Very strange issue evenings/overnight - T1 with pump

manicdefender

Member
Messages
6
Type of diabetes
Type 1
Treatment type
Pump
DISCLAIMER: This post is NOT requesting medical advice but a general question to the community.

So I have been a T1 since 2007, generally well controlled (HBA1c is around 46). Been pumping for around 10 years. Most evenings I have this weird problem which results in my BG going low. So I'll do the usual, a piece of toast, or a few biscuits and milk etc. BUT it's a struggle to keep my BG up in the evening (what I would normally have in the day to treat a hypo, wouldn't bring my blood up sufficiently overnight).

So say I have the toast, and my blood will go up to 6-7. I would need to give very small bolus for it (say 5-6 units). If I were to have 2 pieces of buttered toast in the morning, I'd need more like 25 units. When BG comes up, it'll stay in range most of the evening. But this is when it gets strange. Always around 3AM I'll get a sudden spike where it starts to go about 9. But then as soon as I literally move in bed or stand up, a fast arrow points up and if I'm not on top of it, it'll climb to around 13-14. Of which I work hard to smash it back down again into range.

This has only started to happen over the last 6 months, with no real lifestyle changes. I am on the slightly heavier side and am T1. However, the consultant thinks I may be quite resistant to insulin generally so I am on Metformin additionally as a trial. 500mg before bed. I've always needed large boluses (think around the 35+ units mark) for most carby meals.

Other meds include Esomeprazole, Propranalol (for migraine prevention) and domperidone for nausea. Pump insulin is Humalog. Consultant appts keep getting cancelled because of all the strikes recently. But I'm struggling to think about how to describe this to them as it sounds crazy.

The basal rate is: 00:00-04:00 1.4 units per hour
04:00-08:00 1.60 units per hour
08:00-14:00 is 1.90 units per hour
14:00-18:00 is 1.25 units per hour
18:00-22:00 is 1.35 units per hour
22:00-24:00 is 1.50 units per hour

Any advice people?

Thank you.
 

eventhorizon

Well-Known Member
Messages
529
Type of diabetes
Type 1
Treatment type
Insulin
Hi.

If I were having this issue I would be increasing my basal in a 00:00 to 06:00 time slot. Also from my point of view of one (me), you're overall basal amounts look very low compared to what seem fairly high carb ratios.

The evening lows would suggest too much insulin at dinner time.

Purely my thoughts.

Cheers