Night time high BG

I think this is a good solution - it should work. Perhaps 2 basal dosages are all you require. If so, then syringe insulin should work just fine. I don’t have any problems with your proposed solution. Its totally the right place to start.

I have decided to wait on splitting my basal injections. With Lantus, I did this because the regular dose seemed to last 20 hours and then fade, so I had highs in the early morning when I took my shot in the morning, so I took a larger shot in the morning to get me through the day, and then a smaller shot at night to boost its effectiveness during the early morning (3 to 6 am) hours. I switched to Triseba after doing research and finding out that this appears to be better at working for a full 24 hours (because it actually lasts up to 36 hours). I am now on my second day of not eating anything after dinner and things are going better. I am also realizing that I need to pull back a bit on my bolus dosage ratio, because for the second night, I have gone low a few hours after dinner. without snacking (and then I’ve corrected with glucose tablets or juice, just enough to get me back to 90-100) and then I tend to stay at 80-90 all night, through the morning. So, hopefully, splitting doses won’t be necessary, and with Triseba, as others have said, if I split doses, I risk stacking the basal insulin, which could get tricky.

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Sounds like you are doing very well Michael. I think one of the best things about using Tresiba is that there is no need to split the dose.

Hey, just wanted to report that my Dexcom clarity app is showing that my average blood glucose has dropped in the past week from 133 to 113. Still tweaking the Triseba dose, but avoiding snacking after dinner continues to be a good solution for avoiding going high at night (but still have issues with going low when my BG is within normal range).

Wow! A 20 mg/dL drop in average blood glucose is a big drop. Congrats on doing the hard work of cutting out after-dinner snacks. Thanks for the update.

I have used Lantus, Levemir, and now Toujeo for long-acting. Every few years my endo tells me about the latest insulin with durations of 24 hours, 36 hours, and now 42 hours with Tresiba. With each one, it comes back to the fact that my A1c’s are better with splitting the dose morning & night vs. a single dose.

My nighttime CGM graph, unless I eat something late in the evening, is now usually flat - wherever it starts at bedtime is where it ends in the morning. Also almost zero “dawn phenomenon” which is great. I’m often not ready to eat and get going with short-acting insulin right after I get up. Totally works for me.

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I use also Tresiba but I’ve had no problem with it normally lastly well over 24 hours. The only time I have problems with high blood glucose while sleeping is caused by eating too late (I try to eat at 5 pm and go to bed at 10 pm) and eating to much protein and especially fats at dinner as a shot (I’m not using a pump) of Humalog at mealtime does not last long enough to cover it. If I can’t avoid it I usually take a little Humalog a few hours later or at bedtime knowing it is going to go up. It’s a little scary taking Humalog at bedtime if it’s not overly high “yet” but I usually look at my CGM and if it is trending up it is a good indicator to take a “booster” of some Humalog. Also as you age your digestive system typically takes more time to digest foods and it helps to thoroughly chew your food to make digestion easier. Hope that helps!

Have you ever considered experimenting with Regular insulin in this situation? Its longer active time can better match the slower digestion of high fat and/or high protein meal.

I have not done this experiment myself since I favor using an insulin pump. Before I started looping, I used extended pump boluses to dampen down any late rises from certain meals. An extended bolus is similar in action to the longer acting curve of Regular insulin.

@Terry4 I thought Humalog was a “regular” insulin, do mean use an intermediate acting insulin like NPH? That would also work but sounds more complex than my 2 shot approach of Humalog with a shot at dinner to cover carbs and a second shot a few hours later to cover protein/fats, which gives me a similar effect to an extended bolus using a pump or using NPH combined with Humalog at dinner. Since I don’t use a pump I end up having to give myself 4 to 6 shots of Humalog a day to get good control so it’s no big deal. Seems to work since my time in range has been around 87%, which I think is great for someone not on a pump.

@Mike_F – Humalog is in a class of insulin formulations known as rapid acting analog insulin. These insulins became available in 1996 when Humalog was introduced. Within a few years Novolog and Apidra joined the ranks of RAAI. Please excuse my review of relatively recent insulin history.

Regular insulin was on the scene for many years before the rapid acting analog insulins arrived. It was the early '80s when Genentech formulated the exact match of mother nature’s home-brewed insulin, amino acid for amino acid. And this manufacture was done using a recombinant DNA process using beneficial bacteria strains to do the work. I believe the first commercially produced insulin of this type was Eli Lilly’s Humulin-R in 1982.

Up until this time many people used insulin that was animal-derived (pork or beef) and those insulins were close enough for good therapeutic effect but not an exact match to natural human insulin.

Humulin-R shared the performance characteristic of the short-acting animal insulins.

The biggest advantage to using Regular insulin is that you would not need to follow up with Humalog-booster following a meal.

Humulin-N is another form of this exact-match to human insulin. It adds another ingredient to slow down this formulation and is termed an intermediate action insulin. It acts similar to the much longer used NPH.

It sounds like you are satisfied with your current insulin regimen and you should be with 87% TIR. I only commented since you mentioned the secondary rises you get after dinner. Learning and using more than one method to achieve the same effect has little downside and may come in handy in ways you had not considered before.

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