Facing a dilemma at the moment. Mom is currently on 19 units of Tresiba( she administers Basal around 7:30 - 9 pm) daily. However, 19 units keeps her blood sugar at about 90-125 all night and until 6:30 ish pm. But, right after 7-7:30, her blood sugar increases to 250-280. Why does the increase take place after 7 pm?
Her blood sugar numbers before 7 pm, are perfect. Anything after 7 pm, we’re looking at 250 and over.I am afraid to increase her units to 20 because what if her blood sugar drops during the night /day since 19 units keeps her at 90-125?
Any ideas on what to do? splitting the basal? start with 20?
Help!
*** Note-
Breakfast is at 8-9 am
lunch is between 12:30-2 pm
Dinner- 9/9:30
Thanks everyone for all of your support- you guys rock, really!
I’m almost positive it’s not that because, we have tried with different meals and slight adjustments with her ratios and the increase always increases after 7 pm? At first we thought maybe it might be the meals but this has been happening for a couple of days now- close to a week
Mom has dinner at 9-9:30 pm- she gives herself insulin 10-20 minutes prior to dinner.
She doesn’t follow a standard dinner menu, most nights it’s about 40 grams of carbs or 30 grams of carbs and about 10 grams of protein. But that’s not all the time. I have also noticed with low carb meals, her blood sugar would also reach 250+.
Mom has lunch at 1-2 pm
Her blood sugar does level out throughout the night only after I give her Tresiba at 9-10 pm, her blood sugar would be about 130 around 4-5 a.m.
Sorry about that, what i meant by post meals was ( Lunch)
Most days, lunch would be about 12- 2 pm ( 2 hours later her blood sugar would be about 110-120). 4 hours later, it would be under 130. However right around 7/ 7:30, her blood sugar would start spiking into the upper 250+. Her blood sugar doesn’t spike after breakfast or after lunch but rather right around 7 pm and on wards.
OK, got it. So, if she has lunch around 12-2, the bulk of her digestion will be over before 7, as will be (mostly her bolus insulin). So we can mostly rule out the effect of lunch, and she is having dinner after that evening peak.
I am not sure how old your mom is. Can you rule out hormonal peaks around that time? Or is she doing stressful activities around that time? Or exciting activities? What other reasons could possibly cause her to spike around 7:00-7:30?
My son is not on Tresiba, so my experience is not first hand. But everything I read about it seems to imply that a duration under 24 hours is pretty much impossible. One possibility would be how the effect of two Tresiba injections stacks. If each injection’s DIA lasts, say 45 hours for her, that would mean that she is always under the effect of 2 injections of Tresiba except after 6:30pm when the effect of the first day’s Tresiba injection would start wearing off. So, in that case, possibly from 6:30-9:30 she is only under the effect of 1 Tresiba injection, but the rest of the time she would be under the effect of 2 Tresiba injections.
Of course, the tailing off for Tresiba is not an on-off switch, so it is not that simple. If this happened to me, I probably would consider injecting Tresiba 2x per day. Have you discussed this problem with her endo?
I wish that some Tresiba users would comment on this thread:-)
she had lunch today at 1pm. 2 hours after lunch was 110, 5 hours after lunch was 132- 7 hours after lunch ( 8pm) was 278. Like I said, the spikes are occurring after 7 ish pm only. early on in the day as well as late at night, her blood sugar levels are under 130.
My mother is in her late 50’s. Usually around 7-8 pm, she would read a book/newspaper/watch tv. We went out for a walk earlier in the evening and walk we got back home, her blood sugar was 278. This was at 8:03 pm. I haven’t had a chance to speak to her Endocrinologist yet as he will be returning on Wednesday from vacation. I will def call him once he gets back. I tried googling possible reasons but I can’t seem to get a clear enough answer as to what may possibly be going on. At first I thought perhaps it may be the fat/protein digesting extremely slowly but it turns out the same thing pretty much happened with a bowl of tuna salad!
Instead of 19 units for tonight, I gave her 20. I’m hoping this makes a difference. I have actually thought about administering her insulin 2x a day- that seems to make the most sense in the event 20 units doesn’t work.
I will post back with updates
.
Thanks for all of your help!
As I understand it your mother had misdiagnosed diabetes for over a decade. And she recently got diagnosed as T1 after having severe symptoms including weight loss. If your mother had elevated blood sugars for a decade she may have something called “gastroparesis” which is damage to the nerve that controls stomach emptying. Bernstein has a bunch of information on gastroparesis on his site with many useful recommendations. It would be worth at least ruling out gastroparesis.
So it does not seem that it could be activity related at all, and probably not from stress.
Would you have noticed if it was happening before last week? If this is a problem of duration of insulin action, it is very unlikely that it would have just started happening.
I used Tresiba for about four months last year. I remember the package insert shows a duration of 42 hours. I found taking it once per day worked fairly well for me. I don’t think Tresiba is tailing off around 7:00 p.m., especially if you’ve been using Tresiba for three days or more. I never tried dosing Tresiba twice per day because I think it did its job well enough at once per day. You could experiment with taking half the daily dose twice per day and see what happens.
Mom had a whipple surgery on the 21st of November. For about 3 weeks, her blood sugar was completely out of control due to an infection. After she was put on Antibiotics, we were able to get her blood sugar to be in somewhat control besides the spikes after 7 ish p.m( current issue ).
Prior to surgery, Tresiba worked great. She was taking 24 units before and her blood sugar would 98% of the time be within the 98-115 range. There were days when she would forget to take Tresiba and her blood sugar would still remain within that range. I gave her 20 units at 8 pm and at 3 am, her blood sugar was 81. Good thing I checked it last night otherwise, she would have woken up with a hypo. Now it is, 143.
