any comments on I let pump? That is recommended being pushed by Dietician and Dr. Endo. I am still doing MDI and lots of them for glucose fluctuations.
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You are getting too much basal during the night. It could be that your evening meal bolus is too high. Otherwise, if you are splitting your basal, then your evening basal dose is too high. Either way, too much insulin during the night.
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What besides a pump has your healthcare team suggested for the overnight lows? Is it a slow drop over a couple hours leading to a low or a sudden drop over 15-30 minutes?
Until you figure out the cause the temp fixes are shoot for a higher target BG before bed and/or eating a low glycemic index snack before bed.
If you split your basal dose you can take a lesser dose at bedtime. As said before it is either too high of a basal dose during the night or some kind of night time bolus hitting your system at night. Especially if you take a dose at night. While Basal insulins are long acting, they vary in strength. Lantus basal is notorious for getting night time lows, Lantus peaks at around 6 hours after you take a dose, so if you are taking a dose at night, it could be hitting you while you are sleeping or it is too high in general and it’s more prevalent at night when you aren’t eating. It’s also notorious for wearing off before 24 hours. I included a chart before of peak times.
I don’t know anything about the pump mentioned. Some endos seem to push a specific one, maybe it’s because they only have to deal with the same one and it’s easier? But if you get a pump, you only get one every 4-5 years per insurance. Except possibly Omnipod which can be handled through pharmacy depending on your insurance.
A pump allows you to vary the dose depending on need. But you probably need to do some basal testing to see if your basal dose is right.
https://www.diabetesnet.com/about-diabetes/insulin/insulin-action-time/
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Thank you for your informative response, Marie. I take Tresiba at night which I was told was 30-48 hours in action. Told to take daily despite this…never explained reason for the change but was warned about Lantus and lows. I do not seem to get a many lows but sometimes take bolus at night because my glucose is so high…and don’t want to sleep with it that high. High risk of getting low early in AM. Do you see and endo and if so, how often? I have read that people only see them every 3-4 months which did not seem enough for the mess I am in.
I see my endo about every 6 months by choice. A pump requirement is every 3 months and the CGM requirement is every 6 months by Medicare. I have a patch pump Omnipod (with partial MDI) which is weirdly covered by Medicare under Pharmacy and has no requirements. I usually have a 5.1-5.3 A1c and am in range 96%. So it really isn’t necessary for me to see an endo any more than the requirements I have to do and checking blood work to make sure I stay healthy). She is wonderful, my 3rd endo, but mostly there for script writing. I learned everything I know mostly from this site and from the helpful people on it when I first started using insulin and was failing/flailing and started looking for information to help. I was misdiagnosed and given no information about insulin dosing.
One question, are the lows only on nights where you have taken an adjustment dose? Because if it is, you might consider you are taking too much? Your correction dose might be too high or you aren’t letting the insulin have enough time to completely work? If it is only on those nights for me I would consider lowering the dosing some.
If it’s not only on those nights. Then eye the last time you took insulin and the amount you took. I need less insulin per carbs at night. I usually have a couple of crackers or a tangerine with some vitamins and often take no insulin with it at night. It usually is under 5-10 carbs. I have taken correction doses, but I try not to overtake it. I can be guilty about that because I want my levels down. My last insulin dose is best before 6 pm, otherwise I can end up dropping too much at night easily with a correction. If you are eating and dosing later, maybe you need to adjust the insulin you are taking or add a snack before bed, to boost your levels a little more. Maybe write your BG down at bedtime and make a note if you dropped. It might give you a better idea of what your bedtime level needs to be.
And if your basal is off, it throws your bolus dosing off. If you are taking too much you drop too much when not eating, if you aren’t taking enough you end up taking extra insulin and then can also drop too much.
Tresiba most/all don’t split it and I think it stays pretty flatline. It is meant to be daily. The dosing is based on that. So you might be taking too much of it or it could be your bolus dosing at night. Always do very small adjustments at first! And with Tresiba adjustments, your results might take more time to figure out. Maybe someone on Tresiba can help you better with that to know more about if you need an adjustment on basal.
