[Penny]

Last week, when I had my A1C, and doctor appointment, I discussed with the doctor that my fasting levels were usually between 135 and 160. We talked about liver dumps and such, and he just wanted me to increase my Lantus by 5 units for a while. The rest of my day from after lunch, my levels are good to great. But my 13 hour fasting level in the doctor's office was 193! I have been doing the extra 5 units for one week now. Today is typical of what has been happening:
at 8am.... fasting 158
I took 7 units of Novolog (doctor's instructions)
850 Metformin
2 Glyburide
and other medications
I ate less than 200 calories, and 20 carbs
At 11, I took my exta 20 units of Lantus
At 1pm with nothing to eat since breakfast...155
I do morning chores, which include going up and down stairway about 8 times carrying laundry, sweeping my wooden floors with a broom and dustpan, making beds, cleaning up the kitchen. Nothing too strenuous, but not easy with my aching body.
I will take another 7 units of Novolog, 850 Metformin, and eat a lunch of 20 or less carbs. If it goes like it usually does, when I check after lunch, I might be 110, and the rest of the day, I kind of struggle to keep from going low.
I just don't know what to do about the fasting levels. I try to have a high protein snack about 10pm....I take the Lantus at 11. I have tried cutting that out, but it seems to not matter. The doctor wants me to increase Lantus by 5 units at a time, until my fasting levels go down.

[Harold]

Hi Penny, Have you tried having a snack in the middle of the night like 2 or 3 in the morning hours? Heard of this working for some people and not others. Try different types of snacks to see what ratio of carb-protien-fat might work.

[Penny]

Originally Posted by Harold

Hi Penny, Have you tried having a snack in the middle of the night like 2 or 3 in the morning hours? Heard of this working for some people and not others. Try different types of snacks to see what ratio of carb-protien-fat might work.

I can try that, I always wake several times during the night.

[4519]

Originally Posted by Harold

Hi Penny, Have you tried having a snack in the middle of the night like 2 or 3 in the morning hours? Heard of this working for some people and not others. Try different types of snacks to see what ratio of carb-protien-fat might work.

This may be a stupid question. Why would eating during the night lower fasting glucose numbers? I know that our bodies do get ready, so to speak, during the night for the mornings activities. Why would adding fuel to the body make it handle glucose better?

[Penny]

Originally Posted by 4519

This may be a stupid question. Why would eating during the night lower fasting glucose numbers? I know that our bodies do get ready, so to speak, during the night for the mornings activities. Why would adding fuel to the body make it handle glucose better?

As I understand it, I have liver dumps in the middle of the night. A snack late at night is supposed to prevent that, but doesn't seem to be helping me any. I did wake one morning at about 3:30 and was 125, I took a few units of Novolog, and woke to a 95, 4 hours later. But I was told this could be a dangerous thing to do.

[4519]

Ok, can we take that theory a little further and say why this happens? I understand the liver idea, that is easy enough to understand, but why what is the thinking behind the liver not doing that because we have comsumed some protein earlier that night?

[Penny]

Originally Posted by 4519

Ok, can we take that theory a little further and say why this happens? I understand the liver idea, that is easy enough to understand, but why what is the thinking behind the liver not doing that because we have comsumed some protein earlier that night?

I know there are a couple of discussions about that on the forum. The answer is for greater minds than mine. My doctor suggested I was having liver dumps, but really did not have an answer, other than to take more Lantus.

[Harold]

Originally Posted by 4519

This may be a stupid question. Why would eating during the night lower fasting glucose numbers? I know that our bodies do get ready, so to speak, during the night for the mornings activities. Why would adding fuel to the body make it handle glucose better?

Conventional wisdom, for what it's worth, gives two reasons why someone may have high morning fasting bg levels. The one most mentioned here is of course the Dawn effect. Which it is believed to be caused by hormones released about a couple of hours before waking. These hormones, released by the pituitary gland, increase insulin resistance and extra long acting insulin given before bed is given to counteract the effect. The one least mentioned is the Symogi effect. Which is nothing more than the liver overreacting to a low bg during the night and releasing way too much glucose. To counteract this effect the idea is to have a snack to keep the bg level above the threshold that causes the liver to dump glucose. So an easy way to determine if it's Symogi versus Dawn is to have a small snack in the middle of the night before the liver dump. Of course timing is everything, but a small snack of 70 calories (15 carb grams) at the right time can hold off a liver dump for the rest of the night. No it's not a stupid question, it's a stupid tricky desease.

[Penny]

At about 4 this morning, I woke and was 78. I ate a cracker and a piece of cheese, and was asleep before 4:30. It was a difficult night, I got up at 9 and was 139. Better than it has been, probably higher because of the stressful evening/night. I will try for a few more nights, as things settle down to see if it helps to eat a bite of something when I wake during the night.