Bedtime

Hi everyone,

Every now and then at bedtime, my number is higher than normal.
What to do, if anything?

If it happens regularly it may be that your basal insulin is a little low during that time; but since you describe it as happening now and then, it could be dinner or ask after dinner snack is affecting your numbers. Fatty meals (no offense to your eating habits🙂) can take longer to digest, and insulin needs time to work - how long depends on which type you take. I don’t recall from your previous posts whether you use a pump - if you do you can see how much insulin on board remains and calculate if it’s enough to bring you back to normal with a little more time. It may be tempting to add on more insulin but depending on what’s on board that may cause you go low later.
It might help to look at (or keep) a diary to see if certain foods, activities, or stresses are a common denominator so you can try to adjust accordingly.
I’m not a medical professional but find the above holds true for me. Your doctor can give you specific guidance.

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Thanks, Dorie, for the feedback. Yes, only maybe a half dozen times since diagnosis in early December. I am going to eat fewer carbs at dinner to see how my numbers are. I do notice that when I walk post meal my next reading is lower than usual so I may start that again.
I have no pump and not yet started the CGM. I don’t know why I am reluctant to use that system. Yes, I do know why. I will be checking it CONSTANTLY and am fearful of my high numbers.

I understand. There are some posts where people talk about feeling a need to check constantly - or very frequently. It’s something people can train themselves to stop doing but it does take some work. For some a CGM is a necessity for safety sake, while others can’t imagine not using one even if that’s not the case. But if you’re doing well without that’s fine too.

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Hi! I like your idea of adding in a short walk. I usually take a 15-20 minute walk if I eat more than 35g of carbs at a meal. I’m usually able to stop the huge spike I see after carby meals and then I’m normal about 3 hours after dinner. Just make sure if you do anything longer you don’t go overboard with activity without adjusting insulin first or you may find yourself a bit low while your insulin is doing it’s thing. Dorie is right about anything high fat too. I can be great for the first two hours and then spike at hour 3 which can be frustrating.in fact I had Buffalo Wild Wings on Saturday and it made my sugars in the morning harder to control than normal(for me high fat meals can really be the enemy). Logging stuff will definitely help you see a pattern!

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Thanks! I did not realize that about the high fats. I have nuts as snacks often! Yikes!

Hi Cathy @HopeFloats2020 , what you are experiencing is not too unusual. Thr three tips that Dori offered are tight on, o I won’t repeat. You are still very “young” with diabetes and I expect that you will be noticing many more traits. Yes, moderate exercise like your after meal walk, does cause a drop in body glucose for many people with diabetes - me included.

What you didn’t mention, is the number of hours bedtime is since your last meal. To determine is your evening meal insulin dose is sufficient to counteract the meal carbohydrate count, I think that you should try checking your BG 2 hours after eating, and then compare that with your bedtime reading. With that information, you [with guidance] may be able to devise a corrective. Also, what is “higher than normal”{ at bedtime? You certainly don’t want to be so low that you will have a hypoglycemic event in your sleep.

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Hi Dennis,

I wait at least 4 hours after dinner for bedtime. The higher than normal a few time has been in 150s, 160s, 170s and one it was 198! This has happened 12x since diagnosis early Dec. I am near positive that those are evenings where I snacked and mostly on nuts. My current target range is 100-140. A half dozen times at bed it has dipped below that, mostly in 90s. Is that too low for bedtime? The thought of hypo scares the crap out of me mainly because I am alone. I suppose if I go into coma overnight I wouldn’t know it! Funny, not funny.
So, when I have high fat foods, what should be eaten with it to better control the potential spike? Maybe I should slap that CGM on! Again, scared of change and seeing true numbers.