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An add on. High fat meals can slow your insulin working as fast. Even a high fat meal can affect me the next day! And protein needs some insulin. It varies how much protein can affect a person. When eating a medium carb meal a lot of people don’t add on any extra for protein. But if I eat a high protein meal and lower carbs? I need to dose for it. And protein hits the system usually later than carbs. Heavier exercise affects levels too. I ride my exercise bike almost daily and so don’t make adjustments for it. But if I snorkel I need to lower my basal rate for almost a day. When I started PT the same thing happened. It wasn’t strenuous exercise but I guess it was different than what I am used too. When I start to go to high my preference any time of day is getting on my exercise bike until I start to drop. But some people have an issue exercising too close to bedtime.
Thank you for that thorough response. This is the kind of information I have been craving for over a year since I joined and could not communicate with anyone being blocked!!
You say you got most of your info from this website?? I have already gotten more ideas in two days than in three years, my first dietician being helpful but I now look at as lacking in teaching me general coping and glucose regulation.
My first endo told me it takes 12 years for someone to (die) of diabetes effects ( I assume unregulated glucose). What a thing to say?? She also emphasized the Type 1 was not my fault (four times). That was nice but I wondered why I got this at age 72. I wear the Libre 3 CGM. How does the Omnipod pump work out for you? I was shown that but told have to use G 6 with it. Do you have to enter carb amounts eaten into phone? I want a pump that adjusts to what I am eating? Does Omni do that?
Thanks for the help.
Marie, Was not aware fat and protein need insulin as much. I only count carbs (when I do)…and give no thought to the protein or fat. You have your glucose regulated very well….I am a mess……I remember when I told my CDE that my glucose was in range 75% of the time like that is the goal….she sort of scoffed. Yours is 96%, a model Type 1. I just wonder how much damage I have done to my brain as I read both high and especially low BS damages brain cells….don’t seem as sharp anymore.
Hi Andrea,
I wouldn’t stress too much about whether your episodes of high or low blood sugar have damaged your brain. It’s impossible to tell and you can’t change the past - although I would think it unlikely. Having wildly bouncing blood sugars will tire you out, make you feel like hell and make it hard to “stay sharp”. If you can get a handle on your control, you will probably feel sharper.
I encourage you to count carbs all the time so that you can accurately dose and adjust doses if you regularly go too high or low. Eating the same foods most of the time will enable you to better tailor your dosing.
I think the “standard” goal for TIR is 77% between 70 and 180 so if you’re actually at 75% then you only have to stay in range 30-45 minutes more each day to meet that basic goal! Once you achieve that you can work on trimming the highs and lows and continue to improve.
The Joslin in Boston has a 3 day outpatient program to help people improve their diabetes regime. I took it 18 years ago when I was first diagnosed and it was excellent. You might check it out.
Maurie
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@Andrea8 Fat doesn’t need insulin itself, it just makes you more insulin resistant. So you could end up needing more insulin for carbs because of that. It also slows down the absorption of food so the carbs you eat hit later, meaning you have a tendency to spike later. Insulin helps with protein use in general, but the trick is it will use protein for energy if there aren’t enough carbs. Hence the high protein low carb meal spiking BG levels. Some people seem to be more affected than others. I bought a high protein low carb shake thinking it was a safe thing to consume and my BG levels kept spiking. Then I found out why. So some will dose when they consume high protein low carb, but at a much smaller ratio.
It’s just like the other day I hadn’t eaten except for a piece of toast in the morning and it was near bedtime. I figured I probably should have some protein for the day so I made a couple of vegan hot dogs (no bread) and ate them with just some ketchup. I took 1 unit to make up for the ketchup and didn’t think about it. Until 2 am my CGM alarm is going off and I’m 188 and climbing. I was tired and thought it might be my pod site failing and took some insulin and went back to sleep. In the morning my numbers were perfect once I dropped, my pod site was okay and then I realized hot dogs and the protein, and that it hits hours after and it has never worked out for me before when I’ve eaten high protein before bed. It just had been awhile before I had done that and forgot!!!
That’s me though, one thing to learn fast is we can all respond differently to anything.
I have great control, but I still have issues too!!! 76% TIR is great and better than most type 1’s. That’s why your doctor is happy about it! Bg control takes work and keeping track a lot and some people have extra issues that can make it very difficult. A lot of us on this site have a tendency to be very avid about BG control. Learn the basics and @still_young_at_heart is right, then you start to refine the edges.
