Struggling with evening meal

Hi have you checked your basal rate on an evening? Ie no carbs. just to make sure it's your meal that's doing it. Are you on injections or pump?

@Casper60, can you provide an example of a typical meal, blood results and timings? And as @1Sarah1 has said, when do you do your basal?

Casper60 said:

I do my Basel at 9 pm and my tipical bloods start off about 7 than drop to 3-4 than arise of up to 15 after 4 hours. This seems to only a problem with the evening meal so I can't understand what's happening. I take injections but have applied for a pump but have been told by the consultant that my units are too small and because my Basel is only 7 it would be difficult to split that dose over a 24 hour period.

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When do you eat your evening meal? I suspect that the rise over four hours is partly due to your basal running out rather than you having too much of it.

Based on what you've mentioned so far, it sounds as though your I:C ratio for dinner is probably a little too high, resulting in the post meal hypo, but in addition your basal insulin runs out after about 20-22 hours, resulting in the later rise in levels, as your evening injection will take a couple of hours to kick in. As a result, you get both the low and the high, and it doesn't make sense.

In response to your consultant, there's nothing stopping you from trying splitting it, probably starting with 4u in the morning and 3u in the evening and then adjusting from there. But that's a decision that you'd have to make for yourself.

As an aside, when I was on Lantus I used a lot more than you and split the dose.

Casper60 said:

I do my Basel at 9 pm and my tipical bloods start off about 7 than drop to 3-4 than arise of up to 15 after 4 hours. This seems to only a problem with the evening meal so I can't understand what's happening. I take injections but have applied for a pump but have been told by the consultant that my units are too small and because my Basel is only 7 it would be difficult to split that dose over a 24 hour period.

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Hi @Casper60 I agree with @tim2000s that it coukd very well be your basal running out.

I don't know what your consultant meant about your "units being too small". Babies and toddlers go on pumps and I'm sure their total daily insulin is tiny. I also have a small basal amount - 7 units approx - and have absolutely no problem splitting that dose over 24 hours. In addition, the pump allows me to tailor my insulin to my need hour by hour eg having more to cover the Dawn Phenomenon.

Casper60 said:

Basel is only 7 it would be difficult to split that dose over a 24 hour period.

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Can't believe they've said that, the beauty of a pump is the ability to deliver insulin in very small increments, push them again and ask why it would be so difficult.

Provided basal needs are being met I would think that taking the dose after eating is worth a try.....

this would depend on whether your insulin/carb ratio is correct also......

if your always high 4 or 5 hours later after evening meal you could assume that the ratio is wrong.......even before timing is considered......

My 2yr old is about to go on a pump and she only has 3 units long acting so not quite sure why that would be an issue.

Casper60 said:

I eat healthy foods with plenty of fruit and veg, no red meat and occasionally sausages and bacon but my downfall is potatoes. Oven chips and boiled potatoes but I've cut down the amount instead of cutting them out altogether.

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Try dropping potatoes altogether and looking a lower carb alternative. I couldn't handle potatoes at all no matter how much insulin i used and gave up. Now I eat cabbage or celeriac root as a substitute. Roast Celeriac root is delicious. I never tried it but there are numerous mashed cauliflower recipes as substitute for mashed potatoes.

The exact same thing happened to me when I ate potatoes or any starch for that matter. I have found the only way to get my insulin there at the same times as my carbs is to only eat above ground veggies as my carbs. I eat 30 C per day and not all people are willing to do that but it was the only way for me to stop the hypo/hyper rollercoaster.
Avocado/Guacamole is my best go-to food for steady BS. When/if you drop potato/starch test often. You will need less insulin.

That's a big weight loss. I sympathise as I'm slim myself. I carb count and I eat approx 180g carbs a day and good amounts of protein and fat. I don't have any problems with potatoes. The only form which catches me out is mashed potato, but I think that's because it's harder to count the carbs.

Have you tried sweet potatoes?

Have you tried something like adding beans or pulses to your meal? Or extra fat?

I still think you should look at your basal too as it seems you've tried a lot with your bolus.

Before FINALLY being diagnosed as T1 I lost tons of weight and was severely malnourished and protein deficient. I was literally skin and bones. For me just starting insulin helped tremendously. I gained my 20#s back and it stopped. I only ate 20g Carbs with each meal for the 1st 2 months but could not stabilize BS. (hypo/hyper in a matter of an hour). Since then as I said I only eat above ground veggies for carbs as that is the only way to keep BS steady. However I eat a LOT of fat in the forms of avocado, nuts/seeds, olive oil, olives and mayo. I don't eat a lot of saturated fats as they too raise me but I require LOTS of healthy fats for energy, steady BS and weight maintenance. If I don't have enough fat in a meal I roller coaster too. I eat moderate amounts of protein. Mostly fish and poultry but I do eat small amounts of red meat.
In the absence of carbs over 50% of protein turns to BS so I bolus for that too. I have to keep carbs low, protein moderate and lots of fat to maintain good BS. Not all diabetics choose to eat this way but when I roller coaster I feel like I am crawling out of my skin and not to mention the fear od serious hypos. I put that all to rest by the diet I have and take 1 unit Novolog with each meal so hypos never get scary.
I would recommend changing some of your carb to fats. Fats slow digestion therefore slow spikes. Balanced meals work well. Some veggies, some protein and more fat. My diet is 75-80% fat. Blood lipids are good as long as I don't over eat saturated fats.

This works for me but not every one wants to do it. The idea behind it is that all carbs (even lettuce) turn to BS, 50% of protein and less than 10% fat. So if you minimize the foods that turn to BS (carbs and P) you minimize BS. Fats will also help people gain weigh.
Hope this helps, I understand the too skinny thing all too well.

The other question is what are you eating for your other meals? Maybe less high GI carbs? Could that be why you don't have problems with BF and lunch?

The other question about basal / bolus is what are your numbers before you take basal and fasting? If they are within 30 points you are taking about the right amount. Then you would need to find meals and doses that work with bolus insulin. I have found consistent meals from day to day at each meal works best. About the same amount of carbs, P and Fat. Then I know exactly how much to bolus. Basal is supposed to keep you steady during fasting times (sleep) and not used for meals, that is what bolus is for.

Casper60 said:

My weight has plumitted since I've started carb counting so I need alternative foods to replace the potatoes and other starchy vegetables. I've lost over a stone in weight in 3 months so I'm struggling to keep what weight I have (I weigh just 7 stone and been told at clinic I'm seriously underweight). Any more advice please.

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What's your calorific intake a day? And have you had any thyroid checks?

Have you tried injecting in a different location? I seem to be really sensitive to insulin taken in my stomach (having a big drop after food and going high if I have a lower I:C ratio) in my leg it seems ok though, I've started splitting between the two sites to try and stop peaks and drops...

I've also upped my carbs again after losing weight going low carb, don't think a low diet sits me unfortunately!

You could also ask to try a different long acting, I've mentioned before I've had a lot of success with Tresiba, it's longer lasting so shouldn't run out on you (I'm on 7 units per day myself).