[MissJess]

Hi guys,

I am 23 years old, type 1 diabetic for 6 years now. I take lantus and humalog injections. These past few weeks I have been noticing that my blood sugar will go really low in the middle of the night and when I wake up in the morning it will be REALLY high. For example.. last night before bed at 10:30 my blood sugar was 145. It went low 2 times in the middle of the night, first time around 12:30am and the second around 2:30 am. I woke up both times sweating and my heart was pounding out of my chest. I keep a juice box next to my bed so I dont have to go far. I woke up at 6 for work, got ready and checked my blood sugar and it was 300!! This has been happening almost every night, maybe every other. I go to sleep, my sugar is fine, I wake up and its so HIGH. I used to take my lantus in the morning with breakfast and I thought maybe that was just wearing off by the morning, but recently I have switched back to taking it at night and still, the same thing. Any advise would be greatly appreciated. I have been logging all my blood sugars due to my glycomark test coming back poor. Too many fluctuations throughout the day. Also, my AIC was 6.4 when I saw my doctor a few weeks ago.

Again, any advice is greatly appreciated.

Thank you

Jessica

[poodlebone]

You could be experiencing the Somoygi effect. This is your body's way of helping you out of a low, causing a liver dump to raise your BG. Unfortunately, it doesn't know when to stop! That combined with the juice caused your BG to go too high.

When I was first put on Lantus I was told to take it once in the vening. I was having lows overnight but since I'm hypo unaware, I wouldn't wake up. I would usually still be way too low when I did wake, unlike you. I was then told to split my dose in two, taking it morning & evening 12 hours apart. That was much better although I would sometimes wake up too high. I had been playing with the split, giving more at night than in the morning but was put on a pump very soon after that. I'd suggest asking your doctor about splitting the dose. It does mean two injections vs. one but you may get better control that way.

[MissJess]

Thank you for your response. Yes I have been doing research on the Somogyi Effect. I want to bring that up to my doc when I go back to see him. In the mean time I am trying to test as often as possible. I dont understand though, when I wake up like that its very sudden and scary. My first thought is just to treat the low. I dont understand why my liver would still continue to release glucose?? If that even makes sense, Lol. I am still trying to make sense of it all. It is very frustrating for me since it is almost every night. I feel like I havent had a full nights sleep in a while.

Thanks for your response.. it is greatly appreciated.

[Subby]

MissJess, the reason the liver releases too much is that it wants to play it safe, and expects the pancreas to release some corresponding insulin to "sop up the excess" and maintain a good blood sugar. That's how a non-insulin dependent's metabolism often works - a seesaw or balancing act between energy and insulin, all monitored and adapted for automatically. In us type 1s, the insulin production is obviously lacking... so the energy release may just send us high!

As for the somogyi effect - just be aware that there is little scientific evidence for it, your doc may have a negative reaction to the idea. Now, the thing is I've observed it strongly in myself, as it appears you have. I think it has general acceptance amongst practising diabetics for a reason - it seems to occur, and reducing insulin in the body during that period, one way or another can rectify the situation. (Or, having a long acting snack before bed may help as well. I used to have a small amount of porridge and milk back in the day).

[jenb]

It sounds like your basal needs may be changing. Have you done some testing? It's possible that changing and/or splitting your Lantus dose can help maintain more constant BG.

Also, you mentioned that you keep juice by your bed. Perhaps you are over-treating your lows. It's so easy to overdo it with juice (at least for me). I use glucose tablets and start with just 1 to correct a low. If my BG hasn't started to rise within about 20 minutes I add a second tablet...hard to do out of a sound sleep, of course, but it does help to avoid those rebound highs.

Jen

[MissJess]

Thank You Subby. Yes, I was also reading that this Somogyi Effect is not backed by scientific evidence. I am waiting on my Endo to call back. I could try taking less lantus before bed, but then I am afraid that my sugars my go high during the day. I work in an office so there is not much activity involved in my 8-4 schedule. I guess I could try eating a small snack before bed. One of the nurses I work with advised to eat maybe peanut butter or graham crackers before bed. I guess I would not take insulin with my snack?? So my sugar is a little higher then normal when going to sleep?

[MissJess]

Hey Jenn, yeah I have tried the glucose tablets. I used those for maybe a year and now the taste of them seems to get to me. I have been drinking the kids Juicy Juice Apple juice boxes. There are only 15g of Carbs in each one. I dont quite understand what you mean by splitting. (Of course I will talk to my doc before making any changes) but.. do you guys mean taking about 12 units in the AM and then the other 12 in the PM? I take 25units of Lantus each night. Or maybe 12 in the AM and then a little less before going to bed?

Thanks!

[Subby]

Snack wise, finding a slow acting carb (slower the better) is the ticket (if you need this: adjusting your dose may negate this need). Yes, not bolusing for it. But it needs to be the right amount and right food not to raise you too much, but provide more energy in your system at the time it needs it during the night. Including some fats like peanut butter can help slow the carbs down.

Splitting means taking your basal in two doses, as you suggest. It need not be a 50/50 split either... you might take 40 at night, 60 in the morning. Definitely talk to your doctor about splitting as an option, it could be a good solution.

Whether the somogyi effect really exists or not is a little beside the point - you know you are going low, and the first step would be to fix the lows. If the highs in the morning still occur having sorted out the lows, you can come back to that issue.

[MissJess]

Thanks guys, very appreciative!! I will mention this too my doc. I am going to fax him over my sugars from the past 2 weeks and see what he has to say about that. I guess this could be the reason for my glycomarks test coming back bad.