Blood sugar going up late in the evening

lgvincent · #1 (**permalink**) 01-01-2005, 08:45 PM

For some reason, I'm having trouble with my blood sugar going up after 9:00 in the evening. Most of the time my blood sugar runs in the 80 to 120 range up through about 9:00. For example, tonight it was 75 at 8:00 p.m. However, when I check after 9:30 in the evening, it's often in the range of 180 to 240. Tonight, it was 200 at 10:00, even though I haven't had a snack yet. Does anyone have any idea about what may be causing this and how I can correct it?

duck · #2 (**permalink**) 01-01-2005, 08:52 PM

When and what was the last thing (or things) you ate? I've been told that basal rate needs can change from time to time, and of course the usual suspects can affect blood sugar levels (stress, hormones, illness). Can you do a basal test where you check your BSLs every half an hour, at least four hours after your last meal and where your starting blood sugar level is between 100 and 140?

lgvincent · #3 (**permalink**) 01-01-2005, 08:56 PM

My last meal was supper at about 5:00 to 5:30 in the evening. I haven't had anything since then. I may try checking it every half hour for a few hours.

Harold · #4 (**permalink**) 01-01-2005, 10:46 PM

Lg sometime around the 4 hour mark after eating I get a liver dump if I have not had a snack yet. It's just a thought but this maybe what's happening.

MarkMunday · #5 (**permalink**) 01-01-2005, 10:53 PM

Quote:

Originally Posted by lgvincent

... when I check after 9:30 in the evening, it's often in the range of 180 to 240....

Could you be running out of basal insulin? I have found, especially after switching to Lantus, that the period over which it acts changes. And is sometime it is inconsistent. If the problem persists, I would suggest starting a new vial.

I stopped doing daily exercise for a few days over Christmas. And my nighttime blood sugars went very high. Could this be an issue?

Cheers,

Mark

sparkle9 · #6 (**permalink**) 01-02-2005, 04:28 PM

I've had the exact same problem with blood sugars going up in the late evening. It's happened on and off for a long time. I completely agree with Mark about exercise. I've tried to follow his advice about getting a moderate amount of exercise every day. When I do this, bs control remains much more predictable and acceptable. Lately I've had some bad days due to company, visiting, bad weather, and too much sitting! Am determined to get back on track tomorrow!

Hope this helps.

Sparkle

scb · #7 (**permalink**) 01-02-2005, 05:07 PM

lgvincent it sounds like you are having exactly the same problem as me! Your levels sound almost exactly the same as mine, always up in the evening.

I'm with Markmunday on this one, I'm thinking it's running out of Basal insulin. I'm on 14 units of Levemir at the moment and I'll up it this week to see if it has any effect, if I get nothing I'll get on to my clinic. Keep me posted on how you get on would you?

lgvincent · #8 (**permalink**) 01-02-2005, 05:10 PM

Yes, it does get hard to exercise this time of year. You get cold days and wet days and overcast days and it's just a pain in the butt at times. I'll keep working at it and try to let you know what happens.

duck · #9 (**permalink**) 01-03-2005, 05:18 PM

Quote:

Originally Posted by scb

lgvincent it sounds like you are having exactly the same problem as me! Your levels sound almost exactly the same as mine, always up in the evening.

I'm with Markmunday on this one, I'm thinking it's running out of Basal insulin. I'm on 14 units of Levemir at the moment and I'll up it this week to see if it has any effect, if I get nothing I'll get on to my clinic. Keep me posted on how you get on would you?

Here's my concern about upping the dosage: If 10 units is done working in 12 hours, wouldn't 15 /20/30 units be complete in 12 hours as well? In other words, wouldn't you need to compensate with another shot later in the day as opposed to more insulin on the old regimen (I am asking, not preaching?)?

scb · #10 (**permalink**) 01-03-2005, 11:32 PM

Yeah Duck that is a concern.It's going to be a bit of trial and error with this one. It may mean a larger dose at dinner might do the trick instead of increasing the basal, it's very hard to say.
On the new doseage my BS was fine last night at a about midnight when I take my basal shot (5.8 MMol/l), but this morning I woke up with a reading of 3.3, very unusual for me as I have hardly ever woken up low. Not sure how much this had to do with increasing my basal.

scb · #11 (**permalink**) 01-09-2005, 11:23 AM

well after a week of upping my basal dose I think it's back to the drawing board. Too many morning lows and not a lick of difference to my night time highs. This has been a pretty difficult week to really get a good idea what was going on. It was my birthday this Friday and I was out three nights in a row. Having a few drinks always raises my BS.
However upping the basal is clearly not the answer. Anyone any ideas?

docta-docta · #12 (**permalink**) 01-09-2005, 10:13 PM

lgvincent'... VERY interesting.

