diabetestalk.net

Type 1 Diabetes Bedtime Blood Sugar

Prevent Low Blood Sugars

Prevent Low Blood Sugars

Fri, 11/19/2010 - 13:49 -- Richard Morris For better blood sugars and fewer lows, test often and review your readings once a week for patterns of lows or highs (or both). Identify problems first, then consider their causes and how to correct them. Make one change at a time and correct lows first. If you need any advice at all about how to correct a problem, be sure to call your physician or nurse educator right away. Do not let control problems linger as they usually turn into larger problems. When trying to prevent low blood sugars, it helps to understand their most common causes. The table below outlines the most triggers for lows. If your are currently experiencing either frequent or severe reactions, look carefully at this list to see what might be causing them. Once you identify a cause, decide upon a correction. Remember: when low blood sugars are frequent or severe, it is almost always necessary to reduce current insulin doses. If lows blood sugars happen infrequently, try to identify the trigger so you can make adjustments when you encounter that situation again. eat regularly or reduce fast-acting insulin for that meal Eat the meals and snacks for which you've taken insulin. Count the carbohydrates in each meal. Match your pre meal Humalog, NovoLog or Regular to the amount of carbohydrate and to the current blood sugar. Learn to use your test results to adjust your insulin and food. For example, if low blood sugars happen in the afternoon, an afternoon snack or less insulin in the morning or at lunch can help. Test before, during and after exercise. Long periods of exercise can cause low blood sugars up to 24 to 36 hours later. Be alert for change in your daily routine, such as travel, vacation, weight loss, etc. Be careful with alcohol. Inebriation and hypogl Continue reading >>

My Three Most Important Blood Sugar Readings

My Three Most Important Blood Sugar Readings

In my own blood sugar management and life with diabetes, there are three times of day that are the most important to me. Knowing what my blood sugar is at these times of day has become so important because I’ve seen how much they impact how I feel, what my A1C level is, and how much they effect my blood sugars for the entire day. Those three times of day are: Fasting blood sugar (right when I wake up, before eating breakfast) Bedtime blood sugar (right before I go to bed and pass out for 8 hours) Post-Prandial blood sugar (1-2 hours after any meal) My pre-meal blood sugar is of course very important, but the three times of day listed above are crucial to ensuring that my pre-meal blood sugar is on target. When I focus on those three, my pre-meal blood sugar doesn’t seem to be an issue. Here are a few tips and explanations for why these three times of day are so important. Fasting Blood Sugar This blood sugar, first thing in the morning, the most important to me. I’d like it to be between 70 to 110 mg/dL. Not only is this blood sugar reading a reflection of your basal rate or long-acting insulin dose while you’re sleeping, it’s also a reflection of what you ate at dinner/dessert, and if your insulin doses or oral medications are finely-tuned enough to help your body handle that food. Waking up with a high blood sugar every morning would tell you a) You aren’t getting enough insulin while you sleep and b) you aren’t getting enough insulin with the food you ate in the hours leading up to bedtime. And of course, if you’re low every morning, it implies that same imbalances but in reverse. Both situations, high or low, are not ideal. Waking up with an in-range blood sugar first thing in the morning is also crucial because it means I will have gotten a good nig Continue reading >>

Tips For Managing Nighttime Hypoglycemia

Tips For Managing Nighttime Hypoglycemia

Many people with diabetes (both type 1 diabetes and type 2 diabetes) experience hypoglycemia while sleeping—this is called a nighttime low (as in low blood glucose level). Many factors contribute to nighttime hypoglycemia. Being familiar with the causes will help you understand the signs and take steps to prevent nighttime lows. Episodes of hypoglycemia can be uncomfortable and frightening. Severe hypoglycemia can cause seizures and be life-threatening so it's important to recognize the problem and respond appropriately.Read on for tips to help you prevent hypoglycemia. Recognizing the Signs Shakiness and irregular heartbeats can be a sign of approaching hypoglycemia. Symptoms can develop when blood sugar drops below 70 milligrams per deciliter (mg/dl). Eating dinner much later than you normally do, drinking excessive amounts of alcohol or having an unusually active day can contribute to the condition. Sometimes exercising too close to bedtime can trigger it, too. Experts say it's best to avoid exercising within two hours of bedtime. If you frequently wake up with symptoms of hypoglycemia, such as a headache, nausea, restlessness, dry mouth, light-headedness, or sweating, start testing your blood glucose level as soon as you get out of bed. If it's low in the morning on a regular basis —below 70 mg/dL— you and your doctor should take steps to stop the nighttime hypoglycemia.Not everyone experiences symptoms so it's possible (and potentially dangerous) to ignore the problem. To avoid what is known as "hypoglycemia unawareness" routine checking of levels at night and in the morning is vital. Strategies for Preventing Nighttime Hypoglycemia To reduce the risk of nighttime hypoglycemia, you need to come up with a way of ensuring you have more glucose in your body duri Continue reading >>

