Freestyle Libre - Being high in the night

[slip]

could you talk us through the whole of yesterday? What results, injections, and what type of food was consumed, amount of carbs, any exercise etc etc all with as accurate timings as poss. and reasons why you did so and so - helps us build a picture.

As an example:
07:00 woke up, did test: 12.3, took 2u QA as correction,
07:15 took dog for short usual walk.
07:30 breakfast: bowl of cornflakes + milk (50g carbs), test: 11.1, 10u QA + 8u basal then off to work
09:30 test: 5.6
10:20 packet of crisps (12g carbs)
12:45 Lunch: sandwich, crisps apple and choccy bar (70g) Test: 3.8, 12u taken after eating
15:00 test: 8.6
17:15 ran for bus!
18:00 test: 4.2
19:00 Dinner: spag bol (40g carbs), test: 5.3, 7u again taken after eating
21:00 test: 8.8
22:30 bed, test: 12.8, 2u QA correction + 16u basal
07:00 test: 12.3

 

[RobertJ]

I tend to take the view that if I run high 2 nights in a row and am pretty certain that my food/insulin has run out before bed that it's my basal which needs adjusting.

Running high can be for various reasons, so exercise, stress, adrenaline, hormones, illness/infection or simply because the insulin has gone off, if you've changed your basal pen for a new one and it's still running high then you will need to look at your dose. The libre has done the same for me, so pinpointed when it's rising and shown me where I need to adjust. I will be honest I don't take it as a given that my basal dose is constant either, it changes throughout the year, more in winter, less in Summer etc, there's many reasons why you need to increase/decrease but it's seeing a pattern and knowing when to adjust.

That's interesting. I will consider raising it then.

What do you think about the idea of doing the basal injection at, say, 9 in the evening rather than just before bed? Do you think this is a sensible strategy to avoid long gaps where the morning's basal insulin has long since run out?

 

[slip]

You may need to up your morning basal, not bring your evening one forward. Upping your morning basal does depend on what test results you get normally through the day though.

A basal test will help identify issues, and the Libre will make this so much easier too.

 

[Juicyj]

I don't think it's a case of reviewing the timings of the injections as it only starts to run out around 20 hours, so there's ample cross over with the 2 injections.

I know we've all said it but doing the basal tests will accurately pinpoint where the adjustments will need to be made:

http://www.salforddiabetescare.co.uk/index2.php?nav_id=1007

 

[pinewood]

I also think it sounds like a basal issue. It's a pain but I expect you will reap rewards if you do a fasting basal test and see what happens; it sounds to me like your basal needs increasing.

 

[RobertJ]

Last night, like the one before, was awful. About an hour after my evening meal it was 7.4, then it started creeping up and reached 9.1 so I gave 2 units of Novorapid. This was when I got into bed. I also gave 12 of Levemir rather than the usual 11.

After reading in bed for a bit, it was 11.6 and I gave 2 more units of Novorapid.

When I woke up it was 13.6 and had been stable at roughly that figure the entire time I was asleep.

Here are some stats from the Libre that people might find interesting, from the last seven days:

Average glucose: 8.7
00:00-06:00: 9.2
06:00-12:00: 9.6
12:00-18:00: 7.3
18:00-00:00: 8.4

Time in target (5.1-7.8)
Above: 63%
In target: 29%
Below: 8%

 

[slip]

Ok so what did you eat for dinner last night? how many carbs did you think it was and what ratio and therefor what novorapid did you do and when(in relation to the meal).

 

[Juicyj]

Hi @RobertJ I know it's hard but do not get down about this, you're adjusting and learning at the moment. Going back to the advice given yesterday can you start doing some basal testing ? Also give it a couple of days to see the full effects of any changes to your background insulin. The positive thing is you are aware of it and it will get better now you've acknowledged it, sometimes it's easy to just get complacent and leave it as it is.

I had the opposite issue to you last night, before bed I tested and I was 4.5 which then dropped to 3.90 so had to sit up for an hour until I felt ok to go to bed, it's just the nature of the condition, it certainly keeps you on your toes

 

[RobertJ]

Ok so what did you eat for dinner last night? how many carbs did you think it was and what ratio and therefor what novorapid did you do and when(in relation to the meal).

To be fair, I think I underestimated my meal last night. It was a pasta dish (5CPs) and then some Greek yoghurt with a bit of honey and some dried fruit and nuts (3CPS) and an apple (1CP). My ratio is 1.5/1 so I should have given 14, however I only gave 13. I should also say I gave 8 before the meal and 5 after.

What I don't understand is, even if I didn't give enough, how come 4 units of Novorapid later on didn't do anything to make it come down? How can all that insulin do nothing?

 

[RobertJ]

Hi @RobertJ I know it's hard but do not get down about this, you're adjusting and learning at the moment. Going back to the advice given yesterday can you start doing some basal testing ? Also give it a couple of days to see the full effects of any changes to your background insulin. The positive thing is you are aware of it and it will get better now you've acknowledged it, sometimes it's easy to just get complacent and leave it as it is.

I had the opposite issue to you last night, before bed I tested and I was 4.5 which then dropped to 3.90 so had to sit up for an hour until I felt ok to go to bed, it's just the nature of the condition, it certainly keeps you on your toes

Thanks, @Juicyj but I've had the condition for 14 years. Considering how seriously I take it, I should be doing better by now. As I said earlier on, of all the nights in those 14 years, I honestly believe 99+ percent of them have been spent high. By all accounts, this just isn't good enough, and the health consequences worry me all the time.

 

[Juicyj]

Thanks, @Juicyj but I've had the condition for 14 years. Considering how seriously I take it, I should be doing better by now. As I said earlier on, of all the nights in those 14 years, I honestly believe 99+ percent of them have been spent high. By all accounts, this just isn't good enough, and the health consequences worry me all the time.

I think the health consequences worry all of us, I worry about my vision more than anything but if you spend too long thinking about it you will start to worry, the mind being what it is. Someone on the forum said 'mark a line in the sand and start from here' that's seems applicable in your case, don't worry about the what if's and the past, do what you can now to make this work better, I normally run high myself at night so before bed around 8 mmol/l then at waking anywhere up to 13 mmol/l am working through some changes at the moment, but just taking it slowly, so gradual increments on my basal each night till I can get my waking around 2 mmol/l to my bedtime reading, last night was unusual only because I took my bolus then didn't have as many carbs as i'd planned to as I didn't fancy it, so I knew I could come down but had an orange later to compensate and still went to 3.9mmol/l. We generally know ourselves where we go wrong but when you are living with your own condition 24/7 it helps to sound it out, you will get there

 

[slip]

Sorry should have asked what was your level before the meal too!?

Pasta tends to be a slow release high carb meal, but you obviously know that as you split your bolus anyway, your carb portions seem about right although without weighing/seeing your plate difficult to be certain - and I'd probably suggest that actually the carbs were more than what you thought

It maybe you have 2 things going on, your carb ratios may not be right and also your basal is running out towards the end of the day - which would account for the extra QA units not lowering you, they are making a difference - stopping you from going even higher, you just perceive it that it isn't making a difference.

A series of basal tests is the only way to understand what's going on and why - and then you'll be able to get it sorted.

 

[pinewood]

Have you done a basal test? This screams out (to me) that your basal is too low.

 

[genix]

I agree Robert. I tried levemir and found I had to almost triple the dose to stop my levels rising at night and so I went back to lantus which gave me a straight line with 14 units at night compared to nearly 35 units of levemir. I would keep upping it until you find the dose that works or change insulin.