Hi JessL, first time using this forum myself, but thought I could maybe help.
I had experienced this problem for about two years and have recently been able to solve it.
I'm on Tresiba to, and the problem was these wicked late night spikes, similar to the ones shown by Levy in her screenshots. Note the dips, before the spikes. I got this too.
In my case, my Doctor suggested that it might be a rebound high. So I reduced my dinner ratio to try and prevent the drop. This... did not help. In fact, it made it worse. So increased my ratio beyond what it was originally at and I was just going low, in the first few hours, and then high later, though not as high. I then tried introducing a walk into my post-dinner routine and returning to my original ratio. This was a bit more hit or miss. Sometimes it worked, sometimes it really really didn't. I tried increasing my Tresiba but this just resulted in me consistently going low between 6 am and 8 am. I also tried splitting the dose, whilst this worked for a while it didn't eradicate the problem. I probably tried a few other things, but to put it bluntly, I was stumped, my Doctors were stumped, and the only solution my Doctors could offer was switching me to a Pump, which I am still waiting for.
However, I've fixed the problem without a Pump.
At the start of this year, I suddenly started to see that the same thing was beginning to happen with not only my dinners but my lunches too. I reduced the carb intake in all of my meals, but whilst this stopped the worst peaks I was still spiking pretty hard, whilst suffering the effects from reducing my food intake below the recommended amount for a man my age.
One realization fixed all my problems.
Whilst I was on Levimir if I took 9 units of Humalog when I actually needed 10 (due to miscounting my carbs). I'd know about it pretty fast, I'd see this Spike happening within an hour, at most two. As such, this is what I was expecting to see with Tresiba. However, I cannot stress enough, in my personal experience, this is not the case. When I get a dose of Humalog wrong with Tresiba (as I did when I made this realization) the Spike doesn't, generally, happen till much much later*. Tresiba seems to rely on your Blood Sugar being in equilibrium with your Fast-Acting Insulin. As such, a small mistake (unless done with a High GI meal) tends to show up hours later. For instance, I took just 0.5 of a unit more than I required for dinner last night. I went low FIVE HOURS later.
This being the case, I'd propose two things based on Levy's data. The dips that her blood sugar took before the spike I think suggest that Insulin was taken too early. So you can fix this by either changing your injection time or splitting your dose. Which is best? Well, you'll just need to try yourself and see what works. I try to avoid splitting when I can, as fast-acting Insulin taken too late, can have a tendency to send you Low, which is not a great risk to take at night. Furthermore, though, I would also say from my own experience with Tresiba it is likely that to avoid going even lower before the spike the dose is actually lower than it needs to be, so you need to increase your overall ratio once you're taking your Quick Acting at a more optimal time. I have done this myself and eradicated the spikes pre-bed.
*In fact a small error tends to take longer to manifest than a big one.
I had experienced this problem for about two years and have recently been able to solve it.
I'm on Tresiba to, and the problem was these wicked late night spikes, similar to the ones shown by Levy in her screenshots. Note the dips, before the spikes. I got this too.
In my case, my Doctor suggested that it might be a rebound high. So I reduced my dinner ratio to try and prevent the drop. This... did not help. In fact, it made it worse. So increased my ratio beyond what it was originally at and I was just going low, in the first few hours, and then high later, though not as high. I then tried introducing a walk into my post-dinner routine and returning to my original ratio. This was a bit more hit or miss. Sometimes it worked, sometimes it really really didn't. I tried increasing my Tresiba but this just resulted in me consistently going low between 6 am and 8 am. I also tried splitting the dose, whilst this worked for a while it didn't eradicate the problem. I probably tried a few other things, but to put it bluntly, I was stumped, my Doctors were stumped, and the only solution my Doctors could offer was switching me to a Pump, which I am still waiting for.
However, I've fixed the problem without a Pump.
At the start of this year, I suddenly started to see that the same thing was beginning to happen with not only my dinners but my lunches too. I reduced the carb intake in all of my meals, but whilst this stopped the worst peaks I was still spiking pretty hard, whilst suffering the effects from reducing my food intake below the recommended amount for a man my age.
One realization fixed all my problems.
Whilst I was on Levimir if I took 9 units of Humalog when I actually needed 10 (due to miscounting my carbs). I'd know about it pretty fast, I'd see this Spike happening within an hour, at most two. As such, this is what I was expecting to see with Tresiba. However, I cannot stress enough, in my personal experience, this is not the case. When I get a dose of Humalog wrong with Tresiba (as I did when I made this realization) the Spike doesn't, generally, happen till much much later*. Tresiba seems to rely on your Blood Sugar being in equilibrium with your Fast-Acting Insulin. As such, a small mistake (unless done with a High GI meal) tends to show up hours later. For instance, I took just 0.5 of a unit more than I required for dinner last night. I went low FIVE HOURS later.
This being the case, I'd propose two things based on Levy's data. The dips that her blood sugar took before the spike I think suggest that Insulin was taken too early. So you can fix this by either changing your injection time or splitting your dose. Which is best? Well, you'll just need to try yourself and see what works. I try to avoid splitting when I can, as fast-acting Insulin taken too late, can have a tendency to send you Low, which is not a great risk to take at night. Furthermore, though, I would also say from my own experience with Tresiba it is likely that to avoid going even lower before the spike the dose is actually lower than it needs to be, so you need to increase your overall ratio once you're taking your Quick Acting at a more optimal time. I have done this myself and eradicated the spikes pre-bed.
*In fact a small error tends to take longer to manifest than a big one.
