Rising in My Sleep

For the past few days I've been really struggling with my BG levels.

On a "normal" day, I would wake up in the low 100s (or around 70) then lunch would be in the low 100s or below. Then dinner would be in the high 100s. After dinner has always been my trouble area.

However, lately, I've been struggling all around. I was waking up in the 40s a few days ago and now I'm waking up in the 300s. I'm checking the Dexcom and it's showing that I go to bed really stable around 160 and then almost as soon as I fal asleep, you can see my BG just JUMP up to the 300s and stay there all night long!

Then, it takes me over TEN hours to get it back to normal. TEN hours. That's ridiculous. I end up having to correct TWICE within 10 hours, instead of correcting once and being done with it.

It's really making me exhausted and I'm not sure what to do anymore.

My eating habits have not changed in the past 6 months. I'm pretty low carb and definitely don't eat much of anything at all. A typical day looks like this:

Breakfast: sugar free (lite) frappuccino (37g)

Lunch: protein bar (37g)

Dinner: meat and veggies (typically NO carbs)

Bedtime Snack: (below 30g carbs) typically carrots or cottage cheese or peanut butter

I take my Levemir dose at night between midnight and 1:00am.

My issue is that I'm doing my basal at night, and then I'm maxing out my BG about three hours afterward.

I've been using Levemir for 3 years.

Anybody with suggestions? I CANNOT use the pump. Please do not suggest it because it will not help me.

I can not explain your sudden highs, sorry. But with the CGMS you will likely have more info at hand than before.

If you are maxing out after the Levemir shot constantly then I would suspect that the Levemir from the previous shot is running out. It takes some time until the Levemir from the new shot can be active. In the mean time your levels will increase. This would mean that you have a gap in basal coverage.

I have recommended to split the Levemir and this is still my number one idea despite of your concerns. But there is one thing you can do now: inject the Levemir earlier. I would suggest to take it at 21:00 to 22:00. This way you have a chance to make a correction before going to sleep between midnight and 1:00am. So if you have a rise in your BG you will not stay high for the whole night.

While you sleep there is sometimes a hormonal release. What type of lifestyle do you have during the day and evening before bed? For instance those who exercise can raise there blood sugar due to the fact that adrenaline (spelling) also releases glucose. You could be releasing stored glucose as soon as your body is at rest.

Thanks Holger. I had a feeling you were going to suggest that again, (haha) but my concern was that a few days ago I was consistently waking up in the 40s. Thank goodness the Dex has an alarm!

My number one fear is insulin shock comas while asleep. I’ve done that too many times and wish to NEVER go through that again. So, waking at 40 is wicked scary. Especially when it’s for about 5 days straight.

But, I DO see what you’re saying about splitting the dosages. I do understand that part (that maybe the insulin isn’t working to its potential) but my issue is that I inject at around midnight and my BG goes up about 3 hours later… and then REFUSES to come down.

It’s hard to explain. And if its just the fact of the “old” Levemir running out, then why did it take 3 hours for it to show in my BG readings? It just doesn’t make sense to me at all.

I’m really not trying to be difficult, but my Endo is telling me not to split my Levemir- but then again, I’ve went ahead with my own diagnosis before (without his approval) and it worked. So… I’m a little stubborn, but I’m also very careful about this stuff. And scared.

Honestly, I lead a pretty laid back lifestyle. I walk a lot, but I don’t do any strenuous exercise. I spend a lot of time writing and many hours standing during band practice and stuff (singer).

For the past few days, though, I have been crashing from exhaustion. I end up falling asleep around 8 instead of my typical midnight. Then, I wake up to take my Levemir and then go back to bed. I’ve been so tired lately, but maybe it’s the combination of more sleep and then strained BGs that is causing like a domino effect?

Can you take your Levemir in the morning?

I think in your current situation you have a dilemma. You have to shoot a huge amount of Levemir to cover as much as possible of your coming day. At the same time this one load of Levemir makes it likely that you will go low at night. If lows are your major concern then splitting can do no harm for you. Yes, it will be different. Some carb factors will need to be adjusted at times where your current one shot-levemir is starting to fade. By shooting Levemir twice you should be more sensitive to insulin - especially in the evenings. But these adjustments are easy to figure out. You just test more when you do the switch.

