a lid on morning BGs, that would make a big difference. I hate the idea of starting another drug, though.

Is you basal set right? Could you be running low on last basal shot. Are you on split long-acting insulin?

How many carbs do you consume for a typical dinner?

Just some random thoughts...

I am on insulin pump and turn my hourly basal up about four times the amount at night as it is during the day and take bolus upon bolus.
I do not eat over 45-50 carbs per day.
Are you type 1 or LADA? Wondering if LADA runs with insulin resistance but its weird that its only at night. I require very little almost no insulin during the day.

I have a lot of trouble at night as well...before I got on a pump I was regularly taking two to three times as much insulin to bring down my blood sugar over night (assuming I woke up and caught it.) As it is now, I have my highest basal rates starting at midnight and going until well into the morning. My only way of avoiding running high all night so far has been 1) not eating within 3-4 hours of my most inactive time and 2) cranking up the basals when my CGM says I need it most. Unfortunately for me, these changes in basal usually only work for a week or so and then something happens to change everything, so nothing is ever perfect.

I have found, however, that my a1c has hovered in the mid to low 6's as long as I'm diligent about the rest of my sugars. I wouldn't worry about what your a1c is going to be as the stress alone can cause trouble. It may be fine and the stress was unwarrented :)

Hi! I have LADA also and am on an insulin pump. I know it's common for people to have what is referred to as Dawn Phenomenon. I have it. My blood sugar spikes crazy high between the hours of 3 am and about 10 am. I really believe there are times of day that we are more sensitive to insulin than others. What do your basals look like 2-3 hours before dinner?

The reason I ask this is in order to prevent my 3 am spikes I have had to increase my basal rate several hours BEFORE I seek that spike. I'm not a doctor but I'm wondering if you can experiment with an increased basal rate a few hours before dinner.

Another idea might be increase your carb to insulin ratios during that time. For example, my normal carb/insulin ration is 1 unit to every 15 carbs. However, nighttime meals are a problem for me so I adjusted my ratio to 1 unit for every 10 carbs.

I'm LADA, T1. I'm insulin resistant in the morning and sensitive for the balance of the day. Overall, I'm relatively insulin sensitive at average total daily dose of less than 40, a little bit over 0.5 units/kg body weight.

I've never read about anyone having this problem in the evening, before. It's like you have a different circadian rhythm.

What happens if, for dinner, you eat a couple of hard boiled eggs, some low-carb veggies, with some nuts and cheese? Would your BG still spike? And then walk for a few miles 30 minutes after eating? I wouldn't know what to suggest. I'd definitely eat your larger meal earlier in the day.

I agree with what other ssuggested, especially the point to increase basal rates one or two hours BEFORE you actually need them - it takes that long for the change in rate to kick in. I have my highest basal rate of the day from 3:00 to 8:00, but have my second-highest of the day from 5:00 to 9:00. If I don't have an increased rate around dinnertime, I end up going high in the evening. I also have my I:C ratios and ISF change throughout the day.

I wouldn't worry too much about what your actual A1c number will be. Even if it is high, if you are aware of why it's high and are actively working on it then it doesn't really matter. A few months of intermittnet highs is not going to cause too much damage to your body in the grand scheme of things.

So sorry you are struggling with this Lil Mama,

My bg is crazy and unpredictable, it can go up at any time and stay there for hours or it can crash often rapidly and without much warning. Usually for me it is dp that gets out of hand, or just eating anything at all. I'm not on a pump and I would have thought increasing your basal rate would help so I can't offer more advice except to try eating something that metabolizes slowly like flax seeds to see if that calms your liver down, maybe for some reason it is releasing glycogen at that time when you're not eating? Assuming this isn't an after meal spike.

Today I was above 200 for 5 hours and nothing brought me down, I did two corrections and had taken a huge first meal bolus. Then I wasn't sure if I had forgotten my basal(still on mdi) and I went for a walk which finally got me eventually to 150's, I guess all that fast acting was still in there ready to act, lol. Mind you I had already been running around all day active so this time I think it was the lack of basal. Then I took half my basal, assuming because I hadn't logged it in my phone I really had forgotten it after taking a large correction, took a dinner bolus and went back to 90's fortunately. I just took my second basal which I take around 2-4 am to stop dp. I also have to take fast acting starting at any time in the morning when I start to spike from dp because the basal isn't enough once I get up.

