Dinner High.

photo (38)I committed this Diabetes Awareness Month to also making it My Diabetes Awareness month, and henceforth doubling down on my d-efforts in order to get my A1c to that coveted “somewhere under 7″ status. So peeps, I’m trying. And when you pay this much attention to this obnoxious disease, you start to notice patterns. Patterns that you simply can’t ignore anymore if you’re truly going to go from good to great management.

The pattern I’m noticing and quite literally can’t ignore (because it’s waking me up to tell me I can’t ignore it) is high BGs in the middle of the night. I’ve blogged about this before and vowed to do a basal test to see if that needed some tweaking but I haven’t done it. Mostly because in order to test your basals in the middle of the night you have to eat dinner at like, 5pm all early-bird special and stuff and I find that particularly hard to do. Which I am certain is at least part of the problem.

Jacob and I tend to eat on the later side of the evening – 8pm -or 8:30. He usually gets home around 6:30 or 7 and then we often go together to the grocery store and always try to cook with fresh ingredients when we can. Although this is a good way to prepare food (and our bonding time), it means nothing is actually ready to eat until about 2 hours before bedtime. We also rarely cook anything carby, like pasta or potatoes because it’s tough for me to manage and Jacob is a saint, but that means we make up for that lack of volume with more proteins and fats. These macronutrients, as we know, break down hours later. So I’m pretty sure that our late mealtimes and food choices are contributing to peaks in the BG circa 3am.

I’ve been much better this month about actually doing something about those middle-of-the-night highs and not just hitting the Dexcom “snooze” button and waking up all dry-mouthed and yucky, but I’d love to prevent them in the first place. If we don’t change our food choices (which, since we don’t eat any carbs, I can’t really ask my poor husband to also cut all the fat out of diet as well) in the evening, I’ve got to find a basal strategy to combat it, which may mean running temp basals on nights with late mealtimes or just setting a basal pattern that ramps up around 2am.

But to be sure it’s the food and not the general basal rates, I’ve gotta do one of those annoying basal tests.Maybe it’s time to go visit my grandma on the east coast and let her treat me to the 5 o’clock special! :)

Did you enjoy this post? Why not leave a comment below and continue the conversation, or subscribe to my feed and get articles like this delivered automatically to your feed reader.

Comments

Ooooh. Here, have the German special on food advice. That ought to be helpful!

How about actually having a carby meal a little later. Say three hours before bedtime. Unless you are actually going for the “ultra-length carbohydrate saturated in fat” solution (wholegrain dumplings with a leg of pork, to stay with the German special) this peak should be gone after your bolus expires. Dinner at 8, to bed at 11? Sounds much better than dinner at 5 and then snack on cucumber all night.

With “normalish” amounts of protein, I tend to be okay after three hours as well (my values – not neccessarily transferrable, but there you go).

And a few carbs would avoid the hunger-ketone induced insulin-resistance in the middle of the night (which may not be there, but this is free-advice-hour on the interwebs, after all).

I’ve run into this problem before, and I think what happens when I eat late (which for me is the exception, not the rule), I’m not getting an accurate read before bedtime (since these “late” meals are usually only 1-1/2 or 2 hrs before I go to sleep… I don’t think that is enough time for the insulin and food to work things out). I do not have a CGM, but I’m sure if I did I’d see the same thing, since my morning numbers are atrocious on those nights. I’ve never even noticed a difference related to the contents of the meal, carb-y or not. For me it is an easy fix since 99% of the time my husband and I are Early Birds. On weekends I am usually up later anyway and do a few extra BG checks and I can catch it while it is just creeping towards high.

Floh!Thanks for the advice but I want to be sure I am understanding – are you saying have a high-carb dinner closer to bedtime, because all the carbs and insulin will be “done” with my system four hours later allowing me to test my basal rate? Or are saying if we’re going to eat late, go for the full carbs to avoid a delayed high? Either one is a novel idea and I like it. The German special sounds AMAZING by the way.

Hi Alexis,

I run a very simple basal pattern. One set basal for my awake hours, 6am to 9pm, then a 50% higher basal during my sleeping hours. Adjust rates to maintain 50/50 bolus/basal ratio on a weekly basis until you find your balance. May have to adjust seasonally. Working pretty well for me, last a1c was 6.6.

Good luck.

Mike

Mike that’s a good call to work backwards on this – start with a 50% increase and go from there until I find the right spot. Thanks for the tip. Hope you are doing well!

An engineering solution to a problem with multiple variables. Your results may vary and all bets are off for Thanksgiving!

Glad I found your blog again. I’m doing fine with no big changes from the last time we talked. Hope you are doing well too.

To clarify, I always run a 50% higher basal at night from my daytime basal. I adjust both basal rates so that the 24 hour total is equal to my average daily bolus totals. The bolus/basal ratio should be an easy number to find on your pump when you run a seven day average. Make sense now?

Mike

Sorry for the delayed response: My solution would be a relatively low fat/low protein meal. That should avoid the late rise. However, to avoid the meal ending up “fall coloured leaves with tapwater”, your only other option is pretty much carbs :)

“Normal” speed carbs are done (my experience) after roughly three hours, so a basal rate test should be okay. Anything extremely slow would probably be bad for the testing. Also, a carb-meal would make sure you’re not running into hunger-ketones which (again, my experience) lead to insulin resistance and could be another cause of the late night spike.

However, if you never have carbs for dinner, that would be covered with the basal rate and then you probably shouldn’t change the type of meal from “normal”. Wheee… I love how simple diabetes is at times :)

I’m dealing with the same issue you are so I don’t have any advice *yet* but I am amazed that you go to the grocery store and cook fresh ingredients every day, I wish I could do that!

Yes Mike that makes sense now! Thanks for the additional explanation. And oh yes, all bets are off for Thanksgiving! I can’t wait :)

Ha! Thanks Floh – oh yes, always so simple right? Haha.

Kelley I wasn’t always that way but it’s my husband’s highlight of his day and a time for us to bond before winding down for the night. Sometimes I’m like can we just heat up some leftovers though? Hehe.

Leave a comment