How can I get my blood sugars level in the evening without having them creep up

[Ryann1990]

I currently take humolog in the day and Tougeo in the evening My recent HBA1C was 6.4 my levels are for some reason spiking to massive highs in the evening the average sugar is 16.4 to 10.5 which is annoying. Iv tried eating less taking less insulin taking more insulin but cant seem to get a good baseline. any tips or ideas would be appreciated.

 

[evilclive]

When's your last dose of humalog and how long after that are you getting the massive highs?

 

[Deleted Account]

When do you take your Toujeo relative to your daily spike?
I am not familiar with that basal insulin but I know some people find their basal does not last a full 24 hours so they start going high as it runs out.
One way to overcome this is to split your basal into a morning and evening dose.

I know some people have done this with Lantus but don’t know about Toujeo.

 

[evilclive]

Theoretically Toujeo lasts a lot longer than Lantus - it's intended to be single dose.

 

[Ryann1990]

When's your last dose of humalog and how long after that are you getting the massive highs?

Last does is at 6 o’clock in evening and by 10pm it’s high

 

[Ryann1990]

When do you take your Toujeo relative to your daily spike?
I am not familiar with that basal insulin but I know some people find their basal does not last a full 24 hours so they start going high as it runs out.
One way to overcome this is to split your basal into a morning and evening dose.

I know some people have done this with Lantus but don’t know about Toujeo.

I take it at 10pm but I had to lower from 26 units as I wasn’t having hypos in the morning so down to 22 now but still getting the highs in the evening

 

[Deleted Account]

I take it at 10pm but I had to lower from 26 units as I wasn’t having hypos in the morning so down to 22 now but still getting the highs in the evening

This does sound like your basal insulin "running out".
Whilst Toujeo lasts longer than Lantus (usually), it may still not be making it through 24 hours which means you start going high before you take your 10pm Toujeo dose.
Can you discuss splitting your Toujeo dose (one dose in the morning and another at night) with your diabetes team?

 

[hh1]

It could also be what you eat for your evening meal. If I eat lower carb and high protein/fat, I get a high later on in the evening so have to split my bolus

 

[JMK1954]

Toujeo lasts more than 24 hrs. I know this from personal experience but it was what I was told by the DSN/consultant anyway. When I was put on it, I found my BS levels went crazy. It could rise or drop by as much as 10 mml over four hours. How long have you been on Toujeo ? What was the reason for changing to this insulin ? Has this rise been happening ever since you started using it ? Sorry for all the questions, just trying to get the picture.

 

[becca59]

I use Toujeo and have being keeping a record of effectiveness. As have had problems with high levels. Week one brilliant, week 2 not bad, week 3 poor and week 4 dreadful. It says on the box it is meant to last 6 weeks. Err they wish. Tend to ditch after 3 weeks now. Which is a terrible waste as am only on 10 units a day.

 

[Ryann1990]

I changed insluins because I have spent the last 3 years on a blood sugar rollarcoster to be honest the said it would give me better control I normal don’t eat a lot in the evening as I was getting these awful highs no matter what I ate so just thought might as well just starve myself now on really as nothing seems to change it to be honest I am always tired and feel like death as my sugars are all over the place all the time really I cry a lot and feel anxious and sick a lot of the time just in a really bad way iv tried working my ratios out with my food but nothing seems to be working most likely because the basal is out of whack. Are blood sugars supposed to swing a lot throughout the day ? As in like 12s and 14s and 7s and 8s is this quite normal for most people or do people just sit at 8 and 9 all day long just seems like it never sits still I don’t have hypos anymore though which is one good thing but stuck in the higher side of things just feel spaced out all the time as well which am convinced is brain damage from all the highs

 

[JMK1954]

People are put on Toujeo because DSNs are told (and apparently believe) that it magically keeps your BS levels level/stable all day. Well, have a search on this forum to find what people who have actually used it think. I did that when I started taking it. There is a division of opinion about it. A number of us apparently find that it does a lovely job of keeping BS level. The rest, like me, find it a nightmare. I suspect that the truth is that it can keep BS level, but only if you are taking the number of units which for you is correct, while also eating the correct amount of carbs to match your fast-acting at every meal.

You do know that Toujeo is three times the strength of standard Lantus, don't you ? I spent 6 weeks sending my DSN increasingly desperate messages about my uncontrollable and ridiculously unstable BS when I took it. She kept telling me to up the number of units I was taking. When I did, my waking levels rose from 11mml at first to 16 or 17 mml with one unit more. At this point, i got frightened and demanded a change to something else.