High Blood Glucose Levels Before Lunch, Dinner Or Bed

High Blood Glucose Levels Before Lunch, Dinner Or Bed

Tweet If you are regularly getting high sugar levels (hyperglycemia) before one particular type of meal, that is either lunch or dinner, or before bed, then a change in your diabetes management is likely to be needed. This guide sets out the common reason for high sugar levels before meals and lists the action that can be taken to prevent the high patterns from continuing. Also see the guide on high sugar levels through the day which includes a number of additional reasons as to why blood glucose levels can run too high. Underestimating meal time insulin at your previous meal A common reason for high sugar levels before lunch, dinner or bedtime can be taking too little short or rapid acting insulin at your previous meal. Fig 1: High sugar levels and underestimated insulin High sugar levels before Underestimated insulin Lunch Short or rapid acting at breakfast Dinner Rapid acting at lunch Bed Short or rapid acting at dinner Action Consider increasing the amount of insulin you take at the time of the previous meal. This method works best if you tend to have similar meals at similar times of day. When increasing insulin, do so gradually to reduce the risk of hypos occurring. If the carbohydrate content of your meals varies from day to day, you may wish to consult your health team before increasing insulin doses to prevent unnecessary hypos. An alternative to increasing your insulin dose is to slightly decrease the amount of carbohydrate at the previous meal time. Be careful if you are considering increasing insulin Make sure your health team are happy for you to adjust your own insulin doses and consult them if you are in any doubt. If you increase your insulin, do so gradually to prevent risking severe hypoglycemia from occurring and test your sugar levels regularly to ch Continue reading >>

What Are Blood Sugar Target Ranges? What Is Normal Blood Sugar Level?

What Are Blood Sugar Target Ranges? What Is Normal Blood Sugar Level?

Understanding blood sugar target ranges to better manage your diabetes As a person with diabetes, you may or may not know what your target ranges should be for your blood sugars first thing in the morning, before meals, after meals, or at bedtime. You may or may not understand what blood sugar ranges are for people without diabetes. You may or may not understand how your A1C correlates with your target ranges. How do you get a clear picture of what is going on with your blood sugar, and how it could be affecting your health? In this article, we will look at what recommended blood sugar target ranges are for people without diabetes. We will look at target ranges for different times of the day for people with diabetes. We will look at target ranges for Type 1 versus Type 2 diabetes. Is there a difference? We will also look at what blood sugars should be during pregnancy for those with gestational diabetes. We will look at other factors when determining blood sugar targets, such as: Age Other health conditions How long you’ve had diabetes for Stress Illness Lifestyle habits and activity levels We will see how these factors impact target ranges for your blood sugars when you have diabetes. We will learn that target ranges can be individualized based on the factors above. We will learn how target ranges help to predict the A1C levels. We will see how if you are in your target range, you can be pretty sure that your A1C will also be in target. We will see how you can document your blood sugar patterns in a notebook or in an “app,” and manage your blood sugars to get them in your target ranges. First, let’s look at the units by which blood sugars are measured… How is blood sugar measured? In the United States, blood sugar is measured in milligrams per deciliter (by w Continue reading >>

What Are The Ideal Levels Of Blood Sugar?

What Are The Ideal Levels Of Blood Sugar?

