Hi. I’m a T1 pumper and several times (maybe 5 times) in the last eight days my blood sugar is pretty good (160-180) two hours after a dinner (I eat early) but then is spiking in the evening (like 7-8 pm). I give myself my regular correction, maybe even a little less then usual, still being a little high when I go to bed at 9:30 (I get up early). Lately, I’ve been waking up with low BG once or twice a night. I can’t figure out why or what I can do differently to stop this from happening. Any ideas. Thanks.
Roz
ps. I’ve never posted before but I’m on this site all the time and I really appreciate this group. I really feel like I have support when otherwise would have none. Thank you!
My daughter has a similar pattern to the one you describe having. She spikes much later, however, which I believe is due to growth hormones, so I’m clueless as to why you spike at around 7 to 8 PM. For the past few weeks, she has been going low once or twice during the night, long after any IOB remains from earlier corrections. She has been dipping low most mornings, almost as if she is experiencing a "reverse Darn (as Brian has coined the term!) Phenomenon. While my daughter is well past her official honeymoon period, based on the amount of insulin per kg weight she uses on a daily basis, I can’t help but think she has a few rogue beta cells that haven’t yet heard the news that that particular battle has already been lost. What I try to do is to set a reduced basal rate in anticipation of these lows. While this has helped a little, you all too well know how it goes: there is an ethereally thin line between trying to prevent a low and going high…
Hi Roz1,
I have to reduce my sleep basal by more than half of what I need during the day. If you need a “regular correction” then that basal and bolus situation needs some adjustment. Basal testing seems like something you should do, and then tune in your insulin to carb ratios accordingly with your own eating habits. The why is simply too much insulin, the what to do is reduce that.
Thanks karen57, I will reduce my sleep basil tonight on my pump and see if that helps. It’s just weird that I’ve been fine for so long and then all of the sudden this is happening. I’m ready for a goodnight sleep though, it’s a love/hate relationship right now with my CGM. lol.
This is a feature of diabetes, not a bug. This is how most people’s diabetes acts. Diabetes is dynamic, not static. It will settle into a fairly steady pattern for a while until it changes. The key thing to understand is that you need to go with the flow and change with it. Don’t let weeks go by, standing pat, insisting that you have the perfect setting. (It worked so well for for days/weeks!??) If you have a pattern of lows or highs (I consider three episodes a pattern), then take action.
A pump s a great tool to shift insulin delivery when diabetes demands more or less insulin. Your big challenge is to decide whether you need to change basal or bolus delivery. If your blood sugar spikes 3-5 hours after a meal that contains significant protein and fat, especially when carbs are limited, then it is likely that you need to add some insulin as part of your bolus to cover protein and fat. I use the extended bolus option to do this.
Your lows while sleeping could be from over-correction of the post-meal highs or it could be that your basal profile while sleeping is a little too rich. Or it could be a combination of these two factors. Remember to change basal rates two hours before the spike shows up. I like to change my basal rates in 0.1 unit steps. This is significant enough for me to actually see the effect. My basal rates vary from 0.5 to 1.2 units per hour. Your situation may be different and need a different incremental basal step change.
Traditional basal rate testing can be helpful but takes some persistence to get through it. I like Gary Scheiner’s protocol.
I like to think of my pump in terms of driving a car. Sometimes you need to step on the gas pedal, sometimes the brake, and sometimes you just coast. It all depends on the driving environment. There is no universal driving formula to program into the car and then forget it. You have to see and respond to changing insulin needs in a timely way. Stephen Ponder calls this sugar surfing.
Don’t get me wrong. I am not changing all my pump settings all the time but I’m not afraid to make a change when my body asks for it. Good luck. In your insulin pump you have a very effective tool. It’s in your best interests to experiment with all your settings and learn how they work with your body.
Thanks for the advise. I just looked at my pump and although I have 4 different basil time settings, they are all set the same at .75 units an hour. Sometimes I feel completely overwhelmed at trying to figure out exactly what’s going on and separating basil from bolus. I’m a single mom, I teach high school kids and have three kids of my own in sports almost every night. Sometimes I feel thankful I even remembered to bolus. My A1C is usually in the low 6’s so I’m proud of that but I know I need to get a better understanding of this disease as I’ve had it for eight years now. I have CGM and I’m wearing it now but sometimes I don’t wear it because them I find myself checking it ALL the time and the T1 feels all consuming. I am in awe at how some of you have such great control and understanding of what is going on with your D. Thanks for letting me vent a bit and I will look into the resources you mentioned.
Wow! Just reading this makes me wonder how you can make any time for your diabetes. I enjoy the time luxury of being a single retired guy. You are really challenged with time management. Make sure you do not short-change your diabetes, however. It’s tough, I know. You need to take care of your diabetes so that you’re there for all your children for the long run.
I learned that diabetes is not an insatiable beast as it seems at first. When I decided to give diabetes all the time it demanded, I discovered that it is not a bottomless pit of neediness. It is finite. By doing this I learned a lot of effective techniques to manage diabetes and found my “free time” mostly restored. It’s a paradox and a single mom high-school teacher with three kids may not reach that same conclusion as easily as I did. Just be aware that giving it slightly more time than you at first think it needs can grant you some time rebates.
Good luck!
By the way, your CGM is a huge asset. Use it and learn from it as much as time allows. It enables you to learn your body’s customized insulin needs, something no book, doctor, or diabetes social community can tell you.
I agree about reducing your nighttime basal and see what happens. Maybe don’t correct so much for that later spike. I often reduce my corrections from what the pump says depending on how I feel and what time it is, my level of activity etc. I have the same problems, often an early spike and then a later spike, sometimes a later spike, lately if there is no spike it means I will crash badly, it is different each time and there is no way to figure it out for sure. Another thing you can do is have a low carb snack at night along with the correction.