 

[evilclive]

You do know that Toujeo is three times the strength of standard Lantus, don't you ?

Three times the concentration : but if you take eg 10u Toujeo, it's got the same amount of insulin glargine in it as 10u of Lantus.

When considering the concentration of these insulins, if you're using pens the best approach is the simple one, which is just use the U number on the pen and don't worry about the concentration. If you want to think about the concentration, remember the pens dial a different number of U per volume (or different volume per U) to compensate for it - Toujeo only comes in its own special pens.

Now, the clinical effect of Toujeo is a bit different because the way the more concentrated insulin reacts with your body is slightly different - the smaller volume makes a difference. I think insulin glargine works by crystallising out at body pH then very slowly dissolving, and a more concentrated solution could well give bigger crystals and hence a slower release. So it's ok to have a different body reaction to it.

I used Lantus for several years, but it wasn't working great for me. I tried Toujeo and didn't like it because its peak was at the wrong time for me. Now on Levemir 2 doses, which seems to be behaving fairly well. But what works for me might well be the wrong approach for others.

And my fun U fact, mentioned a couple of months ago : a U of insulin is the amount required to put a rabbit into a hypo.

 

[Ryann1990]

Reckon all of these highs could be causing my spaced out dizzy feelings ? Just feel like I’m floating out of myself sometimes ? I was on Levimir before going on tougeo but it was rubbish maybe I need to come off the tougeo my diabetic team just say keep tinkering with the basal dosage until the numbers level out it’s so annoying since going on it iv had no baseline sugar readings and am still on the rollercoaster of highs spikes and corrective dosages

 

[JMK1954]

Well, as Toujeo is not supposed to have a peak of activity as far as I can make out, that's interesting, Evilclive. My problem with Toujeo was that I was told to start on 5 units a day. Every time I upped the number of units, my waking level rose. As soon as I took my usual fast-acting and ate, it dropped like a stone. Any exercise made it drop it even faster, so it became a problem to get to the shops/ library/doctors, as that involved a walk to the bus stop, a wait for the bus, and a walk at the other end. By that that time my BS was down to the normal range , having woken at 17mml with the extra unit of Toujeo that the DSN insisted I take. Before I was ready to head back home, I was dramatically hypo. Crunched the usual Glocotabs and sat down. Still hypo ten minutes later and 15 mins later. By twenty minutes later, BS was rising again but never stopped. Before my next meal it would be back at 12 or 14 mml.

The DSN kept telling me that my BS was still around 11 mml at night because the Toujeo was running out. But the point about Toujeo is that it lasts more than 24 hrs. She had persuaded me that I could take the Toujeo earlier than my previous basal as it would keep my BS level all right and the still active fast-acting from my evening meal would not matter. I believed her.

To see what happened, I deliberately stayed up an extra 2 hours without taking the Toujeo. My BS fell from 11 mml to 7mml in an hour and a half. This showed the Toujeo was driving my BS up. Then I took the Toujeo and I was back at 13mml by morning.

 

[JMK1954]

Ryann1990, I think you are going to have to stick fairly rigidly to regular meal times and accurate carb counting to sort this out. You have said you have been frightened to eat much carb in the evening, but actually we are all more sensitive to insulin in the evening. The rise in your BS in the evening could be triggered by a failure to eat enough carbs to cover the insulin you have taken for the meal, as well as by eating too much carb for the insulin. Anxiety over keeping your levels down gets to most of us at times, but the levels you have are hardly life-threatening. Extra exercise etc may also increase how sensitive to insulin you are.

I would get the evening meal right first.Test after one hour and keep testing every half hour or so to see what happens. Look at when the peak activity of Humalog(?) is and what happens before and after. Try again next day upping the carb count of the meal say 10g. Nobody can give an instant answer to your problem. You need to investigate it first and find the cause. Does an extra 10g of carbs make things worse or better ?

