Night time lows

[juniorgee]

Hello all,

First time poster here and was hoping to get some advice on my basal dose.

I was diagnosed with Type 1 diabetes around 2 months ago and have been following a low carb diet (eating between 30 and 50 grams of carbs a day).

After some trial and error in the initial few days/weeks, I found that 11 units of Tresiba was working for me and has been up until about last week. I am a Dexcom G6 user and saw that my BG would start to rise again 4/5 hours after eating a meal so I increased my basal dosage to 12 units. I no longer see the increase hours after eating but I am now going low overnight.

I take my Tresiba every night before bed (around 11pm). I was wondering if anyone else has experienced this and whether changing the time of day that I take the Tresiba to the morning would stop this happening? I've also seen across other forums that some people have had success with splitting their Tresiba dose but I'm unsure if this would make a difference considering the profile of the basal.

Appreciate any responses!

 

[ert]

To test your basal dose you should skip dinner or eat a carb free meal. Your bedtime BS reading should hold a straight line until the morning.
Once you have established your basal is correct you may find you need a small correction dose as a split dose (a later dose) for the protein that are taking longer that 4-5 hours to digest. I include protein in my dosage calculation as I'm on a low carbohydrate diet (20 - 30 grams a day) following Dr Bernstein and always split my meal dosage.

 

[juniorgee]

To test your basal dose you should skip dinner or eat a carb free meal. Your bedtime BS reading should hold a straight line until the morning.
Once you have established your basal is correct you may find you need a small correction dose as a split dose (a later dose) for the protein that are taking longer that 4-5 hours to digest. I include protein in my dosage calculation as I'm on a low carbohydrate diet (20 - 30 grams a day) following Dr Bernstein and always split my meal dosage.

Thanks for your prompt reply! I am currently on MDI and am limited to a minimum of 1 unit bolus (novorapid) which is why I haven't tried bolusing for protein just yet as I am worried it would make me go too low. I've tried asking my diabetic nurse to prescribe me a half unit insulin pen but she freaked out at me upon learning that I am following a low carb diet and refused to prescribe it to me.

 

[ert]

Thanks for your prompt reply! I am currently on MDI and am limited to a minimum of 1 unit bolus (novorapid) which is why I haven't tried bolusing for protein just yet as I am worried it would make me go too low. I've tried asking my diabetic nurse to prescribe me a half unit insulin pen but she freaked out at me upon learning that I am following a low carb diet and refused to prescribe it to me.

I have a half unit insulin pen which helps. You need to contact your diabetes specialist team to ask for one. Dr Bernstein's Diabetes Solution explains how to dose for protein if you are on a low carbohydrate diet. If you are on a high carbohydrate diet you don't need to include protein in your calculation due to 'the law of big numbers' which is an engineering term.

 

[juniorgee]

I will try to reach out to my diabetes team again to request the half unit insulin pen and will retest my basal.

Is anyone able to give some advice on whether changing the time I take my Tresiba (from before bedtime to the morning) would alleviate low blood sugar overnight.

I don't really suffer from DP but do see my BG increase once I've got out of bed and start my day pre-breakfast.

 

[dancer]

I will try to reach out to my diabetes team again to request the half unit insulin pen and will retest my basal.

Is anyone able to give some advice on whether changing the time I take my Tresiba (from before bedtime to the morning) would alleviate low blood sugar overnight.

I don't really suffer from DP but do see my BG increase once I've got out of bed and start my day pre-breakfast.

I know nothing about Tresiba but, before going on the pump, changing the time of my Lantus from bedtime to just before my evening meal (around 6pm) stopped early morning hypos. You would be better asking your diabetes team about this, especially as you have only been diagnosed for a short period of time.

 

[Finnlee]

I haven't used Tresiba, but I had a lot of night time lows with Abasaglar and found that splitting my dose between bedtime and breakfast helped a lot.

I started with a 50/50 split (bedtime/breakfast) and adjusted each dose slowly until I found what worked.

Of course, once I found doses that worked, my pancreas decided to start working a bit more (I'm still honeymooning) and I've recently had to reduce both my morning and evening doses. Be prepared for regular tweaking if you're also in the honeymoon period!

 

[Ipodlistener]

I'm 10 months in and eating 30-85g carbs at mealtimes. My Novo doesn't work for the 1st hour. The 2nd hour is where the magic happens. After that my BG starts to rise slowly. But it depends what I've eaten. I always try to be 7.5 but lower than 9 for bedtime. I'm on Abasaglar which lasts 24hrs. Normally wake to 6.5. Are you finger pricking when going low? Just relying on the Dexcom. Do they get compression lows like Libre2?

I was a A1C of 6.9 Now a 5.7 most days 100% TIR

 

[juniorgee]

Thank you for your replies.

I will trial taking my Tresiba earlier to see if that helps at all. If that doesn't work, a split dose may be the next best option.

I always double check lows with a finger prick when I get an alert from my Dexcom to make sure it's not a compression low.

I've not had another A1C since diagnosis but that was extremely high - I think around 14%! Hoping to turn that around with the low carb lifestyle as soon as possible. My next A1C is early September so fingers crossed! I'd consider my TIR good; according to my Dexcom I've been 99% in range over the last 30 days. Just need to stop these pesky overnight lows so I can consistently get a good night's sleep.

 

[EllieM]

Is anyone able to give some advice on whether changing the time I take my Tresiba (from before bedtime to the morning) would alleviate low blood sugar overnight.

Trialling an earlier time sounds worth a go to me. (If you report back here on the result it may help others).

Personally, I also like the idea of speaking ro your team and asking for a half unit pen

 

[juniorgee]

Trialling an earlier time sounds worth a go to me. (If you report back here on the result it may help others).

Personally, I also like the idea of speaking ro your team and asking for a half unit pen

That chart is very interesting considering Tresiba is supposed to have a flat profile!

I decided to take my basal earlier last night and even earlier today (but not in the morning as I was scared the overlap might drive me low). I will continue scaling back a few hours each day until I get to the morning.

I'll post an update with my findings.