If it isn't one thing with diabetes, it's another — from trying to figure out what the heck's going on overnight, to the understandable paranoia that sometimes sets in. But we at the 'Mine are here to support you! We've got another edition of our weekly advice column, Ask D'Mine, hosted by veteran type 1, diabetes author and community educator Wil Dubois.

{Need help navigating life with diabetes? Email us at AskDMine@diabetesmine.com}

Joanne from Maine, type 1 writes: For the last week or so, I have been consistently low at bedtime, but then high overnight. I hate being up to 200 all night, so if I'm over 150 at bedtime, I usually take a small insulin correction... but then I often go too low later. This seems to be a pattern, but I'm not sure what to adjust, the basal or the dinnertime bolus? Is there a way to tell which of the two is "off?"

Wil@Ask D'Mine answers: A quick review for you type 2s, type 3s, and diabetes groupies (I actually haven't met any diabetes groupies yet, but I keep hoping): basal insulin is the "foundation insulin" we type 1s take to control blood sugar between meals and overnight. It can be an extended-release insulin that's taken once per day, or can be a constant drip of fast-acting insulin from a pump. Bolus insulin is a stronger, faster, shorter-lasting insulin that's used to help our bodies metabolize meals and snacks and dietary indiscretions.

Sounds simple, right?


Sorting out the cause and effect from the two overlapping insulins can be a Herculean task. And I probably won't be able to give you THE answer today. But I can give you some tools you can use to discover the answer for yourself.

First off: consistently low at bedtime suggests to me that you're taking too much of your fast-acting insulin with dinner. The job of fast-acting is to negate the effect of the meal. It lasts for around four hours in most folks, so four hours after dinner your blood sugar should be back to where it was before you ate. If it's lower than where you started, assuming you weren't high and took a little extra to correct, then you're taking too much. In this case it's the dinnertime bolus that needs to be adjusted.

Now, if your bedtime is less than four hours after dinner, and you take a correction for a 150, you could be "stacking" your insulin. You're piling new insulin on top of insulin that's still on the job; and that'll lead to a low down the road. Just remember that if you took insulin less than four hours before, your sugar will continue to drop. If it's been more than four hours since dinner, then the correction may be too aggressive.

If everything checks out with the meal time, and the correction, then there are three likely causes of waking up higher in the morning than when you went to sleep.

First, your basal might be wearing off. If you are taking a shot of basal insulin in the morning, it might be wearing off overnight. It's supposed to last 24 hours in most people, but in some folks it can wear off in as little as 18 hours. Or if you're on a pump, the rate could be too low during sleep.

The second possible cause is the dawn phenomenon, in which your wake-up hormones raise your blood sugar right before your alarm goes off in the morning.

And the third possible cause is the funkily named Somogyi effect, a.k.a. rebound hyperglycemia, where you sleep though a severe low in the middle of the night—either triggered by too much nighttime basal, an overly aggressive bedtime correction bolus, or by too much dinner insulin—and your body dumps sugar into your system to save itself. If you find yourself getting higher and higher in the morning, even though you are increasing your basal insulin every day, you're very likely suffering from the Somogyi effect.

There are a few other oddball causes of overnight elevations like high fat foods, sleep apnea, sleep walking to the pantry, and alien abduction—but let's not make this any more complicated than it already is.

To get to the bottom of this you're going to need a glucometer, a compass, an alarm clock, a pad of sticky notes, a pen, and a flashlight with a red lens.

I'm just kidding. You won't need the compass.

You said you were low at bedtime and high overnight. I read that to mean you found yourself high in the morning. We need to know when the rise actually begins. You assumed that you ran high all night, and maybe you did, but have you proved it? I think, by now, you see where the alarm clock is going to come into play.

What you need to do is set your alarm for various middle-of-the-night times and check your blood sugar. I'd start around 3am. Of course having the fricken' alarm shatter your slumber can raise your blood sugar, too, so have that meter close by the alarm clock and test without delay. And be sure to buy something nice for your type 3. You know, to make up for the shared inconvenience.

I recommended the red flashlight to save your eyes the trauma of a bright light in the middle of the night. Oh, warning: a red-lens flashlight will make your blood drop will look like the creepy X-Files Oil Aliens.

