I’ve had diabetes for 26 years. For the past five years, I have been unable to get my blood sugar under control during the night. I go to bed between 80 mg/dl [4.5 mmol/L] to 120 mg/dl [6.7 mmol/L] and wake up at 2 or 3 a.m. at 300 mg/dl [16.7 mmol/L] to 400 mg/dl [22.2 mmol/L]. I tried reducing my Lantus at bed and eating a snack but nothing seems to work. Can I be producing sugar at night for another reason besides “Somogyi?”

The reason your blood sugar is high in the morning is not due to a “Somogyi Effect.” You need to have enough insulin on board to inhibit the liver from putting out glucose. It does this by breaking down the polymer of glucose known as glycogen and it also makes glucose from smaller substrates termed gluconeogenesis. What you need to do is to have insulin on board overnight so as to inhibit this glucose output by the liver. That means having an insulin that is there when the peak occurs. Even though you are okay when you go to bed at night, the insulin has to be there on demand. If you check your blood sugar at 3:00 a.m., you will see it is probably high.

I would recommend you speak with your physician about a way to get insulin on board to address this. You might do this with an extra dose of NPH in the evening that peaks between 3 and 6 a.m. You can also do the same with an insulin pump where you can program the pump to put out more insulin during these periods of increased demand. It does not look like you can rely on Lantus to keep your sugars down over the night.

JTL