A blood sugar or blood glucose chart identifies ideal blood sugar levels throughout the day, including before and after meals. Doctors use blood sugar charts to set target goals and monitor diabetes treatment plans. Blood sugar charts also help those with diabetes assess and self-monitor blood sugar test results. What is a blood sugar chart? Blood sugar charts act as a reference guide for blood sugar test results. As such, blood sugar charts are important tools for diabetes management. Most diabetes treatment plans involve keeping blood sugar levels as close to normal or target goals as possible. This requires frequent at-home and doctor-ordered testing, along with an understanding of how results compare to target levels. To help interpret and assess blood sugar results, the charts outline normal and abnormal blood sugar levels for those with and without diabetes. In the United States, blood sugar charts typically report sugar levels in milligrams per deciliter (mg/dL). In the United Kingdom and many other countries, blood sugar is reported in millimoles per liter (mmol/L). A1C blood sugar recommendations are frequently included in blood sugar charts. A1C results are often described as both a percentage and an average blood sugar level in mg/dL. An A1C test measures the average sugar levels over a 3-month period, which gives a wider insight into a person's overall management of their blood sugar levels. Blood sugar chart guidelines Appropriate blood sugar levels vary throughout the day and from person to person. Blood sugars are often lowest before breakfast and in the lead up to meals. Blood sugars are often highest in the hours following meals. People with diabetes will often have higher blood sugar targets or acceptable ranges than those without the condition. These Continue reading >>

What Are Your “diabetes Landmines?” The Seven Mistakes I Always Make And What I Learned Trying To Avoid Them

What Are Your “diabetes Landmines?” The Seven Mistakes I Always Make And What I Learned Trying To Avoid Them

twitter summary: Adam shares seven diabetes landmines – his mistakes that routinely lead to out-of-range blood sugars – and some solutions he’s been trying short summary: In this article, I share my own “diabetes landmines”– seven small mistakes I seem to make again and again that “explode” into out-of-range blood glucose values. These include: overcorrecting low blood sugars with too many carbs; overcorrecting a high with too much insulin (“stacking”); snacking directly out of the package; eating when I am not hungry; eating too quickly or overeating; eating too close to bedtime; and not increasing my basal rate following a night of poor sleep or on a day with little exercise. I also identify some solutions I’ve been using to try to overcome these mistakes. After writing my last column on the 22+ short-term factors that affect blood glucose, I wondered... “Even though diabetes is very unpredictable, are there some consistent reasons why my blood glucose falls out of range?” Yes. I call these my “diabetes landmines”– small mistakes I seem to make again and again that seem to “explode” into out-of-range blood glucose values. The list below highlights the seven mistakes I routinely make, and also details some solutions I’ve been trying out. Writing this list and the potential solutions was highly valuable for me; for the past few weeks, I’ve been more aware of my own “diabetes landmines” and have felt more equipped and motivated to avoid them. Try writing your own list along with some solutions, and email me at adam.brown(at)diaTribe.org or tweet me at @asbrown1 with what you find! Mistake#1: Overcorrecting low blood sugars with too many carbs, only to go high afterwards. I consider myself someone with a lot of willpower, but wi Continue reading >>

6 Ways To Prevent Low Blood Sugar At Night

6 Ways To Prevent Low Blood Sugar At Night

Nighttime dips in blood sugar levels are common among people with diabetes. Authors of a study published in June 2013 in Quality of Life Research noted that people with diabetes — type 1 or type 2 — experience low blood sugar (hypoglycemia) during sleep more frequently than many doctors realize. Nighttime hypoglycemia can be caused by a number of different factors, from exercising too close to bedtime to drinking alcohol in the evening. If untreated, low overnight blood sugar levels can lead to headaches and loss of sleep — and in extreme cases, seizures or even death. The good news is that preventing low blood sugar while you sleep can be achieved with a few simple steps: 1. Check Your Blood Sugar Before Bed “For everybody with type 1 or type 2 diabetes, it’s absolutely critical that they check their blood sugar before going to bed to make sure they’re not going to have an episode of low blood sugar during the night,” says Helena W. Rodbard, MD, medical director of Endocrine and Metabolic Consultants, a private practice in Rockville, Maryland, and past president of the American College of Endocrinology. If your blood sugar levels are low at bedtime, eat a healthy snack before going to sleep. The size of the snack should be in proportion to the dip in blood sugar. For instance, a small drop in blood sugar requires only a small snack. If you use an insulin pump, consider temporarily reducing the active dose of insulin. 2. Know the Signs of Low Overnight Blood Sugar Symptoms of hypoglycemia usually develop when blood sugar levels drop below 70 milligrams per deciliter (mg/dl). They include shakiness, sweating, confusion, erratic behavior, headache, and lightheadedness. With nighttime hypoglycemia, you may wake up with these symptoms or with a higher blood su Continue reading >>

