My 8 year old son was recently diagnosed 10 months ago. The most difficult part of managing his blood glucose is at night. His dinner is low carb and lightest meal of the day. His blood glucose will be steady for hours before bed and right when he falls asleep his blood sugar begins to rise. In fact, it rises more once he falls asleep than it does when he actually eats a meal. He will be in the low 100’s for 2-3 hours before bedtime and after falling asleep he will be in the 200’s within 1-2 hours. He sweats quite a bit during this period of time. We try to correct the high with 1. -1.5 units, but it almost seems he becomes insulin resistant as it has very little effect.
Has anyone experienced this and if so, what seems to help prevent these high? Again, it’s like clockwork, once he falls asleep his glucose rises regardless of his dinner.
Hi @Luke123 . I second what @KayCeeR said about basal rates - if something happens consistently chances are it’s time to tweak some pump settings. And if the correction formula no longer works that may need to be updated as well.
Our body’s need change from time to time so you’ll learn to recognize when you may need to make some adjustments. In time you’ll get comfortable making them yourself but for now work closely with your doctor for guidance.
It slowly rises once he falls asleep. It happens also when he takes a nap in the middle of the day during the weekend. We will give him a 1 unit correction to bring it down a little while he’s sleeping. He’s not on a pump. We just increased his Treaeba dosage from 2 units to 3 this week after our Endo appt.
Not sure we want to increase the Treseba, the one unit really holds his number down and with Gym the other day he went down to 55 which never happened when he was on 2 units. Most times his number will go up with activity.
I started to ask if he was on a pump or not. Many people take shots and do very well. I would suggest talking with your doctor. There’s something called dawn phenomenon which causes glucose to rise, but that’s typically in the early morning hours. Since it happens when your son takes a nap there’s another mystery. Not to accuse or anything but do you think your son might be sneaking a snack before he lies down? He might feel a little more secure knowing he had something in his system - even if it’s not needed.
No sneaking in snacks. As I mentioned he sweats a lot as he falls asleep so I don’t know if it’s adrenaline that is causing his glucose to rise. When his sweating stops his number tends to level off. This morning he woke up at 82 so the extra unit of Treseba is bringing him back down. When he plays soccer specifically and he’s very aggressive, his glucose will shoot to the upper 200’s.
The doctor didn’t have much of an answer for us when we brought up the situation. It’s frustrating as the hardest part to control his glucose isn’t when he’s eating, it’s when he’s sleeping.
This is a common phenomenon during competitive sports and strength training. I subbed in once as a yoga teacher for a power/core class and my BG was almost 200 by the time class was done!
Luke @Luke123 it could be that your son’s diabetes is “maturing” in that he has now arrived at true autoimmune [T1] diabetes - meaning that he is no longer producing insulin naturally.
As you know, the human body needs insulin 24 hours every day even if we di not eat, and the Tresiba insulin formulation [Degludec] prescribed by his doctor is “long-acting” insulin that has a peak 1 - 2 hours after injection and also provides “background” insulin needs for 12 - 24 hours. A “fast-acting” [such as Humulin] or "rapid-acting [such as Humalog] insulin would be prescribed to cover meals and to be used for correction doses; the rapid and fast acting insulin formulation exhaust all effectiveness in a matter of a few hour. This diabetes management method is called MDI or Multiple Daily Injections. You didn’t mention the type insulin you used for correction when his BGL went high.
Maybe the next time you and your son visit with his doctor you could suggest that it is time to reevaluate insulin needs for an active and growing boy. It could be that your son’s diabetes needs are changing at practically an everyday pace - keep in mind that no insulin dosing regimen is set-in-stone.
He’s on Novolog fast acting Insulin. When he was initially diagnosis with an A1C of 12 we had him on Novolog for the first 3 weeks but he kept going low. He was eventually off insulin all together for the next 7 months. He was still consuming 100 - 150 grams of carbs per day during this period of time. Even while he was off insulin his glucose always increased at the onset of falling asleep and then came down overnight below 100.
He’s currently on 7-10 units of Novolog with about 150 -200 carbs per day. 3 units of long acting Treseba.
Doctor says he’s defiantly still “honeymooning” based on his dosages.
I just find it odd that it’s like clockwork that his glucose increases every night once he falls asleep.
His A1C was 6.7 during our visit earlier in the week.
Appreciate everyone’s feedback. Just seeing if anyone experiences the rise once you fall asleep and if there is any adjustments to diet or regiment that helps prevent it.