What makes your situation frustrating is the rapid increase in BGL over a span of just 60 to 90 minutes. You can be fine one moment, and an hour-and-a-half later, find out that you've more than doubled your glucose levels, without having eaten anything for 4 or more hours!

You should watch what your amount of calories at dinner come in as being CHO, protein, and fat. Protein and fat require several hours of digestion time. It's possible that the protein and/or fat from your meal are hitting you. That may help you to start finding out when it's going to hit.

It sounds as though you're hitting your meals hard enough with insulin (any harder and you'd go too low).

Once you determine if it's high fat or protein, you'll be able to pre-empt your evening highs with insulin before it begins to spike up. It means more shots, but chasing down the cause of the 4hr. postprandial spike can be turned into a game that you won't let yourself be declared a loser.

One other problem is that you might end up gaining more weight with the extra insulin. You might look into Amylin (Symlin) when/if it is approved by the FDA. It's another shot, but it should tell your liver to not perform a glucose dump. Symlin is due for an FDA approval letter in the end of March 2005. Some fear it might not succeed in the marketplace, but its purpose to replace the other hormone produced by beta cells.

Clinical trials have shown symlin to reduce postprandial glycemic variations, but the true test will be when results are posted to the message boards.

Also, like what the other posters said, exercise will improve your insulin sensitity for 24 and even up to 48 hours. Exercise equipment will be cheap in the newspaper by March/April, when people start to give up on New Year's resolutions.

Dr. Quack

leking · #13 (**permalink**) 01-12-2005, 06:45 PM

i think this is the right thread.

i am on 3 shots of novorapid in the day, then one shot of lantus before bed. my blood sugars are ALWAYS high at about 12am. its so annoying and making it hard to get to sleep. would splitting my lantus be a good idea? does this mean half before bed and half in the morning?

and exercise is nothing to do with it i'm sure.

HeatherP · #14 (**permalink**) 01-12-2005, 09:44 PM

Leking, I would think that if you were needing to split your Lantus into two shots you be most likely to be having higher sugars towards the afternoon and evening rather than at midnight. What time do you take your Lantus? I suppose you could be having some drop-off between the end of the previous 24hrs and the most recent shot.

Are you sure your ins:carb ratio is correct? Could it be being affected by the actual content of what you're eating and not just the amount of carbs? You could also try having a light snack before bed - maybe some protein and about 5-10 grams/carbs.

I found that I had to split mine, I inject 10u in the evening, and 9 in the morning. I found if I split it evenly I was going low in the afternoons. I also have better control if I inject at 12 hour intervals - between 7-8 a.m. and
7-8 p.m.

docta-docta · #15 (**permalink**) 01-12-2005, 11:09 PM

Quote:

Originally Posted by leking

i think this is the right thread.

i am on 3 shots of novorapid in the day, then one shot of lantus before bed. my blood sugars are ALWAYS high at about 12am. its so annoying and making it hard to get to sleep. would splitting my lantus be a good idea? does this mean half before bed and half in the morning?

and exercise is nothing to do with it i'm sure.

Exercise, food, and insulin all have to do with it. It's just figuring out the right ratios of each.

How many times a day do you test? When is the latest you've eaten? You haven't painted any sort of picture of what your "typical" day is in which you experience a high. Perhaps you're not dosing enough for your mealtime? Or protein/fat finally digest near midnight, resulting in you going high? After you treat your midnight high with insulin aspart, do you wake up normal again? (Could your evening Lantus dose be insufficient?)

We can't play doctor here (though it might be fun

) but perhaps listing a log (with times/events) for a typical day would be helpful. Include foods, exercise, glucose tests, and insulin dosages where appropriate. Maybe we can take a gander at it and see if there's anything that is obvious from our pool of experience.