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Type 1 High BG at set times

Gardevoir

Well-Known Member
Messages
51
Type of diabetes
Type 1
Treatment type
Pump
Hi,

For several weeks, my BG rises at set times and for nearly 3 weeks, I've been staying awake overnight to inject for it and then sleep in the morning.
For context, I take 12 units of basal at 9 PM and I inject to avoid these highs like so:
10:30 PM: 4 units
1:30 AM: 3 units
3:30 AM: 4 units
6:30 AM: 3 units
1:30 PM: 5 units

These times basically never change. If I correct at these times with these units, I stay stable. This appears to be unaffected by my sleeping patterns (happens regardless of when I sleep, for how long and how well) and unaffected by meals (I tried eating a lot for several days to see if it'd change anything and I ate the absolute bare minimum for a few more days, neither of which affected these highs).
Is this a case of simply having to increase my basal? With how much? I tried 14 units for 3 days but as it didn't change anything in the slightest, I went back to 12. I don't know how much I should increase it by. Do I inject 16? 18? 20? I read that my weight in kg * 0.55 is a good starting point to calculate how much basal I'd need but that'd bring me up to 32 units. I almost can't believe that's proper, or is it?
I have an appointment in a few days which we'll most likely use to look into pump options in order to automate this correction process at these set times, or at least make it less bothersome.

I'd love to hear your thoughts.
Thank you in advance.
 
By “topping up” your insulin with these bolus doses, you are effectively giving yourself more background insulin. So, yes, you need more basal.
If you go down the pump route, it will not be programmed to give you these corrections at these times, the Basal will be configured to match the glucose dump from your liver which is the reason you need these corrections.
There is no formula to work out how much basal you need. The one you mention is a guidance only. The only way to find out is small increments and trial and error. Increase your basal by 10% at a time and see how it is for at least 3 days before increasing again.
 
Nothing really to add onto advice on what to do as @In Response has given some solid advice but just by looking at your date of diagnosis you could possibly still be in the honeymoon period which won't help matters very much and your insulin needs may vary during this time. I don't believe in the system of working out how much basal to give by weight, it differs from person to person what you need and when, I never needed even half as much as I should have had.
 
I suppose you also dose for meals based on carb count apart from those regular 'correction' doses?
So I take it you take those 20 units on top of your mealtime doses according to your insulin to carbs ratio?

If so, you use a relatively low basal dose compared to your quick acting insulin, For some, this is the right balance, but for most the amount of basal is closer to the amount of bolus needed over the day, depending on diet, activity, etc.
Have you had any guidance in adjusting your basal?
 
Antje77 said:
I suppose you also dose for meals based on carb count apart from those regular 'correction' doses?
Click to expand...
Of course! My ratio is 1:12 which works very well for me. I take these correction doses apart from anything else.

Antje77 said:
but for most the amount of basal is closer to the amount of bolus needed over the day, depending on diet, activity, etc.
Click to expand...
That would bring my bolus up to something like 30 units.

Antje77 said:
Have you had any guidance in adjusting your basal?
Click to expand...
Basal not so much, but perhaps that's because I haven't asked enough. We had the initial basal be 14 units (if I recall correctly) but I would go low often at random times throughout the day so we changed it to 12 and that worked great for me for many months until this happened but I'm not sure if it's related to basal or not. I don't know how careful I should be with changing my basal. Going from 12 to 16 units doesn't make a notable difference and I feel as if I should increase it by a lot more (jump to 24?) to see whether or not it'll have a positive effect.
 
Gardevoir said:
Going from 12 to 16 units doesn't make a notable difference and I feel as if I should increase it by a lot more (jump to 24?) to see whether or not it'll have a positive effect.
Click to expand...
Forum rules mean we aren't allowed to give you specific dosing advice but I personally only change my basal by small amounts when adjusting. The danger of increasing by a very large amounts is that you have a severe hypo. I'm an advocate of the slow but sure approach.