Hi again @HopeFloats2020 . When my family traveled and I stayed home alone I would set an alarm every 2 hours overnight so I could see how things were going - before BG meters I would just check how I felt and eat a snack if I felt like I needed one.
Using a CGM gives me huge peace of mind now even though my husband is here - and I think it gives him peace of mind too. Not to mention being able to see how I’m doing if I’m driving (I take a peek when it’s safe of course). I’ve actually done a fingerstick at a stop light and been surprised that I barely had time to get through the whole process before the light changed.
I’m a huge advocate for CGMS and do appreciate the fact you may feel compelled to check very very very very very frequently - I did that too for a while. The key is to use it as a guide - a guide to what’s already going on in your body whether you use a CGM or not. Some people want to keep really tight control. Not to fault that, but taking corrective action too quickly in the interest of tight control can be dangerous. I used to see my numbers rising more than I wanted after eating - and I would add on a little more insulin hoping it would help bring me down. It did - but not any faster, and the additional insulin caused me to go low. I wasn’t giving the meantime insulin time to work and adding more did nothing to speed things up. So my doctor have me strict instructions not to give any additional insulin for 4 hours (timing may depend on the type you take) unless I had under-counted the carbs or eaten more food. It was hard but I forced myself not to even look at my screen unless I got some sort of alert. And sure enough, when the time was over my numbers were coming down nicely to a good level.
I’ve shared this story a few times and hope you’re not getting a stereo version. It’s just to say - a CGM is a valuable tool and should be used as a guide. They update readings every 5 minutes so it’s best to check a few to see if a trend continues or if things level out. Obviously take action if you think there could be an emergent situation but try not to feel you must take action right away every time you see the numbers change.
If you do decide to check out a CGM it might be good to ask your doctor or nurse educator at what point you should “do something.” Don’t forget you may have insulin on board that hasn’t had a chance to do its work so they may tell you to wait if your numbers are rising. And if they’re dropping but you’re on the higher side of normal you may need to wait a bit to see if that levels out too. Using one can give you valuable data on how your current regimen is working - info you can’t get unless you prick your finger more more than you currently do.
There’s a CGM called the Freestyle Libre. Keep the receiver close by and it will track your numbers - you just have to swipe to see what they are and it gives you a graph of readings since the last swipe. It stores up to 8 hours I believe. If you don’t swipe over that time you’ll have a gap but you’ll still get the most recent 8 hours.
So I would encourage you to look into one especially since you live alone. The Freestlye 2 has alerts to let you know if you are low or high (I believe you determine those numbers). And talk with your doctor about guidelines for hiw often to “sneak a peak”: you want it to be a tool, not have control over you.
Just some things to keep in mind.

THANK YOU for your story!

Cathy, it very well could be the nuts you are eating during the evenings, even though the carbohydrate count per ounce of nuts is “low”, all foods have some carb which may be pushing your glucose level up a bit. Cashews are an exception to what I just said about nuts - cashews have significant carbohydrates.

The 41 mg Target Range you have set for yourself is VERY challenging, especially if you can stay in this range both before and following meals. The international “medical expert” standard for a person with diabetes is to stay in that range at least 70% if the time. Personally, I feel that the 70% is much “too relaxed” a standard.

Personally, I wouldn’t get into bed without having a snack if my BGL read in the 90s. Prior to using a CGM, my personal rule was to have a bedtime snack when below 110 mg/dl. From what you have written since you joined this Forum, I can not easily see you entering “diabetic coma” *, although you could [and you should expect this] experience “insulin reaction” or hypoglycemic events. Your diabetes management appears to be very good.

      • Diabetes Coma** is "a state of unconsciousness from which the patient cannot be aroused, even by powerful stimuli", usually associated with and caused by extremely high glucose levels for an extended period of time - undiagnosed and non-manages diabetes. EXTREMELY LOW glucose, if prolonged, could also cause coma. Coma, like seizure, is a cerebral shot circuit, a traumatic brain injury.
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Thanks, as always, Dennis for your words of wisdom! I eat mostly raw almonds, brazil and pistachio’s for snack but I suppose I will munch on cucumbers if I feel the need to eat! This would be so much easier if I ate to live and not lived to eat!!!
My endo, by the way, gave me that target range. Hmmmm.

