Middle of the night BG?

[MizKitty]

You'd think after 5 or 6 years of being a type II, I'd be quite the expert on it. But my body manages to regularly confuse me!

Here's the latest: Upon starting LC last August, prior to which my BS readings were always in the 300's, even with drugs, I've watched those numbers gradually come down and improve dramatically.

I now have fasting BS readings in the area of 115 (saw 100 the other morning!!!), and readings throughout the rest of the day between 90- 110.
I'm still on 1500 mg timed release metformin taken in the morning, and 16 units of Lantus (24 hour acting insulin) at bedtime.
All that's great.

The other night I had gone to bed around 11:00, but some noise woke me up around midnight, and as long as I was up wandering around the house, decided to test. I don't think I've ever tested during the night before.

Well, it was 159! I haven't seen daytime numbers that high in many months. I hadn't cheated/eaten anything carby. Is it normal for BS to soar during the night? Is this something I should be concerned or doing something about? If so, what?

[Whoa182]

Do you exercise?

Have you stopped exercising in the last couple days before you took the reading? I ask this because exercise can have an acute effect on glucose levels because GLUT4 receptor moves from the cell cytoplasm to the cell wall and would lower your average glucose readings. GLUT4 is a glucose transporter to get glucose into cells. So if one would stop exercising for a couple days you'd lose that acute effect.

[MizKitty]

My activity level has stayed pretty consistent. My readings during that day had been between 91 and 115 when tested, but I suspect they are at times dropping even lower, as I've experienced some mild dizzyness all this past week.

[MizKitty]

Somogyi Effect (Rebound Hyperglycemia)

The Somogyi Effect occurs after a rapid drop in blood glucose levels sometime during sleep. The body responds by releasing stored glucose (released from glycogen stores) from the muscles and liver in an attempt to elevate blood glucose levels. The body may overcompensate, releasing large amounts of glycogen which results in a "rebound" effect, causing hyperglycemia termed "Somogyi Effect."

This may happen anytime during sleep, but hypoglycemia usually occurs around 3 a.m. The hypoglycemic (low blood glucose) episode is followed by an elevated is followed by an elevated blood glucose level towards morning. Going to bed without a snack or with low blood-glucose, inadequate food eaten for exercise, and too much insulin contribute to this response. (my emphasis added)

I think this may be it. I've been having dizzyness issues lately, I think I've gotten my BG down to where I'm ready to start coming off the insulin. May start slowly reducing that bedtime dose.

If that's the case, and as few carbs as I eat, what is my liver making "large amounts of glycogen" from...? Protein or fat? Should I adjust my evening meal, or add a snack of one or the other to bedtime?

[pauleo]

I also get unexpected increases in blood glucose. Sometimes I get the expected rise after a meal, then it starts to drop, then it rises again. One explanation is the high error in the meter (15% or whatever it is). Another explanation is gastroparesis I think - delayed release of food from the stomach. I'm a newby so I don't have a good feel for what's going on, except that I don't conform to those nice clean glucose response curves you see online. No middle of the night tests so I don't know what happens then. Congrats on your falling FBG!

[Lisa N]

If that's the case, and as few carbs as I eat, what is my liver making "large amounts of glycogen" from...? Protein or fat?

Your liver will make glucose from protein via the process of gluconeogenesis. Cutting back on protein probably won't have much effect because the body will simply take what it needs for the process from your own muscle tissue (not a good thing).
If you are having issues with dizzyness, test when you feel it next and see where your blood sugars are; you may be at a point where you need to start adjusting your medication dosages down.
A snack at bedtime may help if you are really experiencing the Somogyi effect (which happens more with insulin users than those who use oral medications).

[Avalo2]

Personally, I would not react to just one test. (Expect that i might have taken the appropriate amount of Humalog to lower the high sugar.) One test may or may not prove that you consistently have high blood sugar at night. Dr. Bernstein used to make a change in his regimen only after three tests with the same result.

If i remember correctly, he also thought that the Somogyi Effect was a myth. My experience is the same after following Dr. B protocols.

Your high sugar at night could have been from some sugar on your test finger or lancet device. Also, as someone mentioned blood glucose testing machines and/or their test strips can have significant errors. Gastroparesis could also be a culprit after 5 years of very high blood sugars. Anyway, there are unfortunately many reasons to have high blood sugars.

I would recommend getting three or more tests at night that are basically the same before making a lasting change in your regimen.

Much of my dizzyness comes from damage to the nerves serving my blood vessels. So again testing may be needed to confirm that low blood sugar is causing the dizzyness. It could be high blood sugar has damaged your veins like it has mine.

Glycogen comes from carbohydrates, which come from proteins. It does not come from fat. If you are truly having high blood sugars after midnight, I would not recommend adding any food to your evening meal.