But if you're not confident on how to change your basal on your own then this is definitely something to discuss with your team. Having a pump doesn't necessarily mean you don't need to do basal testing but it would allow you to have different amounts of basal at different times of day, which many people need.

Good luck with your meeting with the clinic. As a relatively young T1 I'd hope you were a good candidate for a pump, but suspect they may want to be sure that you are out of your honeymoon period first, as well as being on top of managing on MDI if your pump fails.
 
We can't advice, but I've never heard anyone, professional or diabetic, advice to double a basal dose all at once!
No-one knows what the right amount of basal is, so it's usually slowly titrated up until you find it.

What basal do you use?
Depending on brand, it can take up to 3 days to even notice a difference in BG after a dose increase. When I first started insulin, my diabetes nurse was very clear on using the new dose for at least 3 days before going a little higher.
 
Antje77 said:
We can't advice, but I've never heard anyone, professional or diabetic, advice to double a basal dose all at once!
Click to expand...
Of course. I meant it more in the sense of that the smaller jumps didn't appear to improve it although I must admit that after trying 16 units last night, I've only had to inject 2 times instead of 5 times.
I use Tresiba and will be I'll be trying 18 units today.
 
Tresiba is the longest lasting of all insulins, and thus the one where it can take up to 3 days to notice a change in BG after changing your dose.
If you already increased your dose last night, and noticed a change in the amount of bolus you needed today, please be very careful!

Increasing every couple of days instead of every day just means it takes a little longer to get to the dose you need.
Increasing too quickly could cause 3 nights of hypo hell, having to stay up all night to keep feeding the insulin.

Can you contact your diabetes nurse tomorrow on getting a little more guidance on adjusting your basal?
We cannot give dosing advice on the forum for safety reasons, and we do want you to be safe.
 
Thank you for the advice and I appreciate the care. I might stick to 16 and wait it out as I have an appointment on the 3rd anyways. I'll make sure to bring up my basal and ask for more information regarding it. I'd like to get better at judging whether my basal needs to be adjusted and if so by how much.
I'll be safe! Always
 
@Gardevoir if you find you are needing to change your basal frequently (because of, for example, exercise, illness, hormones), you may find Tresiba is not the best basal insulin for you.
DSNs seem to get very excited by the very flat profile but this is only suitable if your body needs that flat profile. Given the purpose of a pump is to adjust the basal throughout the day, it is rarely what our bodies need.
Maybe something else for you to discuss in the 3rd.
 
In Response said:
if you find you are needing to change your basal frequently (because of, for example, exercise, illness, hormones), you may find Tresiba is not the best basal insulin for you.
Click to expand...
I've so far only had to change it from 16 to 12 a few months after my diagnosis. I've tried experimenting by increasing it to 14 but that's all I've done when it comes to changing my basal (excluding the past 2 days).
I'll be discussing it soon and looking at what's best for me. I'll make sure to post what we came up with
 
I had my appointment yesterday and I've returned with news

We first looked at how I was doing and graphs were pulled up. What went well? What went less well? I brought up my overnight complications and basal changes which then led to the pump.

Although increasing my Tresiba significantly helped a lot, it won't fix my obstacles.
She was pleased with how I managed thus far (except for staying up during the night to inject and go to bed when it's over ) but we agreed that the pump will prove to be useful when dealing with my overnight highs and dawn phenomenon.

I have my phone with me at all times so I saw little need for another device/remote and decided to sway away from OmniPod for that reason. We've decided to give a patch pump of Medtronic a try and given the specifications, I believe I'll be receiving the 770G. I've already received a lot of information regarding it from my specialist but someone from the Medtronic company (or alike) will come over and give me an entire breakdown on who what where.

We'll be starting off slowly. I look forward to it
 
After using Medtrum for 3 days, I'm already very pleased and will most likely stick to them for the next 4 years (contract). I've been able to sleep great and the fear of going high overnight is slowly fading away
Thank you all once again.
 
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