Impact Of Bedtime Snack Composition On Prevention Of Nocturnal Hypoglycemia In Adults With Type 1 Diabetes Undergoing Intensive Insulin Management Using Lispro Insulin Before Meals

Impact Of Bedtime Snack Composition On Prevention Of Nocturnal Hypoglycemia In Adults With Type 1 Diabetes Undergoing Intensive Insulin Management Using Lispro Insulin Before Meals

OBJECTIVE—To determine the impact of four bedtime (HS) snack compositions on nocturnal glycemic control, including frequency of hypoglycemia (<4 mmol/l) and morning hyperglycemia (>10 mmol/l), in adults with type 1 diabetes using lispro insulin before meals and NPH insulin at bedtime. RESEARCH DESIGN AND METHODS—Substitutions of 15 g carbohydrate (one starch exchange) for an equivalent amount of uncooked cornstarch or pure protein were compared to a standard snack (control: two starch + one protein exchange) and to no snack (placebo) in 15 adults using a randomized, cross-over design. All snacks were equivalent in kcal, fat, and total available glucose. An intravenous facilitated hourly blood glucose sampling during the night (11:00 p.m. to 7:00 a.m.). RESULTS—The glycemic level at bedtime (<7, 7–10, and >10 mmol/l) mediated the effects observed. A total of 14 hypoglycemic episodes, in 60% of patients, and 23 morning hyperglycemic episodes occurred over 50 nights. Most hypoglycemic episodes (10 of 14, 71%) occurred with no snack compared to any snack (P < 0.001) and at HS levels of <7 mmol/l (P = 0.05). The standard and protein snacks resulted in no nocturnal hypoglycemia at all HS glucose levels (P < 0.001). Only HS glucose >10 mmol/l was protective against hypoglycemia, even in the absence of a snack (P = 0.05); 46% of morning hyperglycemic episodes were associated (r = 0.37, P = 0.07) with this HS glucose level. CONCLUSIONS—The need for and composition of an HS snack depends on the HS glucose such that no snack is necessary at levels >10 mmol/l. At levels between 7 and 10 mmol/l, any snack is advised, and at <7 mmol/l, a standard or protein snack is recommended. The study, undertaken at the Clinical Investigation Unit of The Royal Victoria Hospital (Montrea Continue reading >>

Sleep Safe & Sound: Avoiding Overnight Low Blood Sugars

Sleep Safe & Sound: Avoiding Overnight Low Blood Sugars

An Essential Blood Glucose Reading Sleep should be restful, yet for people with diabetes it can be stressful. Many factors can affect glucose levels when you sleep. For starters: your body's varied need for insulin, how much glucose the liver produces, what and when you eat before bed, and how much and what type of exercise you've done during the day and near bedtime. It's essential to check blood glucose an hour or so before bedtime. "This is the most important reading of the day," says Gary Scheiner, M.S., CDE, owner and director of Integrated Diabetes Services in Wynnewood, Pennsylvania. "If you take insulin and you check at least three or four hours after dinner, you'll learn how well your dinnertime insulin covered the rise of your blood glucose from dinner." If you eat late, this bedtime reading may really reflect your after-meal level. If your bedtime glucose reading is low, treat the low. If you use insulin as part of your regular blood glucose control, and your blood sugar is high three or more hours after your dinner, you may need to take a few units of rapid-acting insulin. {C} How to Prevent Going Low In addition to monitoring glucose levels right before bedtime, other steps can prevent low blood glucose while you sleep. Snack Smart: If you typically eat a snack before bed to prevent hypoglycemia and keep your blood glucose on an even keel, experiment with different types of snacks. Get a feel for which ones help your blood glucose readings stay within target goals during sleep. Spencer Bond, an active teen PWD type 1, usually eats peanut butter with apple slices or crackers. Because peanut butter contains both protein and fat, it's absorbed and metabolized more slowly than carbohydrate, so it helps to keep his blood glucose stable overnight. "Sometimes I ha Continue reading >>