I use a Dash Omnipod, I love Omnipods patch pump. But I am having a lot of site issues. The Omnipod 5 is supposed to make adjustments to lows and highs. But you still enter information into it when you eat. I think someone using it might be able to help you more with that.
I learned eating protein without carbs like @Marie20 did will cause the body to eventually covert the protein to glucose. Eat protein with carbs, no conversion. It was in Gary Scheiner’s book Think Like a Pancreas. The fourth edition just came out.
thank you, Maurice for your response and your wisdom. The problem is I’m not at 75%. I’m lucky if I get the 45% or 50% in range.
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When I am high at bedtime (like 325) I take some bolus so I am not sleeping with that glucose level. I know it is risky for hypo but often I wake up over 250 if I don’t take any bolus. Like last night I was 242 at 12:30 am and took 5 bolus which would lower it 200…woke up this morning with 126 BG…which is not common for me.
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Thank you young at heart…..I searched Joslin and found there is one nearer to me in Syracuse, NY…I live in Buffalo, NY
You’re very welcome. I hope either the Joslin program or your endo team can help you get everything sorted out.
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If you don’t have a CGM, get one. The readings every 5 minutes will show patterns to which you can adjust your insulin delivery. If you are MDI, splitting the basal dose will be a great idea. Too often peope (including Endos) think that a basal insulin works for the full 24 hours, and tht your need for insulin is steady throughout the 24 hours.
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You are using the word basal the way I was told….longer acting insulin. A type of insulin. Yes I do have a CGM (after 2 years dietician recommended I get Type 1 test because such poor maintenance). I would nuts without it though it is sort of compulsive (the checking). If I had to prick my finger 20 times a day I wouldn’t do it. In fact, when time to change sensor (get to take a long bath) I check on finger and my fingers are sore (and bruised) after 3 finger glucose. Also I am getting high nightime BS (even when Novolog taken at 8 pm…..like last night 351 and rising at 1:30 am…took 6 units fast-acting, had taken my regular long-acting at 12:15 am, woke up with 116. I worry about taking fast so late as they have warned me about low BG during night….But hate to go to bed with it over 300.
Have a Libre 3. Maybe I will talk about splitting my Tresiba into morning/night
doses…..take 22 at night. Have to get confirmed with new endo…On my own I upped the basal insulin to 25 a day. Not sure it does anything
Tresiba, while taken daily, lasts 40ish hours so there is no need to split your Tresiba dose.
Since you and I are doing MDI we take different insulins for our basal (Tresiba) and our boluses (Novolog). People with pumps only take rapid acting insulin like Novolog. They get their basal from many, more than a hundred, small doses of rapid acting insulin delivered by the pump all day.
Did your previous endo/NP/PA have you using a sliding scale to dose your rapid acting insulin?
Insulin and Type 1 Diabetes - Breakthrough T1D
Basal, or long-acting, insulin starts working about an hour after injection and tends to lower glucose levels for 24 to 40 hours, or almost a full day.
Examples: insulin glargine (Lantus, Toujeo) and insulin degludec (Tresiba)Bolus, or rapid-acting, insulin is administered at mealtimes and to manage high glucose levels. Rapid-acting insulin starts working about 15 minutes after administration, peaks (or is at maximum effectiveness) in about 60 to 90 minutes, and continues to work for 3 to 5 hours after administration.
Examples: insulin glulisine (Apidra), insulin lispro (Admelog, Humalog), insulin aspart (NovoLog, Fiasp), and insulin lispro-aabc (Lyumjev)
Automated Insulin Delivery Systems and Insulin Pumps - Breakthrough T1D
- Automatically deliver a small, steady flow of [rapid acting] insulin 24 hours a day (basal insulin), and the person wearing the device can deliver additional doses of insulin (called boluses) to cover meals and treat high blood sugar as needed
- Programmed to meet the individual needs of the person using it
- Insulin is delivered through a small cannula that is inserted under the skin with a needle. Common insertion sites on the body include the thighs, buttocks, abdomen, upper arms, and other locations where insulin can be injected.
- Used in place of multiple daily injections (MDI) of insulin