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The Sandman Cometh…and he brought high BGs…

Wearing a DexCom or any continuous glucose monitor gives you insights to your blood sugars that you could have gone years without ever knowing. You see how certain foods, exercise, or activities like traveling really affect your blood sugar. But the most surprising insight I’ve uncovered using my CGM is what’s going on overnight.

There’s a whole eight hours of blood glucose fluctuations that I’ve been pretty blind to for years with this disease. Wearing a CGM feels like I’m putting on SCUBA gear and finally getting a glimpse at a world that was foreign to me before having this data. And I’ll tell ya – I don’t always like what’s going on in that world. Namely, I’ve got some weird high BGs that crop up late at night. The good news though is that now I’m starting to see where they’re coming from, and I can start to tackle them with a new strategy.

I do have a bit of dawn phenomenon, but that was addressed long ago when I went on a pump and created a basal pattern that bumps up my insulin from about 3am – 8am. These new highs I’m seeing are often in the midnight – 2am range, and they seem to be appearing for two reasons.

The first thing I’ve noticed is that high protein or high fat dinners are causing spikes in my BGs hours after the meal. When I put away a particularly low carbohydrate meal – for example grilled salmon and veggies – my blood sugar will stay put through the next few hours after dinner all the way until bedtime. But as the proteins and fats are digested, the numbers start to climb. To combat this, I’m going to try either an extended bolus at bedtime, or increasing my basals for a fixed number of hours. I never would have known this rise was occurring without my CGM because I was going to bed with good numbers and waking up somewhere in range (probably because my dawn phenomenon bolus was bringing it down a bit).

The second reason for my nighttime highs will be harder to treat – stress. I’m under a lot of pressure at work and home right now, and it seems to be carrying over to my subconscious. I’ve had wild dreams lately, full of vivid, stressful situations that sometimes wake me up out of a dead sleep! More than once after being awoken by these dreams, I’ve looked over and seen the glow of my DexCom, “HIGH” gleaming from the screen. (Just FYI, in CGM world, “HIGH” means you are over 180mg/dL, not so HIGH the meter can’t read it like on glucose meters. Just so you know I wasn’t in the 600s or anything to ca-razy).

On the occasions that the dreams or the CGM wakes me up, I have a chance to correct my blood sugars in the middle of the night, but the issue with this is that the BG is usually rapidly rising because the body is technically under “stress,” releasing cortical and in turn, hepatic glucose. It’s harder to shut off the liver that it is to cover carbs when it comes to exogenous insulin. Also, it’s tricky dosing for these – you want enough insulin to get a liver-induced high blood sugar down, but not so much you go low a few hours later (and have to wake up again). Either way, these are blood sugars that I would not have noticed without a CGM.

If you have never tried a CGM, I’d encourage your to wear just a test unit for a week –you’ll be shocked at how much you learn about your blood sugars so quickly. I mentioned in a post a few weeks ago that most endo offices can put you in touch with a local rep for a CGM company to get you set up with a trial unit. In fact, some offices even do group training sessions with the test units, which is pretty awesome – and free! I’ve learned a tremendous amount about my nocturnal blood sugars in the past 8 months of wearing one, which, when you think about it, adds up to about a third of my life that I didn’t previously have blood sugars for (actually, that would be true if I slept 8 hours a night…which we all know is not even close to true….but still…lots of time…). Pretty amazing what we can see with technology – I just wish there was a way to fix those night time highs without getting out of bed!

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