Managing Your Blood Sugar

Managing Your Blood Sugar

Know the basic steps for managing your diabetes. Poorly managed diabetes can lead to many health problems. Know how to: Monitor your blood sugar (glucose) Find, buy, and store diabetes supplies If you take insulin, you should also know how to: Give yourself insulin Adjust your insulin doses and the foods you eat to manage your blood sugar during exercise and on sick days You should also live a healthy lifestyle. Exercise at least 30 minutes a day, 5 days a week. Do muscle strengthening exercises 2 or more days a week. Avoid sitting for more than 30 minutes at a time. Try speed walking, swimming, or dancing. Pick an activity you enjoy. Always check with your doctor before starting any new exercise plans. Follow your meal plan. Take your medicines the way your health care provider recommends. Checking your blood sugar levels often and writing down the results will tell you how well you are managing your diabetes. Talk to your doctor and diabetes educator about how often you should check your blood sugar. Not everyone with diabetes needs to check their blood sugar every day. But some people may need to check it many times a day. If you have type 1 diabetes, check your blood sugar at least 4 times a day. Usually, you will test your blood sugar before meals and at bedtime. You may also check your blood sugar: After you eat out, especially if you have eaten foods you don't normally eat If you feel sick Before and after you exercise If you have a lot of stress If you eat too much If you are taking new medicines Keep a record for yourself and your provider. This will be a big help if you are having problems managing your diabetes. It will also tell you what works and what doesn't work, to keep your blood sugar under control. Write down: The time of day Your blood sugar level Th Continue reading >>

Type 1 Diabetes And Bedtime Snacks

Type 1 Diabetes And Bedtime Snacks

With type 1 diabetes we never let our guard down- especially in the middle of the night. One of the most vulnerable times people may encounter is during sleep which brings about the importance of a bedtime snack. Safety with type 1 diabetes is always paramount. When we are at rest, our awake clues of hypoglycemia become dampened. Lets look at the importance of a solid bedtime snack with recommendations from Sara Pinson, Registered Dietician (RD). Important food qualities to look for in a bedtime snack with type 1 diabetes According to Sara Pinson, RD there are differences in the food choices we make at bedtime to help stabilize our blood sugars overnight. She suggests combining foods that include both a carbohydrate and a protein to help sustain blood sugars overnight. Sara states: “Carbohydrates that are fiber rich will also keep kids feeling full and decrease the speed at which the sugar travels into the blood stream, helping to combat swings in those in the middle of the night blood sugars.” Top suggestions for a bedtime snack with type 1 diabetes (these are also gluten-free) 1 Cup of homemade trail mix (Kix cereal, rice or corn Chex cereal, unsalted almonds, peanuts, walnuts, pumpkin seeds and a few raisins on top) Cheese (cubed, string) with apple or cucumber slices Boiled egg with a handful of popcorn 1/2 cup of edamame Celery or apple with 1 tbsp of peanut butter or almond butter on top 1/4 cup of hummus and veggies Lowfat or plain greek yogurt 1 whole wheat gluten free waffle with fresh fruit 1/2 cup low-fat cottage cheese with a tbsp of walnuts and fresh sliced berries 1-2 slices of gluten free deli meat with a handful of grapes or get famcy and make lettuce wraps with sliced bell peppers in between Whole grain gluten free crackers with cream cheese on top Continue reading >>

What Should My Blood Glucose Levels Be?

What Should My Blood Glucose Levels Be?

