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waking up with high BG

Question:

: : : This is purely anecdotal based on one case (me): I’d been having trouble : with AM highs especially over the last several months–usually waking up : over 200, and sometimes suspecting that I’d been low in the night and : rebounded.  (My shots included R and N in the morning, R at dinner time, : and N at bedtime.)  I’d tried taking more N at bedtime, taking less N, : eating more, eating less, but couldn’t get any of these to work with any : consistency.  Last week, after discussions with my doctor, I switched : from Regular to Humalog.  Over the last four mornings my BG has averaged : 115. : : Though I’m joining the pump crowd soon, I’m a lot happier with how : things are going now than I was a week ago. : : How long a delay is there between the time you eat dinner (and : presumably take your Humalog) and the time you go to bed and take your : N?  I have the same problem and may try Humalog myself. : It’s nomally between four and five hours between my dinnertime dose of : Regular : (now Humalog) and my bedtime dose of NPH. I thought Id add my experience at this point.. I had this problem with hypo in the night leading to high AM readings. I swapped to Humalog and bingo, no more trouble. The problem was not caused by the night time slow acting insulin as I had thought but by the fast insulin left over from the last meal still hanging around. I would not change back whatever the cost(even though I get it free in the UK). Rob D.

Response:

- Hide quoted text — Show quoted text – This is purely anecdotal based on one case (me): I’d been having trouble with AM highs especially over the last several months–usually waking up over 200, and sometimes suspecting that I’d been low in the night and rebounded.  (My shots included R and N in the morning, R at dinner time, and N at bedtime.)  I’d tried taking more N at bedtime, taking less N, eating more, eating less, but couldn’t get any of these to work with any consistency.  Last week, after discussions with my doctor, I switched from Regular to Humalog.  Over the last four mornings my BG has averaged 115. …. Though I’m joining the pump crowd soon, I’m a lot happier with how things are going now than I was a week ago. How long a delay is there between the time you eat dinner (and presumably take your Humalog) and the time you go to bed and take your N?  I have the same problem and may try Humalog myself.

It’s nomally between four and five hours between my dinnertime dose of Regular (now Humalog) and my bedtime dose of NPH. — Evan Osborne                           *   Wright St. University Wright St. University                  *   Dept. of Economics Phone: (513) 873-4599                  *   3640 Colonel Glenn Hwy.

– —- Eric J. Isaacson             Assistant Professor of Music Theory School of Music              Cognitive Science Program Bloomington, Indiana 47405   WWW: http://ezinfo.ucs.indiana.edu/~isaacso/ Phone: (812) 855-0296        FAX: (812) 855-4936

Response:

This is purely anecdotal based on one case (me): I’d been having trouble with AM highs especially over the last several months–usually waking up over 200, and sometimes suspecting that I’d been low in the night and rebounded.  (My shots included R and N in the morning, R at dinner time, and N at bedtime.)  I’d tried taking more N at bedtime, taking less N, eating more, eating less, but couldn’t get any of these to work with any consistency.  Last week, after discussions with my doctor, I switched from Regular to Humalog.  Over the last four mornings my BG has averaged 115.

…. Though I’m joining the pump crowd soon, I’m a lot happier with how things are going now than I was a week ago.

How long a delay is there between the time you eat dinner (and presumably take your Humalog) and the time you go to bed and take your N?  I have the same problem and may try Humalog myself. — Evan Osborne                           *   Wright St. University Wright St. University                  *   Dept. of Economics Phone: (513) 873-4599                  *   3640 Colonel Glenn Hwy.

Response:

        When I was at my daugters "Group day" appointment for her         diabetes last time i was told something very interesting.             I was told that the Somogyi effect is not as common as             dawn phenomenon or waining insulin levels during night.             They usually would see low BG levels in the morning after             a night where the patient went low.  The reasoning behind             this was that if there was too much insulin at 3am there             is still too much insulin at 6am.  The body works all             night trying to push the insulin levels higher while the             insulin keeps it low.         Any comments?

I think they’re wrong.  The ammount of insulin needed to drop the normal ‘low’ at 3am (say 4.5 or 81) down to the hypo (say 3.5 or 63) is really quite a small amount (adjusting down a unit can cure the problem) *but* the Somogyi effect can bounce you up to the top of normal, even, some say, into hyperglycaemia. So, if you injected the long-acting at 10pm, it took 5 hours to drop the bg by 1 or 18 below normal.  In 3 hours it is only going to get you down by around the same amount – not back down to your normal breakfast reading.   There are other causes of hypo at night: the insulin can peak (when the body’s release doesn’t), or the body can temporarily suspend release (e.g. after drinking alcohol).   Having written that, I’ve just worked out a way that they are also right (if not terribly good at explaining things). Their reasoning could be: * Somogyi effect is uncommon. * Somogyi effect is triggered by hypos, therefore * Hypos are uncommon. They then go on to explain that * Injecting insulin and not eating suggests you will go hypo,   but this does not happen because * The body raises the bg, and the insulin simply balances it, therefore * Hypos are uncommon. And this is true.  But the rarity of night-time hypos doesn’t make the effects of rebounding from them any less severe, as they seem to suggest. I’m pleased your daughter’s high bgs had a simple solution. — Patricia Reynolds "It may look a bit messy now, but just you come back in 500 years."

