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03/16/10 01:04 PM

"My husband's blood sugar readings during the night are very high but are normal during the day and either low or normal in the morning fasting. Why?"
Asked By: crysss  
Category: Type 2

Background Info Hide
My husband has been taking Metformin at Breakfast and Dinner and Lantus at night. His morning fasting blood sugars have been normal to low (a few high 40's - 90's with a lot in the upper 60's). His past 2 A1C's have been in the low 8's. He kept a record of before and 2 hour after meal readings for two weeks and everything was normal except for the low fasting readings. Our doc suggested taking his BS during the night. They have been consistently well over 200. We try to eat dinner at about 6 and he has a small snack at about 9. We go to bed at 10. The doctor recommended not eating a snack, which didn't help. He suggested taking another dose of Metformin at bedtime with his snack. That has also done nothing. What could be causing this and what can we do to get this under control?

Expert Answers (1)

03/19/10 05:20 PM

Hello CrySss; Thank you for asking dLife and being that supportive spouse, the diagnosis of diabetes impacts the whole family, and support is information and education and being there, great job. Unfortunately, the exact "whys", maybe somewhat of an investigation and require some diligence on all parts, (hubby and yourself). To start, the metformin, (metformin works be stimulating glucose uptake in insulin sensitive tissues and enhances insulin sensitivity at muscle and fat cells, it is also programmed to suppress glucose release from the liver, (the body usually releases glucose at 2-3 AM in anticipation of morning called the Dawn Phenomena or could be another metabolic situation called the Somogyi Effect. Both require an investigation of a 3 AM glucose test and testing for ketones in the A.M. This Somogyi effect usually follows an unrecognized and untreated low blood glucose, frequently occurs at night. With this situation the glucose levels are low between 2-4 a.m. The Dawn Phenomenon, resulting in high fasting glucose, varies from day to day, the glucose is normal or elevated between 2-4 A.M., no ketones are present in the urine in the A.M. Lantus insulin is designed to last for 24 hours and does not have a peaking time, or effectiveness remains constant. Once you investigate these specific: times, share you’re your physician. Treatment for the Somogyi Effect suggest a decrease, (only), in the bedtime snack, increase insulin at bedtime or at supper, based on frequency and outcomes.

As a side note, you do not mention his activities/exercise routines. Of the lifestyle changes for Ty 2 to get the numbers in line include: dietary guidelines management techniques, increased activities and medications. These 3 factors impact the blood glucose readings under the 'normal', illness/stress/infections impact the readings adversely. '
Call on us as needed. Regards Sue

Answered By: Susan Throop
Accreditations: RD, CDE, MA
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