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Night time highs

urbanracer

urbanracer

Expert
Retired Moderator
Messages
5,237
Location
Worthing, UK.
Type of diabetes
Type 1
Treatment type
Insulin
Dislikes
Not being able to eat as many chocolate digestives as I used to.
After having been on 25/75 mixed insulin twice a day for a few years I changed over to MDI in mid January. I was warned that I would struggle with my glucose levels for a few weeks but I was initially surprised at how easy the transition was.

From the start I was waking up with BG around 9mmol and I could see from the Libre that my glucose levels had been flat all night which I was quite pleased with. I started to increase the basal dosage in attempt to lower my waking glucose levels and I got below 7mmol.

Things were cushty for a few weeks and then started going awry. I go to bed 2 to 3hrs after eating (my missus is a nurse so we often eat late) with BG below 9mmol. My Libre is showing that I am rising to 15mmol around 2am and I stay at this level for a couple of hours before waking up at 6am with a BG around 10mmol (checked with finger prick).

I'm aware from the PIL that the insulin profile of Abasaglar doesn't last 24hrs at full strength so, over the past 2 weeks I changed my basal injection time from 06:00 to 19:00 but it's not making any difference to my night time highs. I wondered about glyceamic index but what I eat does not seem to make any difference either. I've upped the dosage again but it's still not bringing my levels down.

Any ideas?
 
Hi @urbanracer am not familiar with this basal, but as you're running high after your novorapid's been depleted and have already tried increasing your dose and injection timing with little effect then I'd suggest changing to Tresiba which has a flatter profile than Abasaglar. Oddly enough I've gone high over the past 2 nights so gone to bed in range and woken up at 15mmol/l, not sure if it's infection, hormones or just a basal tweak required, but it's a pain to deal with :banghead:
 
When I moved to Levemir I found basal adjustments somewhat illogical. I would increase the dose, see no apparent effect, increase again, nothing, repeat several times then abruptly find I'd gone too far without ever seeing any gradual changes.
Having reached that point, back off a unit or two & had some lovely horizontal graphs, something I never achieved with Lantus.

I assume that I wasn't giving each adjustment long enough, I should have changed then waited a couple of days. Having a CGM allowed me to get away with "rushing" it.
 
I think Abasalgar is glargine and has been developed as a rival to Lantus. It’s apparently similar. When I used Lantus I found that it didn’t have a flat profile but peaked during 2 - 7 hours after injecting and then gradually tailed off. I tried to solve this by injecting basal at 9pm but the dose to prevent too great a decline after 16 hours led to night-time lows. Maybe changing to Tresiba, or a split dose of Levemir would make things easier for you?
 
@Juicyj ,@DunePlodder @Fairygodmother ,

Thanks for your replies. I will give the latest changes I've made a few days to settle. If there's no change I'll call the diabetes 'hot line' and ask about a different basal.
 
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