Everybody is different, and everybody's blood glucose management will be different, so it's important to check with your doctor about the levels you should aim for. But, there are general blood glucose ranges that you can use as guidelines. Blood-glucose levels are measured in units called mmol/L (pronounced milli-moles-per-litre). The ideal ranges are: Before meals: 4-7 mmol/L Two hours after meals: 8-9 mmol/L At bedtime: 6-10 mmol/L You may need to consult your doctor and change your treatment plan if: Blood glucose is consistently lower than 4 mmol/L or higher than 10 mmol/L before meals Blood glucose is consistently lower than 6 mmol/L or higher than 12 mmol/L at bedtime Blood glucose goals may be modified for children and others who are at greater risk of hypoglycaemia In the US blood glucose levels are measured in mg/dl (milligrams per deciliter). That’s why you’ll occasionally read about blood glucose readings that seem very high, like 140 or 220. To convert the American scores back to mmol/L, just divide the number by 18. How often should I be checking my blood glucose levels? Checking the level of glucose in your blood and keeping a record of the levels is an important part of taking care of your type 1 diabetes. This allows you to identify the patterns of high or low blood glucose levels. The information will also help you and your doctor or diabetes team to balance food, exercise and insulin doses. Ideally you should aim to do at least four blood glucose checks a day, although some people do many more. To get the most out of monitoring, your healthcare team may advise you to check your blood glucose levels before and then two to three hours after food. It’s also a good idea to monitor before, during and after exercise. If your blood glucose level is hig Continue reading >>

Nighttime Hypoglycemia

Nighttime Hypoglycemia

An episode of low blood glucose occurring at night. During sleep, the body’s energy needs fall, and consequently the liver pumps out less glucose, the body’s fuel. In people without diabetes, the pancreas responds to the liver’s lowered glucose production by secreting less insulin, and in this way, a balance is maintained. In people with Type 1 diabetes, this balance is harder to maintain since the pancreas no longer secretes insulin. Instead, a person must inject just enough insulin — but not too much — before bedtime to maintain a normal nighttime blood glucose level. A number of things can throw off the balance. Injecting too much insulin or injecting the right amount at the wrong time can lower blood glucose more than desired. Eating less food than usual during the day or eating the evening meal or snack at a different time than usual can affect blood sugar during the night. Exercising more than usual during the day can also cause low blood glucose at night. Many of the classic signs of low blood glucose — including shakiness, light-headedness, dizziness, confusion, rapid heartbeat, irritability, and extreme hunger — can occur during the day or at night. Nighttime hypoglycemia has also been known to cause night sweats, headache, restless sleep, and nightmares. Nighttime hypoglycemia is a common problem among people who control their blood glucose intensively through multiple injections of insulin during the day. In the Diabetes Control and Complications Trial, a study that evaluated the benefits and risks of “tight” blood glucose control, people on tight control regimens were three times more likely to have an episode of hypoglycemia than those on standard regimens, and more than half of these episodes occurred while people were sleeping. Although Continue reading >>

Low Blood Sugar Before Bedtime?

Low Blood Sugar Before Bedtime?

My DH has been a type 1 diabetic for 18 years now. He's always had good control, but the one thing that bothers me is that he's ok with going to bed with a sugar level in the 50s-60s. He usually wakes up with a bgl of 110-130 and doesn't have a night time snack before going to sleep. Dinner is about 3 hours before bedtime and he takes a slow acting insulin before bedtime too. I don't think it's a good idea to sleep with such low bgls, do you? D.D. Family T1 Carb-loader, Extraordinaire @ 5.5 I'm amazed that he wakes at 110-130. I would have guessed he'd wake at 250 from a rebound. I really don't think it is a good idea to do what he is doing, but everyone is different. Why don't you fix a small snack for him, or tell him to lighten up on his dinner bolus? You need special shoes for hiking - and a bit of a special soul as well. All T1s should be aiming for a change in blood glucose levels of around a maximum of 18mg/dl overnight - personally, I actually like it to drop a little more than that, so that every morning I start at around the 72mg/dl level. If you are going down too much, then your long acting (basal insulin) needs to be changed and if you go up, then you may be hypoing overnight or you need to adjust basal (or have food that is still digesting). I very rarely eat after dinner time at around 5.30pm unless I am being 'weak'! Even then, I would always take insulin unless it was something like a lump of cheese, with no appreciable carb. What he is doing is not actually that bad, but just makes me wonder, why is he doing this? As Vern says, if he hypos overnight, his morning level could actually be really high. I would just support him, he sounds as if he is determined to have good control and that is really positive. Just tell him your concerns, but if he wants t Continue reading >>

More in diabetes