 

[kitedoc]

Hi @Ryann1990, Sorry to hear you are having such hassles.
As a T!D for 52 years, not as professional advice or opinion:
I assume you are about 18 ? If so you may still be experiencing growth spurts which is going to periodically increase your insulin resistance as growing hormones surge for ? 3 weeks or so then drop back. Also your appetite may increase and if that is mainly in carbs that will add further trouble with BSLs.
From about ages 15 to 19 my insulin used to increase x2 to x 3 for 3 weeks or so and then the hypos would start and I would be scrambling to get the doses down.
Unless you have someone advising you who understands this you may not be getting the best advice and any long-acting insulin used may seem to be rubbish.
Having said that there are a lot of posts on various diabetes forums complaining about Tuojeo and the same things you have been experiencing. From what I can work out:
The switch from Lantus to Toujeo is often not a straight swop dose for dose
Some have said that > 50% of Toujeo users develop antibodies to it and this explains its bizarre effects
Some have no apparent problem with Toujeo but it is not clear if these people do or do not have antibodies to it and whether they are all in older life, past growing age or not.
With use of the proper pens for Toujeo there should not be any confusion about dose, provided the person does not decide to spontaneously divide the dose by one third to somehow equate it with lantus
Like Lantus, Toujeo has the same risk of causing severe hypos if accidentally injected into a blood vessel ( a risk not shared by other long-acting insulins, Tresiba or Levemir)
The absorption rate of lantus and Toujeo was reported by the manufacturer to be more reliable than the older NPH insulin.
But data has not supported that finding. I surmise that this is one reason for the difficulties that some have found.
see diattech.com Lantus; Lethal or Lifesaver? # DOC #gbdoc
What to do? Suggestions:
- find a DSN who understands teenage diabetes and that you will not likely be on a stable insulin dose for more than a week or two at a time, until you stop growing
- Toujeo is causing you problems, potentially dangerous ones, discuss changing to something else which is safer all round
- Ask this new DSN if the more flexible insulin for dose changes is levemir because it is a twice a day insulin - 2 chances to get the doses right.? Whilst that means 5 shots per day flexibility with your growth is key to better BSLs - does she agree or not?
- ask about what to do with diet during growth spurts ? more protein rather than carbs maybe?
- ask about what measure to take with food and insulin for exercise
Best Wishes for a better future. Keep growing and learning, I still am !!

 

[slip]

So was the levemir more rubbish than the toujeo is now? and what was tried to fix the levemir before switching to toujeo?

I agree with kitedoc that a split basal would give you more flexibility.

Also if you're not hardly eating in the evening maybe the rise is your liver dumping glucose, maybe force yourself to have a good proper meal that you can confidently carb count correctly for.

 

[Ryann1990]

Hi @Ryann1990, Sorry to hear you are having such hassles.
As a T!D for 52 years, not as professional advice or opinion:
I assume you are about 18 ? If so you may still be experiencing growth spurts which is going to periodically increase your insulin resistance as growing hormones surge for ? 3 weeks or so then drop back. Also your appetite may increase and if that is mainly in carbs that will add further trouble with BSLs.
From about ages 15 to 19 my insulin used to increase x2 to x 3 for 3 weeks or so and then the hypos would start and I would be scrambling to get the doses down.
Unless you have someone advising you who understands this you may not be getting the best advice and any long-acting insulin used may seem to be rubbish.
Having said that there are a lot of posts on various diabetes forums complaining about Tuojeo and the same things you have been experiencing. From what I can work out:
The switch from Lantus to Toujeo is often not a straight swop dose for dose
Some have said that > 50% of Toujeo users develop antibodies to it and this explains its bizarre effects
Some have no apparent problem with Toujeo but it is not clear if these people do or do not have antibodies to it and whether they are all in older life, past growing age or not.
With use of the proper pens for Toujeo there should not be any confusion about dose, provided the person does not decide to spontaneously divide the dose by one third to somehow equate it with lantus
Like Lantus, Toujeo has the same risk of causing severe hypos if accidentally injected into a blood vessel ( a risk not shared by other long-acting insulins, Tresiba or Levemir)
The absorption rate of lantus and Toujeo was reported by the manufacturer to be more reliable than the older NPH insulin.
But data has not supported that finding. I surmise that this is one reason for the difficulties that some have found.
see diattech.com Lantus; Lethal or Lifesaver? # DOC #gbdoc
What to do? Suggestions:
- find a DSN who understands teenage diabetes and that you will not likely be on a stable insulin dose for more than a week or two at a time, until you stop growing
- Toujeo is causing you problems, potentially dangerous ones, discuss changing to something else which is safer all round
- Ask this new DSN if the more flexible insulin for dose changes is levemir because it is a twice a day insulin - 2 chances to get the doses right.? Whilst that means 5 shots per day flexibility with your growth is key to better BSLs - does she agree or not?
- ask about what to do with diet during growth spurts ? more protein rather than carbs maybe?
- ask about what measure to take with food and insulin for exercise
Best Wishes for a better future. Keep growing and learning, I still am !!

I’m. 28 so don’t think it’s a growth spurt somehow

 

[slip]

@kitedoc has lost a decade somewhere..........