Night time highs, day time lows

[EBartlett]

I am a type 1 diabetic on Tresiba and newly on apedra for meals, I just started using the Dexcom G6 a month ago.

I can now see that every night i go to bed with levels within range but as soon as I go to sleep my levels creep up and stay at 13-15, as soon as I wake up in the morning my levels come down to within range again. ( An example is 10pm 7.2, nighttime 15, wake up 9). I take the tresiba at 10pm.

To complicate things I am also have multiple hypos in the day time (mainly afternoon 4pm). Any ideas on what I can do to reduce my nighttime highs, or what could be causing them and the afternoon hypos?

I have put up my night insulin but this isn’t having an affect on my nighttime levels any advice or comments would be appreciated.

Thanks

 

[EBartlett]

Hi @Knikki ,

Thank you so much for your reply.

I carb count for every meal, I find that most of the hypos are between 3-6pm. That’s a good plan point - tonight I plan to set some alarms to check my level using my meter to see how accurate the G6 is.

My dinner usually has about 50-70g of carb in things including rice and potatoes. Is it the higher the carbs the slower the digestion or is something else like fat that can cause the delayed digestion ?

As you suggest I’ll keep an eye on these points and discuss with my DSN. Might need to discuss switching to a pump.

Thanks again

Em

 

[MeiChanski]

Hello @EBartlett and Welcome to the forum.

HMMM Tricky one.

OK are you on fixed dose of insulin per meal or do you carb count and adjust?

Reason I ask is that, say your only eating a bacon sandwich for lunch, which might not have a lot of carbs in it but you take a fixed does of insulin you may be having that too much insulin for what you have eaten, hence the hypo.

Night time is a little more tricky, I would not necessarily believe the Dexcom not with out dong a finger prick, while CGM's can be accuratish sometimes they are not.

The other thing is what do you eat for tea?

Things like Pasta, pastries, curry, Chinese all use food stuffs that slowly digest.

For an example. I might eat a pasta bake and garlic bread and take the correct insulin for the amount of carbs, which when I go to bed some 2-3 hours later, my blood sugars may be around the low 4mmol. However because of the slow digest some 5-6 hours later my blood sugars would be much higher because the insulin has warn off and I have the pasta carbs getting into my system.

The main thing is to make a note of your findings and talk to your DSN or medical team as they will be the best one to advice on how deal with the issues your having.

Hope you get things sorted soon

Thank you for the reminder, it was a lightbulb moment for me. I too, experienced something similar but higher protein/fat compared to carbs. so I was normal for 1.5 hours then later creeped up slightly, then went back into normal range.

@EBartlett Sorry to bombared your post. I don't know if it's a good idea to ask you to do that 2-3am long acting insulin check. I assume you fast after your dinner, so no fast acting insulin on board. do a midnight test, to check. then at 3am do another check to see if Tresiba is doing it's job. This doesn't apply if you're hypoing.

 

[kitedoc]

erhaps ask your DSN about basal testing, i.e. see what your Tresiba is doing.
There are several methods and your DSN should be able to assist you with whatever he/she thinks is the best method
for you to follow.
Best Wishes.

 

[EBartlett]

Hi @MeiChanski

No problem at all.

Thank you for your suggestion, i will do those tests tonight I think. Hopefully that help eliminate some options that could be causing the highs.

 

[EBartlett]

@kitedoc thank you - I’ve never heard the term basal testing, learning there can be different methods to test is also

 

[NewlyLADA]

I was having the same issue and I switched from taking my shot of long lasting from night to day as the peak of my long lasting is 3 hours after taking it.
Another thing they had suggested and I read about it to eat a carb with a protein just before bed, like 1/2 Apple with peanut butter or four crackers with cheese just to give the body something to work on while sleeping ... you might try this first.
I do not do well if I don’t eat prior to bed my GBL is high when I wake up and will continue to rise unless I eat. Seem funny to eat a little sugar and protein if you are high but it works for me.

 

[MeiChanski]

I would also like to add that when you change Tresiba dosages, please give it a 4 day window to settle. Also, please get in contact with your DSN if your highs continue for a considerable amount of time.