Basal problems

Type 1 and LADA
1

For the past 2 weeks I’ve been high altitude hiking, strenuous from 6 to 8 hrs per day. Carbs and MDI bolus during/after hikes have been adjusted OK and I have not experienced notable post meal spikes. I have however managed to totally screw up my basal and would appreciate any ideas how to get back on track.

At home my basal was 14 - 16 units Lantus in evening. I had a strong low dip at about 6 hrs. I switched to 12 hours apart basals and have been cranking up to 9 in AM and 9 in PM with no success. My problem has been 200-250+ BG in late night, 8-9 hrs after my dinner and evening Lantus. I have had to take 2-3 units Humalog to correct night time highs many nights.

My ideas of the possibilities are:
A. Spilt basal does not work for me.
B. Lantus is spoiled or slightly spoiled.
C. Somehow the extra un-bolussed carbs I am taking to cover the exertion (50-75 extra grams daily) is hitting me at night (?).
D. My dinner bolus is too low.
E. Altitude creates need for higher basal.

Any thoughts about this will be appreciated. I’m mostly off the grid so might not answer for a few days. Thanks in advance.

2

First thing I would ask is–what are you eating? Some foods can push the carb load out many hours from when you ate. I’m talking to you, Olive Garden!

Even if you had a pump, delayed carb action can throw you. But the other half of that is, if you did have a pump, you could adjust your basal a bit at night.

I personally don’t use more insulin when I’m asleep, but many people do. it may be that you need more insulin at 5am. Wait, you could be having a really big push of glucose from your liver as part of waking up. How long are you sleeping and when are you getting up? Changing those may reset your body’s clock and throw everything off.

3

try bedtime and when you wake up for basal

4

Just to follow up, it must have been the dinners. I tried to guess on carbs most nights. Bad guesses I guess. After the hike was finished, I got back to normal meals and switched back to evening basal, now all is well.