Overnight blood sugars

[Ovi]

I'm on Tresiba,taking 16u at the moment at 8.30pm but my glucose overnight is quite high compared to the rest of the day and I'm a bit confused a bit. What should I try and change? Increase the amount of Tresiba or maybe inject it earlier? I've attached a screenshot.

 

[Antje77]

What type of diabetes do you have?
Do you only use long acting insulin or mealtime insulin as well?
At what time do you last eat, and what do you eat?

How does the daily trends graph in the app look?

 

[Ovi]

What type of diabetes do you have?
Do you only use long acting insulin or mealtime insulin as well?
At what time do you last eat, and what do you eat?

How does the daily trends graph in the app look?

Type 1,usually last meal is around 7pm,keto diet.

 

[becca59]

My take on this graph would be not enough fast acting at 7pm and your body still processing at midnight. Whilst we are in bed asleep the body doesn’t digest food so quickly which is why eating late is not good for us. Though I know it may not be practical to eat earlier.

 

[Antje77]

Can the higher numbers between 12 and 3 AM be a slow protein rise from your evening meal?

What do the daily trends look like? Thin line with a clear pattern throughout the day or ups and downs t different times?

 

[Antje77]

Whilst we are in bed asleep the body doesn’t digest food so quickly which is why eating late is not good for us.

I do quite well on eating late, I don't think there is conclusive proof that eating late is not good for 'us'. (Not sure if you mean people in general, diabetics or T1's.)

 

[Ovi]

My take on this graph would be not enough fast acting at 7pm and your body still processing at midnight. Whilst we are in bed asleep the body doesn’t digest food so quickly which is why eating late is not good for us. Though I know it may not be practical to eat earlier.

Could be I guess. Yesterday I had 2 ribeye steaks on their own around 7.15pm.

 

[Ovi]

Can the higher numbers between 12 and 3 AM be a slow protein rise from your evening meal?

What do the daily trends look like? Thin line with a clear pattern throughout the day or ups and downs t different times?

Maybe you can have a better idea from that.

 

[Antje77]

Maybe you can have a better idea from that.

Thanks. Very nice line, and I expect your endo/nurse is delighted by your results!

Still, quite some variation there, especially considering you're keto.
For me, the amount of basal I need varies. Tresiba is not an insulin with which you can play with doses on a daily base (by the time a changed dose takes effect, basal needs may have changed again).
I solved this issue by adding Levemir to my Tresiba on an as needed base, but that's a very unconventional solution, and you won't get it if your HCP isn't willing to think very far outside the box. It also means more work put into diabetes.

The variations on your graph are small enough that a pump with a sensor could be a very effective solution, for instance a Medtronic one with the Smartguard system which increases and decreases basal insulin depending on BG.
Of course this means you'd need to want a pump (I don't) and you'd need to be able to get one (can be very hard to impossible).

Apart from the variation, it also shows a very clear pattern where you start rising at around 10pm and dropping again between 3 and 4. Which is a very unusual time for a liver dump, so I'd suspect the evening meal wants some insulin, possibly even in two batches because of the slow action of the protein.

Mind, I may be completely wrong, this is just what I'd be thinking if it were my graph, and our diabetes is very different.

 

[Ovi]

Thanks. Very nice line, and I expect your endo/nurse is delighted by your results!

Still, quite some variation there, especially considering you're keto.
For me, the amount of basal I need varies. Tresiba is not an insulin with which you can play with doses on a daily base (by the time a changed dose takes effect, basal needs may have changed again).
I solved this issue by adding Levemir to my Tresiba on an as needed base, but that's a very unconventional solution, and you won't get it if your HCP isn't willing to think very far outside the box. It also means more work put into diabetes.

The variations on your graph are small enough that a pump with a sensor could be a very effective solution, for instance a Medtronic one with the Smartguard system which increases and decreases basal insulin depending on BG.
Of course this means you'd need to want a pump (I don't) and you'd need to be able to get one (can be very hard to impossible).

Apart from the variation, it also shows a very clear pattern where you start rising at around 10pm and dropping again between 3 and 4. Which is a very unusual time for a liver dump, so I'd suspect the evening meal wants some insulin, possibly even in two batches because of the slow action of the protein.

Mind, I may be completely wrong, this is just what I'd be thinking if it were my graph, and our diabetes is very different.

Thanks for the detailed answer. I'm on keto but around 4 weeks ago I pretty much ate whatever I wanted for about a week and every time I do that it takes me ages to bring my blood sugars back to normal. Whenever I binge eat my overnight glucose takes a massive blow.