I wouldn't call this true insulin resistance but I often find once my bg goes above a certain point it will not come down without large doses of fast acting often, but again it is never predictable and sometimes I end up crashing with any activity so I have to be careful.

Stress makes it worse for me for sure and I had a stressful week with 2-3 days like this, sometimes huge spikes for various reasons, one from crashing from treating another dp spike while in the city all day, not fun! I just got my pump today and will be training soon- I hope this will help me because on the days that I work or go out it is getting more and more difficult to keep control of things.

I hope you get this figured out.

So you are 70-110 mg/dl before dinner and then right after dinner you are high and don't come down? Do you believe that your counting your dinner correctly and bolusing enough for the meal? I don't know about you but dinner is my biggest meal and I have to bolus for protein and if I eat a large quantity I have to bolus even more. Is it possible you are underbolusing for your dinner and then never recovering overnight?

ps. And you should always remember, the A1c is just a number. What really matters is what you have done to take care of yourself. If you have done a diligent job of taking care of yourself you should never feel pain because your body has failed you.

First of all, your frustration is such a familiar feeling ... we have all been there. I am also LADA, T1, diagnosed at age 41, living with it for the past 14 years, Hg A1C 5.8.

I would suggest you start from the basics and eliminate every possible miscalculation.
1. Check your basal requirement. This is typically the most common miscalculation made. I would do it in a classical way - take a weekend and fast all day.
2. Next, check your carb ratio. Again, simply take a meal with known carb content as your first meal after fast (weigh a piece of bread, take a frozen dinner with carb # written on the box, etc.) and cover it with prandial x # of units. Do that until you hit the "bullseye". It will not ever work, howevere, until you figured your basal first.
3. Eat clearly figured meals all day with coverage based on the above and see if you are still off in the evenings and night.
Give us an update, if you decide to try it. Good things come to those who work hard and smart ... you will get there. Mark

What do your evening meals look like?

Have you lowered your basal at night while you are sleeping. I find if I bolus a lot before bedtime I will be super low in the morning. I often set up a temp bolus at 0% -50% for 1-3 hours. It might be worth it to set your alarm one night every hour or two and see what is going on. I was also getting highs with my evening meal so I increased my basal between 5-8pm and I have seen an improvement

can you try to finish eating dinner earlier and see what happens?

Hi Lil MaMa,

I would do a series of Basal Tests over the course of a couple days to make sure that those levels are set correctly in your pump to start things off.

Next, after any adjustments to Basal Rate I would give it a week to see what the patterns are. To do this, use known carb count foods at specific times of the day. So basically your meal times. Then I would test at meal times, 1 hour post-meal and at the 3 hour post-meal mark. (Also of course the usual morning and bedtime testing.)
It will be a boring week food-wise but it will be key in seeing what your body is doing throughout the day in regard to how it is using the food you intake vs. the insulin you are using/have on board.

If your Basal is set properly and you are having the same issue, then time--shift your dosing schedule to allow for better control of resistance and peaks after meals.
Assuming you are using Humalog since you are on a pump here. It peaks at about the 3 hour mark. Try timing that to when you plan eating and see how it works out. Bit of a dangerous game though as you can end up going low in a hurry if you miss or are late for a meal.

I sincerely hope things work out for you with this and please do get in touch with an Endocrinologist as soon as possible for help in this.

Don't stress the A1C numbers. They aren't the beginning and end of things. Just do your best, be diligent in testing your sugars and stay on top of things.
The only important thing here is to feel better and take care of yourself.


I eat the exact same thing for dinner every night: Chicken breast, bag of romaine lettuce, topped with onion tomato bell pepper and vinegar for dressing. Atkins bar for dessert.

I keep a fairly static meal plan as well simply because it gives me something I can count on for my BG levels. I think a decent few of us do.

I would still recommend a Basal test to make sure your baseline is good.

You could also try a temporary rate starting at 3 hours pre- meal and use that for an 8 hour stretch and see if that helps you.

If it does, then you can create a new profile and set it for the new rate. See how that works out. Just be careful and make smaller adjustments.

If you have a T-Slim and are able to upload your pump data and look at it all, you should have a much better idea of your insulin distribution that can help you in making changes.

I also have increased insulin resistance at night. I find that my nighttime basal requirements increase by about 25% vs. the day. I also take Metformin XR at bedtime to help with this.

Hi @LiL_MaMa do you still eat this low carb? Have you been able to maintain weight and maintain a keto diet?