I have noticed that when I eat right before bed (and bolus correctly), I almost always wake up with high BG. I suspect that the role of active insulin changes during sleep, from glucose metabolism to one of the functions listed below (via www.diabetesinformationhub.com).

"Functions of Insulin

In addition to its role of regulating glucose metabolism, insulin also

Stimulates lipogenesis
Diminishes lipolysis
Increases amino acid transport into cells
Modulates transcription
Altering the cell content of numerous mRNAs
Stimulates growth
DNA synthesis
Cell replication"

I recall from biology courses that a few of these functions happen primarily during sleep, so I think that as a rule of thumb, it is best to hit the pillow once the bulk of any active insulin has finished its work.

All opinions, thoughts, etc. will be greatly appreciated,

Brandon (T1 dx 07/21/12 - Minimed 523 no CGM)

Tags: active, bg, bolus, function, glucose, high, insulin, metabolism, sleep

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I notice that too I REALLY try NOT to eat after 9 pm.

I remember putting our kids to bed and telling them they were going to grow some more that night, so be sure to watch it.
I wake up exactly where I left off the night before by giving myself a 1.5 unit dose of Lantus at 9 pm. The problem is, it's in the frig. So's carb smart, grapes, .......
If I think I'm hungry, I have to turn the brain off and get out of the kitchen.

In addition to all those things there are two major factors that affect things overnight. First, despite what you might think, digestion doesn't stop when you sleep, instead, it gets an even higher priority and that may result in food being more bioavailable and leading to a blood sugar rise.

Second, our livers and kidneys naturally clear insulin overnight, particular in the window of about 3-6am. Thus some of your bolus may have been cleared and hence wasn't effective.

I feel pretty nervous about eating and bolusing before bed and try to avoid it. Not because I might be high, but rather the risk of lows.

Perhaps your carb ratio late at night is too high ie you need more insulin to cover it.
A blood test 3-4 hours after would confirm this (yes, I know this is a pain).

I certainly believe everything you mention could be at play. The biggest factor for me is that food before bed seems to increase the effect of my dawn phenomena, but maybe it is related to some of the items on your list?

Some type 1s decide to not eat anything before bed to avoid any adverse active insulin reactions. I prefer to eat a similar food (carbs, and glycemic index) and at a similar time. It works pretty well for me.

It depends on what I'm eating and what my levels are at. I drop on average 20 points during the night. So if I'm at 70 for bed time, I have to eat something for it and not dose in order to avoid overnight lows and wake up at a decent level. Usually a tablespoon of peanut butter on multi-grain does the trick.

Last night was a good example of what you speak about. Was out and about and had a snack before bed (was at 150 around 10:30 pm) and choose poorly (nacho's). I took the bolus for them and even extended it for an hour to counteract the fat. I still woke up over 200 at 7am.

If you are consistently dropping overnight instead of staying flat and there is no more bolus insulin active, then consider making a small adjustment to your overnight basal rates. 20 points over 8 hours is not a lot, so it will likely be a small change. But that's the great thing about the pump - you can easily fix issues like this.

There is no need to "feed the insulin".

You don't need a pump to change your ratio!

I was replying to Black Llama , who just started on the pump....

If you need a basal change for a few hours while you're asleep, it's pretty hard to do that on MDI.

Thanks :D I'm still tweaking my overnight ratio, but I'll take your suggestion. Today was one of the most "steady" days I've had since starting the pump. I was at 91 around 10 am and have not gone over 120 or under 68 all day. My basal stayed so steady that I kept testing to make sure my CGM was reading correctly lol. I'm going to try a 5% reduction tonight on the basal and see how that does.

That's a wonderful kind of day to have!





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