P.S. is it ok to have a no-carb meal now and again?

Hi again. Like an annoying rash, I’m baaack! I’m saddened to see that you eat to live, not live to eat. Obviously eating to live is important but you can learn to do both. I’m nearing the 60 year club and have been on a pump nearly half that time. Using a pump has made it easier to have foods I enjoy strictly for pleasure (the other day I had a small McDonald’s shamrock shake for instance) but people manage with shots as well.
Far be it for me to tell anybody to throw caution to the wind, especially since you are so new - but I hope you will reach a point where you allow yourself to enjoy foods for fun as well as health, learn to look at and manage your numbers without beating yourself up, especially about occasional outliers. In my opinion - which is admittedly different from your doctor’s - the occasional 198 isn’t awful. But if your goal is to stay in the range your endo gave you, speak with a nutritionist and DNE about how you can work in some foods just for fun if you have the desire. A little extra exercise or even timing of insulin can help keep your numbers in or around range.
I often recommend the book *Think Like A Pancreas * - the author works in the diabetes field and has diabetes himself. I actually found it to be an enjoyable read even though it’s about the business of diabetes.
You’re new to this and adjustment takes a while. Hopefully as time goes on you’ll become more comfortable - whatever that means for you. Do the best you can but don’t expect perfection 100% of the time.

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Thanks, Dorie, for coming baaaack! I appreciate the stories and thoughts!

I highly recommend a CGM if you are able to access one. Dexcom is best (from what I have read). I learned that when I am high before bed, when I would correct, I would go too low overnight, and that this was NOT b/c of my correction, but b/c my Lantus was too high. Since I’ve lowered my Lantus, I’m now at a point where my blood sugar won’t drop more than about 10 points, as long as I took the correct amount of short-acting insulin for dinner (including any corrections).

Sometimes, a high before bed indicates a rise in blood sugar that my Humalog ends up “catching up with” and bringing down on its own. Other times, it’s because I just didn’t take enough insulin. In that case, I really don’t want to go to bed with a high blood sugar level, and stay high all night. B/c I use a CGM, I can do a much better job of determining all these things (is my blood sugar just momentarily high? or is it going to stay there so I need to take a correction dose?). Furthermore, the CGM has taught me how much of a correction I need to take if I am staying high (e.g. I was 150 last night ~4 hrs. after dinner, was staying there, I could tell I wasn’t coming down, so I took 0.5 units of Humalog, and came down eventually to 88 o/night - w/out the CGM, I would never know what my correction dose should be, what my Lantus should be, and how my blood sugar is trending over time (i.e. staying high, or coming back down on its own)).

CGM’s are psychologically stressful, but it’s stress that comes more in the short-term while you’re learning better about how insulin and carbs (and fat) affect your body. So I highly recommend. And then you don’t have to worry basically at all about overnight lows, since you get the alarm if you do go low (although, honestly, there are a fair amount of false low alerts as well, since CGM tech isn’t 100% accurate yet).

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Honestly, I get dizzy reading about all this correction crap and I don’t think I can handle. I may just eat lettuce the rest of my diabetic life.

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No need to turn into a rabbit - you’re learning and it’s overwhelming. Take things in stages and you’ll become more comfortable with time. You’ll be spouting diabetes vocabulary with the rest of us in time.

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Yeah, I know, it’s overwhelming. Maintaining a healthy mental attitude is just as important for one’s health as doing the best you can w/ diabetes (and whatever other physical issues we get). (Also, I’m one to talk! This whole diabetes thing, and trying to learn from CGM, has contributed a lot of stress and anguish to my life, but I’m just persevering and have gotten better overtime at dealing w/ both the physical and mental aspects. It’s really hard.) Anyway, just saying, kudos to you and how well you ARE managing it. Perfection is not a realistic goal, and is not even necessary for good health. Doing our best to manage it, and feeling good (mentally), is the best we can do, and that’s enough!

Thanks, Becky!

I am trying to find a mental health professional who specializes in patients with Diabetes. I’m not having much luck.