Overnight highs

[scotteric]

Hi everyone,

After 3 years of very tight control (and feeling very grateful at how lucky I have been with the ease of control) in the past few weeks I have been really struggling.

I currently take 10 units of Tresiba before bed at around 10pm and my I:C ratio is now about 1 unit per 10g (used to be more like 1:20)

A typical day goes like this:

- I wake up @ 6-8mmol / inject 3 units for breakfast / have a small spike to 9mmol or so and then remain nice and steady at 5-7mmol until lunch
- Take 3 units for a low carb lunch / stay steady at 4-7mmol all afternoon
- Units for dinner vary, but even if I have a low carb meal and bolus with very high accuracy this is what happens:
* Inject 30-45 mins before eating to restrict spike;
* Assuming I carb counted and bolused correctly, I'll stay steady in the 5-8mmol range from eating dinner at c. 8pm until going to bed at 11pm (occasionally I will split-bolus or add an additional bolus depending on what I am eating and if my Dexcom shows me creeping up)
* I'll go to bed at 11pm-ish with my Dexcom showing me nice and steady at 5-6mmol
* My Dexcom alarm will then go off between 12am to 3am and I'm suddenly at 11-14mmol???!??!
* I'll bolus but still end up spending the whole night higher than I would like (e.g. 8-11mmol); sometimes my alarm will sound again at 4/5am because I'm still high despite the middle of the night bolus, so I'll take yet another bolus but still be in the 6-8+mmol range on waking.

Previously, I've had perfectly stable overnight sugars and would almost always wake up in the 4-5mmol range. The only time I'd have highs in the middle of the night is if I had a high fat/high carb meal (e.g. pizza/pasta) and the delayed digestion, understandably, spiked me. But now it's happening regardless of what I have dinner, even if it's a salad or low carb option.

Any ideas what's going on here or tips for things I can try?

I always thought our bodies needed LESS insulin at night but I seem to need more.

I'm reticent to increase my Tresiba given my daytime levels seem okay but maybe that's the first thing to try?

I just don't think Tresiba is a good fit for many type 1s, despite the hype, because basal needs differ at night and during the day. Are you able to switch to Levemir? You can take more at night and less in the morning. It lasts about 12 hours on small doses making it perfect for taking 2x/day. It also has a bit of a peak which helps overnight for rising blood sugars. Ive tried Tresiba 3x and each time give up because can't find a dose that works for me all day and night. Levemir is a much better fit.

 

[cz_dave]

@pinewood I have experienced a similar problem like you. I tried tweaking my basal but with no luck. In the end I found two solutions that worked for me:

1. Bolus before going to bed (when eating normal or moderate low carb).
2. Go on a very low carb diet.

 

[pinewood]

@pinewood I have experienced a similar problem like you. I tried tweaking my basal but with no luck. In the end I found two solutions that worked for me:

1. Bolus before going to bed (when eating normal or moderate low carb).
2. Go on a very low carb diet.

Thanks @cz_dave - although that's rather a depressing thought!

I've increased my Tresiba dose from 10 units to 14 units now (yes, a 40% increase!) and it seems to be getting better. My daytime numbers also started increasing (though not as badly as the night) so I'm hoping it was just a general decrease in insulin sensitivity / end of my honeymoon period (dx'd 2014 so probably long overdue). Will see how things go.