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So what's causing this then (complete with Libre trace photos!)...?

S

staffsmatt

Well-Known Member
Messages
320
Type of diabetes
Type 1
Treatment type
Insulin
Morning all,

Just after everyone's opinion on what could be causing an odd level rise I've been experiencing for the last few days / week in the evenings and during the night (sorry it's a bit of a long post).

I have tea at about 6 every night during the week (last night we had chips so I had slightly more carbs than normal (47g) but I've had the same thing happen every night, I normally have about 30g carbs for tea (a microwaved potato).

Around 7 to half 7 my level will drop, last night it dropped to 5.9 (blood check came out higher than the libre reading below). Kept scanning and at about 8 ish I started to rise again and then just kept on going up (this is without eating or drinking absolutely anything since tea.

Before bed (about 9:30ish) I decided that I should have some insulin in case it carried on (2u Apidra), had my basal (8u Tresbida) and then went to bed just after 10:

2212 b.jpg

Woke up in the night and did a scan to find that I had started to drop after the quick acting but then rose again so had another 1.5u:

0150.jpg

and this morning I was back down again (maybe had a little too much in the night but I have been finding that I need more than normal to bring me down to a decent level):

0630.jpg

Now as I say this is happening every night. I'm gradually upping my basal (although my day time levels are fine) and have also tried changing the location of my basal injection, but I don't understand what is kicking off the (pretty dramatic) rise around 9pm, that seems too steep a rise for it to all be basal related. I also don't think that it's my basal running out as I'm on Tresbida so that would be very strange...

The only thing I can think of that happens at 9 every night is that I have just finished putting my son to bed. We have to lie next to his cot to get him to sleep and I do quite often nod off! Could I be having a "dawn phenomena" at night, does it even work like that!?

Any thought are welcome!
 
Fatty food would make your blood sugar rise the way you describe so that at least accounts for the chips :)
 
As @CarbsRok says the chips would cause a delayed bg rise due to the fat content.
 
Yup agree with that (although they were oven baked ones).

Doesn't really explain why I get it with microwaved potato, veg and a smallish piece of salmon though (earlier in the week)...

Oh and this is why I don;t think my basal needs to go up any more, this is after last injecting at about half 6 and sitting at my desk all morning...:

20160318_114434.jpg

*sigh*!
 
@staffsmatt, why don't you have a late lunch and start doing a basal check 4 hours after, miss your evening meal so that you can see how your bg levels behave in the absence of food and bolus dose.
 
Hi,

Great picture of your boy!

I would think it has to be the basal.

How long have you been on Tresiba for? Also, why are you on it? The blurb for using it says that it offers greater flexibility about when you take it as it lasts '42 hours'. I'm not sure how that works, but I would be pretty suspicious of that 42 hour claim. I don't really understand the point of such a long basal action. Possibly you are getting weird stacked basal insulin issues?

I couldn't see the data for your lunch before the first picture but it looks like you coming up from a low after lunch. Could it be that for each meal you are taking a correction (for elevated bloods) and bolus (for food) which then drops you down before your bloods start moving back up?

Are you taking your Tresiba at the same time every day and if so when?

Have you done any basal testing recently? I would bet that it is that and not the 'pizza effect' from your food.

Are your bolus carb:insulin ratios correct? Don't forget that they can change through the day (I've very insensitive to insulin in the morning and so need much more than I am in the evening).

Good luck with it though!

Best

Dillinger
 
Yeah I think I am going to have to do some basal testing, I was holding off as I didn't fancy going from lunch until the following morning without eating! Other problem is I have a really erratic activity level around that time as well so that might be hard to manage, be worth it though..... not today though as I've already gotten tea out of the freezer!

I'm on Tresbida because I had quite a lot of hypos with Lantus and a bad local reaction to Levemir.. I've been on it since November at until the last couple of weeks my levels have been much better so I don;t think it's basal stacking (I hope not anyway!

Cheers for the comment on the photo @Dillinger, that photo is getting on a bit now, should really update the pic!
 
staffsmatt, you can still eat later in the evening after the basal check is complete, but just be aware that you'll be going to bed with active IOB.
 
Wouldn't I want to test through the night as well though as I seem to keep rising from 11pm onwards? As per the first screenshot?
 
staffsmatt said:
Wouldn't I want to test through the night as well though as I seem to keep rising from 11pm onwards? As per the first screenshot?
Click to expand...

No you wouldn't do that if missing your evening meal to basal check, you would do the overnight basal check on another day.

Although the following is for pump users it explains how you should do a basal check in different time frames:

Choose one of the following time periods to work on first

1. Overnight – have an early evening meal which is low in fat and known carbs then after 5 hours test BG every 2 hours throughout the night

Repeat on 3 separate nights. Discuss results with the diabetes team at your next appointment.

2. Morning – miss breakfast; test BG every hour until lunch time

Repeat on 3 separate days. Discuss results with the diabetes team at your next appointment.

3. Afternoon – miss lunch; start testing 5 hours after breakfast, test every hour until evening meal

Repeat on 3 separate days. Discuss results with the diabetes team at your next appointment.

4. Evening – miss evening meal; start testing 5 hours after lunch, test every hour until bedtime

Repeat on 3 separate days. Discuss results with the diabetes team at your next appointment.

http://www.salforddiabetescare.co.uk/index2.php?nav_id=1007
 
staffsmatt said:
Ah right, I'll give that a go then cheers.
Click to expand...
I have been getting the same readings as you. I had settled my night time results in the zone by splitting my Lantas. 22 at night 12 in the day. Then this week for no reason my sugar levels started to climb after bed. Nothing had changed as I was eating the same food at the same time. In getting to 22 I reduced my Lantas down as I was getting nocturnal lows.

My question is do other people now monitoring with the Freestyle Libre get unexplained changes in sugars at night. Tonight I will up my bolus to 24 to see if this helps.
 
If you look at the circadian pattern for insulin requirement, typically your peak requirement is somewhere between about 4am and 9am; you then need less from around 9 to 2; between about 2 and six you get the lowest need during daylight hours; from 6-10 it goes back up; from 10 till 2 is typically your lowest requirement for the entire 24 hour period. From 2-4 you start to see your needs rise again.

The point of this is that if you are splitting your insulin, and are taking more insulin overnight than during the day, it's likely that you will see strange things happening.

The typical DAFNE basal split recommendation with Levemir is a lower dose overnight, done before bed, and a higher dose on getting up, to try and combat the greater need in the morning and to provide better coverage during the day when more basal is required.

While this is only guidance and you do have to find your own way, it also aligns with the insulin curves that Gary Scheiner has produced for pumps.
 
So think I've found out what was causing it... @noblehead and @ carbsrok were right it was the fat. Only it wasn't the fat in my evening meals. I've been trying to put on weight so having snacks of nuts (specifically 5 Brazil nuts after tea) never thought about that as there's naff all carbs in them. Left them off last night though and dead level libre trace over night! Might try having them just before bed instead, think my tea should how mainly digested by then!

Cheers for all of the advice.
 
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