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Medical Forum / Diseases and Disorders / Diabetes / April 2006High BG at night but normal in A.M.
Here's some background: T1 diabetic for 1 yr; possilby still in honeymoon period; Lantus 9 units; NovoLog 2-3 units. I noticed an interesting phenomenon, that may or may not be related to the dawn phenomenon. My BG at night most of the time is high (170-200), but by the time I wake up in the morning it's almost normal (around 130). When I check at night, it's at around 2 am or maybe 3 am. I would think it's too early for dawn phenomenon that is known to occur between 4 am and 9 am. What's even more puzzling, how and why does it drop to almost normal by the time I wake up? If I would not check at night, I would not even notice this and think it's all going great. Now, on occasion, the morning BG is not in the normal range and stays around where it was at night. There's no consistency and complicates situation. If I were always high in A.M. I would raise my Lantus dose, but I would risk a hypo on those days I am almost normal in AM. Did anyone experience a similar pattern? Any solution? Thoughts? Thanks in advance. Lantus is OK (bg good in AM), probably need to up the Novalog at dinner Well, checking 2 hours after dinner the BG is well within normal range (110-140). Then it suddenly rises in the middle of the night and then drops back to normal by the morning or stays high. Why would it drop back to normal? What causes it to normalize? Can dawn phenomenon happen as early at night as 2 am? (I will try checking at 1 am now) > Well, checking 2 hours after dinner the BG is well within normal range > (110-140). Then it suddenly rises in the middle of the night and then [quoted text clipped - 4 lines] > Can dawn phenomenon happen as early at night as 2 am? (I will try > checking at 1 am now) Perhaps you have some endogenous insulin? Something you ate in the early evening is no longer elevating your bg's? When are you taking the Lantus? It isn't suppose to peak, but it does, anyway, with many people. Dave T1Steve wrote in message <1144415127.809560.223170@e56g2000cwe.googlegroups.com>... >Here's some background: T1 diabetic for 1 yr; possilby still in >honeymoon period; Lantus 9 units; NovoLog 2-3 units. [quoted text clipped - 17 lines] > >Thanks in advance. Some Thoughts: 1. Basal Fade: Anytime the level of insulin in your blood drops below about 8 - 12 microUnits/Liter, you will experience Basal Fade, i.e. your liver will "assume" you are in danger of passing out from low blood sugar (no matter what your sugar happens to be) and will release glucose into your blood. Lantus is advertised as a 24-hour insulin. I have read serious medical sites which asserted that the average useful life of a Lantus injection is 19 hours. Some folks see less; some see more. The Lantus activity curves I have seen suggest that there is an induction period after an injection during which approximately nothing is happening. It is conceivable that you are experiencing basal fade during the induction time after an evening dose if you happen to be a "fast absorber" One of the tricks useful in dealing with any basal is to split the daily dose into more injections. That trick is especially useful with Lantus which is often injected only once a day. Some posters have remarked that a 2-injection-per-day Lantus regime is necessary in their cases. 2. Evening Food Effects: When I adjust my basal, I try for a dose such that my midnight-1 a.m. bG is about the same as my 7 a.m. bG. Picking midnight-1 a.m. as a "base" tends to eliminate the effects of an evening snack and its accompanying bolus shot. If you are going to bed with a normal sugar but food in your belly**, you could easily go high during the night, then experience a drop as your Lantus and any remaining beta cells take up the slack. ( Note that many of the Lantus discussion sites report a minor peak at 6 hours after the injection. ) (** Some slowly digesting foods spike my bG at 5 hours after eating. I cannot eat Pizza after 7 p.m. lest I fall asleep before I have determined whether or not my bolus dose guesses were correct. ) 3. Lantus Hypos: A reasonable total daily dose for a youngish, low Insulin Resistant T1 is about 0.2 units/day-Kg body weight. You should be able to take an appreciable fraction of that dose without much worry of a Lantus hypo. Splitting the daily into two shots is a help if you do experience a Lantus hypo. Look for problems at 6 hours after the injection, and especially at 3 a.m. when our insulin needs are typically at a minimum. Basals usually represent 40-50% of our daily dose. Some typical daily doses are presented at this site http://www.medscape.com/viewarticle/436291 Regards Old Al > Here's some background: T1 diabetic for 1 yr; possilby still in > honeymoon period; Lantus 9 units; NovoLog 2-3 units. [quoted text clipped - 17 lines] > > Thanks in advance. DP can start before 4 AM. I went on a pump 10 years ago because of DP that wasn't controllable by MDI. Good luck trying to get it down w/o going hypo, using MDI. Dave |
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