@Luke123 hello. It’s not odd at all actually. Basal insulin, or “background “ insulin is necessary. The amount of basal insulin a person requires varies during the day and night. Everyone has a pattern. Every pattern is a little different. The main reason I don’t inject long acting insulin anymore is because my requirement changes by 40% day and night. So if I were on tresiba, I’d either be high half the day and fine the other half, or low half the day and, well you get it. So I pump fast insulin and it gives me micro doses so my basal is right for me the whole 24 hours.
Sounds very much like a increase basal requirement at night. Not in any way abnormal.
This long slow reduction in his ability to make insulin will mean you will probably have to change your management many times over the next year. That’s ok. The right amount of meal insulin brings you back to your target in 4 hours. The right basal is the amount you need to not rise or fall between meals and overnight. It’s a process. It requires a lot of adjustment. I always suggest buying the book “Think Like a Pancreas “. It is worth it.
My daughter is 10 and we’re about 9 months since diagnosis, and she’s had that same pattern you’re describing of a rise after falling asleep, regardless of what’s she’s eaten, almost every night. I’ve battled it in various ways, and also not gotten many good answers about what’s causing it. From the reading I’ve done, I think it’s growth hormones causing insulin resistance that her body releases as soon as she falls asleep. She’s also grown an incredible amount (4” and 30lbs. since diagnosis). I could not find a way to treat it on MDI, because you’re limited by not being able to vary the basal (long acting insulin). Now we’re on omnipod and it’s been better, although still frustrating at times, because I can increase her basal for the time she usually goes to bed and a few hours after. I’d say having a pump and a CGM are your best shot at trying to manage it.
@alison.covertWelcome Alison to the JDRF TypeOneNation Forum!, and thank you for sharing your experience.
I’m happy to hear that your daughter has had some success with the OmniPod and that it “fits” her needs at this time. You are very correct in recommending a CGM; in my seven decades experience in managing my diabetes I find the CGM to be the most useful tool. You also say, “still frustrating at times”; there will be many of these times for your daughter. It is much easier said than done, but if she [and you] can just look beyond and learn what MAY have happened, her future will be brighter. Keep in mind that not everything about TypeOne can be regulated and beyond our reach.
Yes! This was one of the reasons we started pumping! My 11 yo, dx 2 years ago has this. It’s hormones, particularly growth hormones. Happens all the time! Before pumping, I tried adding Reg insulin at bedtime. The BG rise hits as he’s falling asleep (9ish) til about 12-1 am. Then levels off, and even drops. He would shoot from 100s to 300s…no matter what we did. The R insulin has a longer duration than H, but not the full effect of increasing Tresiba, which could cause lows later in the day if too high. We played with A LOT of things. Ultimately, pumping has helped solve this. We are able to set his basal rates and correction factors much higher for those hours only. If pumping not an option, talk with the endo about either dosing H or R at bedtime on a regular basis. Hope this helps!
Thanks for the reply. This is the exact struggles we’ve been dealing with. We increased his Treseba from 2 to 3 units and notice he continues to go low during the day even 3 hours after his meal. He’s started up with soccer this week and his number held much better during his game ( under 200 ) and came back down on its own below 100 following his game. His night time number was great 90-110 all night which hasn’t happened in months. Last night he did climb to 190 and I gave him 1 unit of fast acting insulin… within 1.5 hrs he was down to 120. Later in the night he continued to decrease and fell below 60 so we gave him a 10 carb juice.
With sports starting back up we may reduce him back to 2 units since 3 seems to be too much right now.
I found that a change of basal to Levemir helped me overcome
This problem. I used a lower dose at breakfast time and a
higher dose in the evening. This is not uncommon. Your
Doctor should know this. You can experiment with injection times.
Great advice here! If he’s not on a cgm, you can do a few pricks overnight to see when he’s rising. I don’t really have any input to add since everything listed is what I’d recommend but just for some reassurance night time has always been where I see my biggest rises and can be so tricky to manage. Hormones through puberty at first and then when I was in my mid 20s I started getting dawn phenomenon pretty consistently so even now if I go to bed at 100 I’ll still usually see a little spike to 130-140 around 2-3 am and then comes down. If he’s eating fairly low carb, at dinner too, is his meal high fat/high protein? I spike high from low carb/high fat/high protein in the middle of the night usually and this also increases insulin resistance in me.
He’s typically getting 15-25 carbs for dinner. I would say higher on the protein than fat for his meal. I have noticed that when he eats a high fat/protein meal (chicken wings/pizza) he will have a bad 24-48 hrs and night time rises peak above 200.
What are some typical dinner meals that you’ve noticed work well?
Could the Tresiba be split into two separate doses, and take more for the evening, less in the morning? It could be that the Tresiba wears off too soon.
