Glucose spike at sleep onset

My daughter was diagnosed about 2 months back - so far we haven’t had many issues staying in control but we do have one puzzling issue.

Whenever she sleeps, her BG immediately rises and then descends 3 hours later - mostly see this at night but also with naps. Doesn’t matter what she ate for dinner or when she ate dinner or if she was low at dinner or high at dinner.

She’s on an omnipod, her basal is .05 during the day so at night we’ve been upping it to .4 / .45 / .5 per hour for the hour before sleep up thru 3 hours post sleep but doesn’t seem be having a huge impact (in terms of highs we are still seeing 250-275).

I’m just concerned that she’s getting such a huge % of her basal in these 3 hours and that it’s not really having much impact. At first I thought it was just a liver dump similar to dawn phenomenon but I’m also wondering if it could be a resistance to insulin at that time. We’ve also tried to correct at night and that doesn’t seem to make a lot of difference either.

Anyone seen anything like this? Most of what I have read of DP refers to it happening much later in the sleep cycle. (with my daughter when you look at her dexacom you can see exactly when she fell asleep and a steady BG rise for about 3hours and then a steady march down.

@johnkeenan Hi John and Welcome to the JDRF TypeOneNation Forum! Your questions, and your posts are always welcome here.

There are many, many factors that affect our body glucose levels {BGL] over the course of the day and each of us can be affected differently by the same or similar factor - sleep, and usually 'lack of sound sleep, is known to cause glucose levels to rise but this doesn’t appear to be so with your daughter. Your daughter could also be in in what is called her honeymoon phase which makes diabetes management efforts difficult. Over the last few months, my BGL has run much higher than normal, but not as high as your daughter’s, one or two nights a week for no apparent reason - and my honeymoon period would have been finished more than 60 years ago. Your daughter’s insulin dosing should be discussed with her doctor.

I agree that the increase from 0.05 to 0.45 units per hour appears huge but it is well known that our body’s insulin needs can fluctuate considerably during the course of the day - my basal rates chance from 0.10 to 0.60 uph.

Keep posting and let us know how your daughter progresses. You will be learning much about diabetes management as time goes on and you will probably see that the one constant in TypeOne management is “change” - what appears to be great management today may not work next week; but you and your daughter will learn what is right for her and diabetes should not deter her from living a full, active life.

I agree with everything Dennis said.

2 months into the diagnosis, she probably still has a very limited function of her pancreas left. Strange things can happen during this “Honeymoon” phase, usually it only takes a tiny amount of artificially injected insulin to bring the Blood Glucose low enough that the last remnant of the pancreas can manage almost on its own. But, this time will come to an end, the necessary insulin doses will increase, and managing her blood sugars will begin to make more and less sense at the same time.

.05 units per hour is a very, very small dosage, but everybody requires different amounts of insulin. My maximum basal rate for comparison is 1.2 U/hr from 4am to 6am, for the time I’m awake it is roughly 2/3rds of that. I require 1.10U/hr in the evening when Im not active, and 1.15U/hr when I first fall asleep. When I had a more active job, I was requiring less than 0.4 U/hr during the workday

So, a possibility, a guess with very limited information, she is active during the day and only needs a tiny bit of insulin to help out her limited pancreas production. When she is asleep, she isnt burning much energy, and her insulin needs begin to far exceed what her body can produce naturally. Maybe it spikes when she first falls asleep because the remaining pancrease Beta cells get overloaded, perhaps they start to respond later and the BG comes back down.

There will be a LOT of situations living with Type 1 Diabetes in which you try to find an explanation for something, but cant. There are just so many things that can affect blood glucose, it’s impossible to analyze every variable and plan for every contingency. Just keep trying and talking with an endocrinologist along the way. There will be lots of changes and upheavals in your daughter’s life that will drastically effect her diabetic needs, but with time will come experience, and with experience you will learn to rapidly adapt to changes.