Response:

… 4/ Assuming that you have increased your medium-term insulin to    the max. you can without going hypo earler in the night …    try switching the dinner injection from R to Humalog: you    may find that R lasts beyond the few hours it is supposed to,    and as Humalog is gone quicker, you may be able to increase the    medium-acting to the point where it can deal with the dawn effect.

… This is purely anecdotal based on one case (me): I’d been having trouble with AM highs especially over the last several months–usually waking up over 200, and sometimes suspecting that I’d been low in the night and rebounded.  (My shots included R and N in the morning, R at dinner time, and N at bedtime.)  I’d tried taking more N at bedtime, taking less N, eating more, eating less, but couldn’t get any of these to work with any consistency.  Last week, after discussions with my doctor, I switched from Regular to Humalog.  Over the last four mornings my BG has averaged 115. Humalog has also helped in the mornings as well.  Breakfast is my largest meal and, with Regular not kicking in earnest in until near lunch time about the time my NPH was also ramping up, it would not be unusual to be well above 200 by late morning, then plummet by 100-150 in the course of a half hour to an hour.  Humalog seems to be getting my midmorning BG into the 120 range fairly consistently, and holding it there until lunch time. Though I’m joining the pump crowd soon, I’m a lot happier with how things are going now than I was a week ago. Eric Isaacson —- Eric J. Isaacson             Assistant Professor of Music Theory School of Music              Cognitive Science Program Bloomington, Indiana 47405   WWW: http://ezinfo.ucs.indiana.edu/~isaacso/ Phone: (812) 855-0296        FAX: (812) 855-4936

Response:

The three most common reasons for high fasting levels are waining insulin, Somogyi effect (rebound), and dawn phenomenon.  The best way to sort it out is to take a bg reading every couple of hours from bedtime to breakfast.  If there is a slow rise from some point in the night to waking, then it is probably waining insulin.  If you are falling sharply, then show a dramatic rise, then it is probably Somogyi.  If you are stable then rise sharply before waking it is probably dawn phenomenon. You may have to do this on several nights or decrease the testing interval for part of the night to really nail things down.  Once you know what the problem is, it is easier to design a solution.

        When I was at my daugters "Group day" appointment for her         diabetes last time i was told something very interesting.             I was told that the Somogyi effect is not as common as             dawn phenomenon or waining insulin levels during night.             They usually would see low BG levels in the morning after             a night where the patient went low.  The reasoning behind             this was that if there was too much insulin at 3am there             is still too much insulin at 6am.  The body works all             night trying to push the insulin levels higher while the             insulin keeps it low.         Any comments?         PS: We raised Brittany bed time NPH by .5 units and the morning             readings went from 150-250 down to 100-150.  I guess they             were correct in this case.  I did not have to get up at 2am             for a week before I made the change either :-) — Rusty Nail (Russell R. Nell) Norland Corporation     W6340 Hackbarth Road, Fort Atkinson, WI 53538-8999              

Response:

  I had this problem for a while as well, and it was solved by splitting my nighttime doses up.  At dinner, I do a shot of only regular, and at around 10:30 (I found by experimentation that this was the best time), I do the NPH shot.     This isn’t something I’d do w/out talking to the doctor about, but it cleared up the problem I was having.   Greg —

    Just a question (not a suggestion):         How many people talk to an MD before making changes         to an insulin regimine?     I very seldom do.  I have read/learned as much as possible about     the different standard regimines and how they relate to kids.       I have used that information to make several changes to my daughters     insulin requirements.  For example,  nine months ago we were having     problems keeping the morning BG levels down.  I changed her NPH     shot from suppertime to bedtime.  Solved the problem, one month later     the doc aggreed with my assesment at her 4 month checkup.  That was     the most drastic change I made but I do change NPH amounts about once     every month or two (as needed) and change regular amounts daily. — Rusty Nail (Russell R. Nell) Norland Corporation     W6340 Hackbarth Road, Fort Atkinson, WI 53538-8999              

Response:

Hi to all of you. For the past 6 month I have been waking up with high BG levels (up to 255 to 300 every morning).

[snip]    I had this problem for a while as well, and it was solved by splitting my nighttime doses up.  At dinner, I do a shot of only regular, and at around 10:30 (I found by experimentation that this was the best time), I do the NPH shot.      This isn’t something I’d do w/out talking to the doctor about, but it cleared up the problem I was having.    Greg — —–BEGIN GEEK CODE BLOCK—– Version: 3.1 GCS d- s+: a– C+++$ UVHISX++$ P+++ L+++ E+$ W++ N++ o+ K w—$ !O M++$ !V– PS PE !Y+ PGP++ t+ !5– X++ !R tv+ b++ DI++++ D++ G++ e h(!) r–* y+* ——END GEEK CODE BLOCK——                                            ======http://acm.cs.umn.edu/~torgo======

Response:

Trying to solve this problem, my doctor told me to measure my BG before dinner (at 8:00 pm) and during the night at (1:30 am). My BG levels are around 110 at 8:00 pm and 110 at 1:30 am, but in the morning, say 7:30 my BG levels are up to 255. My Dr. said to me to reduce my insulin at night because I

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