I am 57 years old and a type 1 and have been for only 10 years. I am 5'5" and weigh 111. I am pretty insulin sensitive I guess, I take 5U of Lantus in the am and 5U at 5:00pm. I need about 1 to 2U at meals. I have been following the a high fat, low carb diet advocated by Dr. Bernstein for about 10 weeks. At the beginning of the diet, I went low overnight and would have to get up and eat a few berries. Now after 10 weeks of this diet, I wake in the morning and my BS is in the 150's. My CGM shows that my BS is around 100 at bedtime then it starts rising at around 12:00am and gets to the 150's and levels off. What changed in these last couple weeks? should I take more Lantus in the evening? or more Humalog before bed?
p.s. I love being in this much control on this diet!
If your blood sugar is rising over night taking Humalog before bed is not the solution. Humalog is strictly for meals. You might try raising your Lantus by one unit in the evening. Or you could consider getting a pump which will allow you to vary your basal rates by when you need it the most, in your case adding more around 10PM to cover that 12AM rise.
Providing you are not eating a snack near bedtime, I agree with Zoe that you probably need to increase your basal or Lantus insulin. As to figuring out exactly what changed to cause this overnight rise, it's hard to specifically draw a conclusion. There are many factors at play. Besides, it doesn't really matter.
What matters is your realization that you are now experiencing an overnight high. Deal with the numbers and facts before you and move on. Diabetes has an endless parade of scenarios it will present to you. The more quickly you sense the abnormality and adjust the better you'll do. Your skill in adjusting and compensating to the current reality, whatever it is, is an important one.
It's kind of like driving. You'll never understand why that car cut you off on the freeway. More importantly, you braked and swerved to avoid a collision.
Your low insulin needs suggest to me that you still have some natural insulin production. Your adoption of a low carb, high fat diet should help you continue your extension of residual pancreas function. Good luck to you.
You're Type 1? I would think you are LADA due to your age at diagnosis and the small amounts of basal insulin you require. For example, I use a pump but I need 19 units per day just for my baseline. You may want to read up on dawn phenomenon, which is early morning highs caused by your body generating hormones in the middle of the night. You may need to adjust the times of day for your Lantus, but you will probably need to do some hourly testing for a couple of days. Humalog is for mealtimes, so you don't want to take that unless you are eating some carb or making a correction.
One thing to remember is that your body doesn’t know the difference between basal insulin and bolus insulin. So sometimes you can never figure out the problem, but you can fix it with a little creativity. One thing about high fat, low carb diets is that fat takes a lot longer to digest that do carbs and you can start seeing a rise in your BG many hours after eating. That is one reason that Dr. Bernstein recommends using Regular Insulin with meals. Dr. B also talks about using NPH at bedtime to help combat dawn phenomenon.
It is possible that you’re seeing delayed digestion from the fat. I try to eat low-carb and am guilty of eating too many nuts and too much cheese. It is hard to track their digestion and I do get delayed highs like you are describing. There is a reason that Dr. B limits nuts and cheese.
I find it scary to take too much rapid insulin at bedtime, but you could consider experimenting with some Regular insulin in the evening. Both Regular and NPH insulin do not require a prescription and you can get them at Walmart for about $30. Technically you should talk with your doctor about this.
There is a Dr. Bernstein group here at Tu and you could see if anyone there has answers for you. http://www.tudiabetes.org/group/drbernstein
There is also a Dr. Bernstein forum that you must register for to use. http://www.diabetes-book.com/cgi-bin/yabb2/YaBB.pl?action=login
Thanks Zoe, Terry, Angivan and Laddie,
Hmmmm, I probably eat too much cheese and nuts too! I should have Bernstein's book handy and reread some parts of it.
I didn't realize that I could get Regular and NPH insulin at Walmart. I will look up the difference between Humalog and those insulins. Also I don't see what's so rapid acting about Humalog, seems like it takes 3 to 4 hours to finally get my sugar to come down.
Thanks for the web sites, I'll check them out.