Stubborn is great. A friend of mine has often lows from Lantus. I told him to switch to Levemir and he wanted to do the switch. I then made the mistake of telling him that it will be perfect with two shots per day. Bad idea, seems that Levemir is now off the table for him. I would always prefer two shots instead of lows but tell that a stubborn diabetic he truely is.

For example: I took my Levemir at 11 pm last night (a little early because I was so tired I didnt think I would get up again at midnight) I aws at 104. Then, at 2:00am, the Dex shows my shooting almost straight up to 280. Then, staying there all night long.

I woke up at 7:00 this morning. Was at 320. Took my usual correction dosage.
Then, at 9:00am, I was still in the high 200s and it was plateauing. So, I took another correction dosage.
Now, it’s an hour later, and I haven’t dropped ONE BIT. Usually Humalog will work in me within a few minutes.

I’m getting so frustrated.
I don’t feel sick, I dont have any infections. I’m just getting wicked pissed off that my “normal” dosages aren’t working anymore. Gonna scream.

It seems that the Levemir was not delivered correctly. What about a malfunction of your Levemir pen. Do you have an old pen to switch to? Another possibility would be to take just the rapid acting pen for both insulin vials. The conversion of the pen should be done within a minute. It is a good test for some days to find out if this is a technical problem.

What do you mean by “take just rapid acting pen for both insulin vials.”? I’m using the KwikPen for both Humalog and Levemir. If that’s what you mean?

I’ve considered that the Levemir isn’t working correctly. Do you know of any other basal insulins that I can try?
I’ve been on Lantus, NPH, Levemir

Do you know of any others that are out there? My Endo is kind of mum about these kinds of details.

I have assumed that you use reusable pens like the NovoPen 4. With these pens you can switch from one to the other by exchanging the vial and the quality of the mechanics is higher.

If the KwikPen is just a prefilled pen that is used once then you should get a new one - with Levemir of course. Show me an NPH vial and I run…

You really think it’s the basal?
Cuz i do too.

I hated NPH too. It was so restrictive because then you had to eat at certain times otherwise you’d PLUMMET.

I have experienced a pen with mechanical problems. If something is odd and I have no explanation I always assume that something is wrong with my pen or the vial itself. So I exchange the vial first and put the old vial into the fridge. If this does not help I will switch to my old NovoPen 3 - the most reliable pen I know.

I have corrected 3 more times since posting in this discussion and I’m FINALLY plateauing in the 120s and 130s. FINALLY. Only took from 7:00am til 3:30pm.

wtf is going on???

Eeeek–from 7-3:30 to get things in range. Hate that! I’ve always have a hard time getting high morning fasting down. Keep correcting & nothing happens. Afraid I’ll crash.

Agree that it sounds like the Levemir isn’t doing it. Though not as convenient, I use syringes because I had problems with pens. While you figuring this out, you could try eating less carbs for your bedtime snack to see if this helps. Maybe something that’s protein.

When my morning numbers were crazy high, I was diagnosed with gastroparesis. The combo of dawn phenomenon & delayed stomach emptying couldn’t be handled with basal. Went to sleep in low 100’s & wake to 250-300–been there.

Splitting basal doses was the best thing I did.

I’m considering splitting. Just afraid. But I was going to take the plunge and split starting tonight. We’ll see if I chicken out. I just can’t handle this anymore. I woke up at 224 this morning. Took my correction 2 hours ago and it’s still sitting at 217.

I thought I had some kind of digestion issue as well. I talked with my Endo about it a few weeks ago, but I’m seeing him for another apointment in two more weeks. I think it takes longer for food to digest in me. Something that would normally take someone 2 hours to break down takes me 5 hours. Which is why I’m never hungry- I think.

How were you diagnosed?

I was entertaining the idea that I was possibly Celiac, but it doesn’t make complete sense. I have no problems eating gluten, other than eating breads make my BG go high anyway. I mostly avoid carbs all together, but SOMETHING isn’t working.