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Struggling with nighttime basal

there does appear to be a morning liver dump in 2 of the pics . and the flat looking one is right in range as a midnight start point

also the 2 with big spikes are looking like rebounds so perhaps your body is sort of going into overdrive
to correct the drops during the night
 
There is, I normally take 1.5u on waking to stop DP. The spikes after the nighttime low I think might be a combination of hypo treatment and DP, or do you mean later on in the day?
 
Three of the four graphs show a very steep drop from midnight followed by a sharp rise. I'm wondering if your evening Levemir dose is actually too high. This might be causing the drop causing a liver dump & subsequent steep rise.
Although two of them don't show you going low it could be that the cgm is a little out & you did have enough of a hypo to trigger a liver dump?
Even the better graph is rising quite steeply at midnight perhaps relating to an earlier drop?
I'm not a Libre user - what do the coloured dots represent?
 

The coloured dots are whenever I scan to check the values. The two steep drops in the right-hand pictures are following correction doses. My Libre isn't normally off by that much so I don't think I will have actually gone hypo, however it was a very steep drop nonetheless. Maybe my body could somehow feel that and dumped some glucose anyway to try and prevent it from plunging into a hypo?

I have been planning to reduce my Levemir for a while, particularly based on those low nights. Every time I plan on doing it, I get one of those weird highs and it gets me all confused so I don't know whether I should do it or not!
 
Sorry @Levy I do remember now that you were on tresiba - how long did you use it for ? I was on it a couple of years ago and it took me a month or two to really settle in with it after making the adjustments.

Anyway going back to your current - personally I would look for more data before making any decisions as there are a number of hypos on your charts and I would be reluctant to make any adjustments from this data alone.

Few questions, what's causing your hypos ? How are you treating your hypos ? Also when are you taking your levemir ?

I would for the time being write down a carb/insulin diary to go with this data and also include exercise too so duration and type, the more info you have the better.
 
@Juicyj I used Tresiba for over two months and saw no change in the nighttime spikes, but they disappeared as soon as I moved back to Levemir. My injections are taken at 8.30am (14u) and 7.30pm (16u).

I have been keeping an extensive diary as you said. All food, insulin, exercise and everything else of interest was included and my consultant has also seen this but neither of us have been able to come up with any explanation so far. I will continue with it though.

The hypos are post-meals and should hopefully disappear now I've tweaked my I:C ratio slightly. Hypos are always treated by either a swig of fruit juice or 2/3 jelly babies.

I've been wanting to do day-time basal testing, but as I suffer from DP I can't NOT take a correction dose in the morning. As you're supposed to not have any bolus active, I wasn't sure how to do it.
 

If you do decide to adjust your Levemir, only reduce your evening dose by one unit then review it over 2 or 3 days. Might be sensible to discuss it with your DSN if you are not sure.
I'm a Levemir user on bigger doses than you & getting the right dosage was a slow process. It initially worried me that I needed much bigger doses than I had on Lantus, but have now found doses which give better horizontal overnight graphs than Lantus ever did.
 
Levy said:
I've been wanting to do day-time basal testing, but as I suffer from DP I can't NOT take a correction dose in the morning. As you're supposed to not have any bolus active, I wasn't sure how to do it.
Click to expand...

With basal testing you need to split this up into 4 segments (overnight, morning, afternoon, evening) and as long as your below 13mmol/l then carry on - so don't bother correcting, however if you do go over 13mmol/l then stop the test and correct. http://www.salforddiabetescare.co.uk/index2.php?nav_id=1007
 
I do go over 13 though if I don't correct. Also, if I only have 1 Levemir shot to cover the day, so how does that work for morning and afternoon because it's not like I can have a different dose for each.
 
Hi Levy, all you are doing is looking for patterns where your BG levels rise/fall by more than 2mmol/l, which then indicates your basal will need adjusting, by breaking it up into 4 segments it's easier for you to cope without the need to eat if you feel that you want to test your basal for longer then just carry on.

If you're going over 13mmol/ try and ensure that in the period before you start your test that your in range by correcting with your novorapid or start it when you are in range (with no quick acting on board) always 5 hours from when you last ate/injected. You could also try eating something low carb too if it helps you stop this rise, best times to look to start it would be afternoon/evening
 
Thanks @Juicyj - I'll give it a try

The only other thing is that even if I did nighttime basal testing, I wouldn't actually trust just the one result purely because I've been seeing such different trends every day. I'd have to do it several times to make sure the outcome was the same before making an adjustment.
 
I agree with you @Levy dont act on one test alone, and also don't make more than 1 adjustment within 3 days of each other, let us know how you get on though as I'd be interested to see what your outcome is
 
I would suggest that your acting time for your bolus needs to be extended... what is your meter set at 4 hours? You may need to tweak this to 5 or 51/2 hiurs.

Basal testing can still be done and should be done uf you have to have correction for DP in mirnings as well.. you want to know that correction is bringing you back to target level at 5 hours from taking it.... so any correction should also be rested to make sure it is right...

I too found tresiba gave me soikes late at night and others dont...
I have also pumped and cannot go back to a pump as my skin blocks the cannulas. I've settled with 3 jabs of insulatard a day but like you also find I can have a few good days/nights and then things go pear shaped.
However, my levels do change around whether my hubby is on his one day of earlies each week, stress (and I have other illnesses to add in to my stress-which have a greater impact and also exercise can throw me enormously.. even if I change from one dog walk a day to two or none as my hubby takes her on both.. or even dog training... but even with identifying those things I still get random blips.. yet I especially eat the vast majority of my my main meals being the same veg, and same food and very, very rarely eating during the day...

Are you exercising on any of these days, or having a day off or weekend off?
 

What's the reason for the extended bolus time? I've always found my Novorapid works very quickly. I don't have to pre-bolus for meals (I tried once and had dropped from 8.6 to 3.8 in 40 minutes).

I also don't have a meter that calculates anything, I do it in my head. It is a good point that that means I normally don't take into account any insulin on board, but I always assumed that whatever is on board is needed to either cover what I ate before, or to correct a high so whatever I eat on top of what would be separate anyway?
 
Your drops from rises are too quick... at any time on all those pictures... acting time is different to offset time... if you drop to normal or below to hypo levels before 5 hours then your acting time is likely to be too short.. this has nothing to do witb the time it starts to work or whether your rises after food are ok...
 
Sorry if I sound really stupid but I don't understand
 
I would suggest you ask your dsn for an accuchek expert meter this will help you determine things better.
 
If you are not taking into account insulin on board at all or know how long bolus acts in your body this too can impact upon the way things act at night especially if you have to correct at all in evenings..
 


Hi, sorry to resurrect this old post but I just wanted to share a small success! My nighttimes have finally stabilised after a lot of basal tweaking and have been very stable over the past week or two!

When i started this thread I was on 14u in the morning and 16u at night - I am now on 16u in the morning and 10u at night and it seems to be working well so far! Very happy to have this large part of my day finally sorted, thanks for all the help!
 
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