unmanageable nighttime highs

Am posting on our teenager's behalf, who has had diabetes for 1 year now and maintained very good control until about six weeks ago. Since then, the glucose readings are consistently high at night, no matter what he eats or when he eats; and no matter how much insulin he injects to correct those highs, or which ratio he uses, the readings do not reduce. Daytimes are fine.

He has (in consultation with his diabetes team): changed insulin cartridges; increased his nighttime Levemir, and the timing of his nighttime Levemir; changed his nighttime insulin ratio. Nothing makes any difference.

We are at a complete loss as to what is going on. Is there anything else he can try?

Perhaps also important: he tends to eat at around 7 or 8 pm, mainly (but not exclusively) slow(ish)-acting carbs, rarely more than 60 carbs. Levels stay between 5 and 6 and then rise rapidly at around midnight to >10 mmol, where they will stay (level) until breakfast. Insulin, if injected, works only after at least three hours, if at all. He wears no pump, but has a CGM...

Hi Juicyj,

no fatty meals, just wholemeal carbs (rice, pasta, other grains) and vegetables. Sometimes pulses. It doesn't really seem to matter what he eats - for example, a dinner of scrambled eggs and peppers has the same effect as, say, a plate of pasta. Exercise has stayed the same, he rotates injection sites (but injects in his arms, mainly) and he has moved the evening Levemir injection to 6 pm (from 10 pm; mornings at 6 am).

Re Tresiba - once risen (the rise takes about an hour), his levels remain flat throughout the night if he doesn't correct, I thought that suggested that the basal insulin was fine? Very happy to stand corrected.

And would a different basal insulin somehow make the short-acting insulin more effective (as mentioned above, corrections don't seem to work, or work extremely slowly, at night. All good during the day though)?

Hi Engineer 88 and urbanracer,

thanks for your suggestions. Re pumps - he isn't keen on sticking more than one device on his body, and on balance, the CGM seemed the more important option... but he uses Humalog and during the day, it takes about 15-20 minutes to take effect.

Re intermediate insulin - can this be combined with fast-acting insulin (i.e. Humalog during the day, and intermediate in the evening)? Am concerned about the potential loss of flexibility, but I guess something has to give...

16!

I had thought about it, but his team did not suggest that this could the reason.

Hello urbanracer,

thanks a a lot; he changed his basal timings two weeks ago.

Will ask about intermediates.

thanks a lot, everyone!