Levels tend to rise towards bed time.

[Dazphoenix28]

Got my ratios correct. 2:10 breakfast, 1:10 lunch and dinner. Breakfast readings and lunch are fine. Pretty much no change in levels pre meal.and 2 hours after. So dinner.. Let's say I have 4 units for 40g of carbs. Bloods before dinner read 7.0, 2 hours later 7.2. 3-4 hours later? 8.2 then start to rise... basal is still active for 24 hours and I take it every night at 10pm. Can't increase basal anymore due to 1 more unit will cause a nighttime hypo. Can't increase dinner either because even 1.5:10 ratio will cause a hypo. Even 1 more unit on top of 4 units will cause a hypo.

I don't eat between meals, I drink plenty of water and black coffee(2 cups a day) with nothing else.

I don't know why it does this. I Always end up having correction doses. My injecting sights are fine as a rotate often, nothing changes for meals and I don't eat junk food.

If I increase my dinner time insulin more than 1:10 within a hour or 2 I'll have a hypo.

I didn't eat any slow releasing carbs for dinner either.

Any feedback would be nice, thank you =).

First picture is recent daily graph. Taking a 1:10 ratio for dinner. Post meal 7.3 and dropped to 5.0 and slowly increasing. If I had 1 more unit I I would be going into a hypo.

Second is me taking a 1.5:10 ratio and it causes a hypo from 9.9.

Third is if I increase my lantus from 16 units to 17 or more causes a hypo every time.

Last is my 16u of lantus. Drops as low as 4-5 so can't risk the chance of increasing.

I go to bed most nights between a 6-10 blood glucose level. I always double check my levels using a glucose machine.

I don't exerice as of yet and I don't have much fat in my diet. Mainly wholegrains and low fat spread.

Most nights I have a salad with a small amount of carbs.

 

[TashT1]

Lantus is supposed to last 24hrs but I’m certain I’ve seen post saying it doesn’t for everybody.

Is there a specific reason you take it at night? You could consult your nurse & consider moving it to morning, it might mean that the basal is more effective by the time you have tea. It might also mean you can play around with your dose & not worry about nighttime hypos.

If all else fails you could try a different basal that can be split morning & night.

 

[ert]

You could skip dinner to see if your basal was lasting the full 24 hours as advertised on the packet. If not, follow @TashT1's suggestions.

 

[jackois]

You could try a short walk in the evening... I often find it useful and saves a correction for a blood sugar on the rise. Once round the block does it for me.

 

[EllieM]

I agree with the suggestion that the lantus isn;t working 24 full hours. Can you get an insulin pen that doses in half units? An extra .5 units of bolus might work, otherwise try splitting the lantus basal morning/night.

Good luck.

 

[KK123]

It's hard isn't it? I have experimented around all scenarios and in the end I came to the conclusion that it can be nigh on impossible to balance EVERY single aspect in relation to insulin and ratios. A normal person's body can do that every single second of every day, the system works to intricately balance the glucose levels, dripping minute amounts of insulin constantly 24/7 to keep it in check. It is NOT possible to do that as an insulin user and to try to would mean a very depressing life in my opinion as you are destined to fail if you're aiming for 100%. Don't get me wrong, I absolutely agree that management is the key and I go to great lengths to manage mine. For an example, I got my ratios sorted but every single day around 4pm my levels would drop into the 3s. I changed bolus/basal/exercise routines in an effort to stop it doing this and yes I managed it but my levels at other times of the day then started to play up when I had a unit less of insulin (went higher than I wanted) etc. I gave up and went back to my normal ratios which MOST of the time (well over 90%) are in target. Yes, most days around 4 I know it's going to drop and so I have a coffee and a lovely, deliciousness, 15g of carby snack and that keeps it above 4. I don't believe we should eat to the insulin but we do have to make an allowance somewhere along the line. Also, if I've eaten more carbs than usual in an evening meal and I know that to take a unit more of insulin might make me go too low overnight, I go for a 10 minute run (on my treadmill so that's a benefit for me to have one). I know that a ten minute run lowers me in that scenario by around 1 or 2 mmols, I restrict it to 10 mins because much more and I'd go too low overnight. You see?, it's complicated! x

 

[MarkMunday]

...... basal is still active for 24 hours and I take it every night at 10pm. Can't increase basal anymore due to 1 more unit will cause a nighttime hypo. ...

Lantus doesn't last 24 hours. The period is dose dependant and smaller doses last for shorter periods. Dived 16 by your weight in Kgs to see what your dose is and compare with the the graph on the right.

This graph is based a glucose clamp study, with the required glucose infusion rate on the vertical axis. At 0.4 units/Kg, Lantus (insulin glargine) is mostly finished after 20 hours. This is why your blood glucose rises towards bedtime. It also takes Lantus nearly 8 hours to get up to speed. This insulin action profile can be flattened out by splitting the Lantus dose. Taking say half in the morning and the other half before going to bed. That way there is more consistent basal insulin action over the 24 hour cycle. Bolusing also becomes much easier, with less need to have different ratios at different times of the day.

 

[Dazphoenix28]

Thanks for the reply guys. Yes, my blood glucose tends to rise even if I don't have my evening meal. I told my dietician this and instead of splitting it, she recommended that I switch to another basal insulin that can be split. I know lantus doesn't last 24 hours but I'm worried to attempt to split it. I'll keep a record of my levels tonight. See exactly when it rises(maybe an hour before I'm due my basal) and see if I can counter the rise before bed.

I recently got the allstar pro pen and it's beautiful. Be a shame to switch lantus to another basal insulin. Have been on lantus since I was 12(28 now). I feel like I'm so close to getting it right. I just need to see what I can do to lessen the rise after dinner. It happens even if I don't have slow carbs.

I felt fine this morning. Actually woke up late and my levels stayed even at 4.5(sensor readings). Blood glucose machine says 5.5 ish so I'm happy sitting between there. Found a way to stop my morning level rises.

Thank you guys for the feedback. I'm going to see my diabetic team for the first time this month.and going to show all the data I've collected. I might try splitting the dose if the rise continues pre bed time. I've seen a lot of people split their lantus dosage but I don't know how. Would I take half before bed and half in the morning? Around what time between doses so I need to wait? 12 hours?

 

[In Response]

I too lean towards the “Lantus not lasting” camp but have another suggestion you may want to look into.
How about a half unit pen for your basal?
If 1 extra unit leads to hypo, maybe half a unit will be what you need.

 

[MarkMunday]

... I might try splitting the dose if the rise continues pre bed time. I've seen a lot of people split their lantus dosage but I don't know how. Would I take half before bed and half in the morning? Around what time between doses so I need to wait? 12 hours?

It is very easy. Just have half your normal dose in the evening and the other half when you wake up in the morning. The timing is not critical, as long as you get the full dose in 24 hours. Don't be surprised if levels during the rest of the day change a bit. Monitor with the Libre and make whatever adjustments you think are required.

I don't split my Lantus dose anymore as I find anything over 11 units makes me go low 20+ hours later. So I take it all in the morning. My experience is not typical. Wasn't always like this. Maybe it has something to do with age and/or duration of T1. Goes to show that nothing stays the same for long. Testing and tweaking is an ongoing process.