You're going to have to dedicate some time to this little project, testing at different times of the night. The goal is to determine when the blood sugar rise starts, and how dramatic that rise is. That, in turn, should reveal the cause, which, of course, will lead you to the cure. This is kinda like the testing that we pumpers do for getting our basal patterns down, but will be much easier for you in this case, as we're only looking for one fact, and you only need to do one test each night—not multiple tests every night.

Here's your cheat sheet:

Evidence: Slow steady raise in blood sugars throughout the night. Probable cause: insufficient basal.

Evidence: Nice blood sugars until just before dawn. Probable cause: the dawn phenomenon.

Evidence: Nicely dropping blood sugars until 2am or so (or about 4 hours after your last fast-acting dose, either dinner or bedtime correction), then an increase well before dawn. Probable cause: Somogyi tsunami.

Happy testing, Joanne, and let us know how it turns out!

Matt from Florida, type 1, writes: Given all the political uncertainties and turmoil around the world, it's made me wonder if I should be "stockpiling" diabetes supplies... you know, sort of survivalist-style. I was wondering, Wil, do you personally stockpile diabetes stuff for the worst-case scenario?

Wil@Ask D'Mine answers: I have personally stockpiled enough infusion sets, cartridges, CGM sensors, insulin, glucose tablets, test strips, and batteries to last until December 21, 2012. There didn't seem to be much point in having anything on hand beyond that date.

But seriously, Matt, no. No, I don't. I did a run of four-day wear on my pump's infusion sets and cartridges a while back, along with stretching my CGM sensors—both at the cost of some nasty skin rashes—so I could bank some extras. But I wasn't preparing for the end of the world. I did it to lower my stress level over the chronic monthly insurance hassles that always seem to make my diabetes supplies a few days late. Having a month or so of diabetes stuff on hand makes me ride out those storms with lower blood pressure.

I don't really worry about anything apocalyptic, and even though our country is a certifiable mess, I don't worry about a civil war, either. Which is not to say you shouldn't be prepared for the more garden-variety disasters that happen every day, like earthquakes and floods. For that you should be prepared (see our preparedness guide here).

I do sometimes lose some sleep over the unintended consequences of health insurance reform. Don't get me wrong. I'm very much in favor of universal health care. I'm just not too sure the current approach is gonna be a good one. Unlike most insured people who say they like their health insurance, I've actually had to use mine (the point at which most citizens discover that their coverage might not be quite what they thought it was), and I still more-or-less like it, even so.

Come 2014 (assuming the world doesn't end this winter) my insurance will go away. It will be replaced by something else. Will it be better? Will it be worse? Will it be more expensive? I don't know.

I like the fact that my being a type 1 PWD will no longer count against me. I like the fact that should I get my ass fired from the clinic, I could buy insurance as an individual—an option I do not have right now.

But I worry. I worry that the wolves are in charge of the hen house. I worry that even with the wolves on collars, some group of boneheads in DC will decide that insulin pumps really aren't needed. Or that CGMs aren't really needed. Or that one test strip per day should be really enough for everyone.

But there's no way to stockpile enough supplies for the rest of my life. Insulin goes bad. CMG sensors are like milk, they have very real expiration dates. Even the sticky stuff on infusion sets fails to stick given enough time. I'm not stockpiling because these things really don't stockpile well.

If it's my future to go back on the needle with too few test strips, a stockpile will only delay the inevitable. If that's my future I'd just as soon buy into the whole Mayan thing.

This is not a medical advice column. We are PWDs freely and openly sharing the wisdom of our collected experiences — our been-there-done-that knowledge from the trenches. But we are not MDs, RNs, NPs, PAs, CDEs, or partridges in pear trees. Bottom line: we are only a small part of your total prescription. You still need the professional advice, treatment, and care of a licensed medical professional.

Disclaimer: Content created by the Diabetes Mine team. For more details click here.


This content is created for Diabetes Mine, a consumer health blog focused on the diabetes community. The content is not medically reviewed and doesn't adhere to Healthline's editorial guidelines. For more information about Healthline's partnership with Diabetes Mine, please click here.