My fasting BG is still ~200. I am not taking a bolus before bedtime. Sometimes I am just too tired and fall asleep. Wondering what I am doing wrong? Taking Novolog bolus 1-4 units with meals, usually a 30 gram carbs meal, 45 grams at highest, not that often. I am new to insulin, started at the end of October 2016. I have brought my A1C down from 12.4 to 8.1 and now go to endo on Tuesday for 90 day check.
Just curious, do most folks have to take a fast acting bolus at night before sleep? It only lasts a couple of hours, right? Novolog only lasts a couple hours, I think…
I will try tonight to take a bolus around 11 pm if my BG is high enough to warrant a shot.
Trying to figure this out. I take Tresiba 16 units each morning.
I’m not familiar with Novalog or Tresiba but will share my experience with a similar pattern. I suddenly started with a high in the AM pattern (160-200 every day) about 18 months ago. I had been using insulin over 10 years and clueless as to why the shift in pattern. My Dr was new to me and had no insight. Was doing 2 shots/day w a different insulin. Had to be very careful with the second shot to not go too low at night. My last A1C was up so I asked to start pump therapy. I started on the Omnipod insulin pump last Jan and I was amazed that the night lows and morning highs stopped within two days! Getting a steady basal dose with a pump 24/7 made all the difference for me. My guess is that I was going low more at night than I realized and the “dawn effect” was kicking in. One thing I really noticed from the pump training was bolusing only for carbs to be eaten or correcting if your last bolus was too low. So different from shots which are trying to deliver basal and bolus in each shot. Not easy!
Ideally, you would be taking your bolus before meals in an amount to cover the carbs in that meal and if you did so accurately, you should be down to your pre-meal level (usually somewhere around 100) before bedtime. If your BG is higher at bedtime and you’ve allowed say, five hours from your last bolus for the insulin action to be over, yes, a correction of Novolog is in order.
But if your morning high is, instead, a result of a rebound from a night time hypo (also referred to Somogi effect) or the result of dawn phenomenon (a liver dump of glucose that often takes place in the early morning hours), taking an extra dose of Novolog at bedtime would likely be wrong timing and could cause a hypo (or an even worse hypo in the case of rebound) instead of a better morning number.
Sounds to me as though you should do a proper basal test. I strongly recommend you get one of the following books to assist in your diabetes control: Using Insulin by John Walsh or Think Like a Pancreas by Gary Scheiner.
Thanks-I think my basal may be too low. I may need to increase it by one unit per day for a few days and see what happens. I need to do a proper basal test, will work on that. I did check out Think Like a Pancreas from the library last fall. My granddaughter was here and I had to skim it. I will read more. Thanks
What you may be describing is dawn phenomenon. Here is a good description of the phenomenon by the mayo Clinic. If it is dawn phenomenon using Novolog is unlike to have much impact expect to increase the risk of going low over night.
I believe that additional basal insulin may be something to investigate, but I caution that you should discuss the matter with your doctor to come to a sustainable plan. your doctor will be able to provide some thoughts and recommendations to assist in getting better control of the early morning highs.
As others have mentioned, using a rapid insulin when going to bed won’t help with Darn Phenomenon. It will wear off before it is needed in the morning and actually might cause you to have a low overnight.
Tresiba lasts 42 hours, so a good approach to establishing a proper basal rate is to slowly increase your basal until your morning blood sugar comes down to a normal range.when you go to bed with a normal range (ideally less then 10-20 mg/dl change in blood sugar overnight). If you start to experience lows during the day then you will need to reduce your basal. I take my Tresiba at night, that means that I can be assured it has reached peak activity by the time I awake. You may never get a basal injection to work perfectly, but you just do your best and then take a correction in the morning if needed.
Thanks Brian. I would like to try taking the Tresiba at night so the peak will be when I wake up. How can I switch if I am taking it in the morning? Just start taking it at night? or half a dose the first night then a full dose the second night so I don’t take a 1.5 dose?
I need to get to ~100 in the morning rather than 200. I had a steak with mushrooms and onions around 7 pm. Ate nothing else and woke up with BG 210. Taking 16 units of Tresiba. So today I tried 17 units this morning. Will see in a couple days if it makes a difference in the morning and ask my endo tomorrow.
Actually they tell you that Tresiba is very resilient around timing. They say that if you miss your dose at night you can just take it in the morning. You would probably be fine just switching your dose timing from morning till night. If you want to be conservative you could take a half dose at night and then a full dose the next night.
I used to do this when I was on MDI (Lantus-Novolog) because Lantus didn’t seem to deal with my dawn phenomenon (DP), especially if I’d missed being able to get out for exercise for more than a few days due to sickness, weather etc. It kinda sorta worked more or less, probably by knocking me low enough that the DP had a deeper hole to dump into. This was way before I had a CGM and I wasn’t getting up in the night to test either. My endo did NOT like it, and as others point out it’s not a good way to deal with DP. She had me taking Metformin, which did help a bit (I still take it). I’m not sure why she never recommended splitting my Lantus dose, which seems to help for a lot of people–the stuff actually wears off before 24 hours and I used to take mine first thing in the a.m. But the only thing that really-truly finally kicked its butt for me was changing to a pump. Just gives you a lot more ability to adjust basal to your actual bio-rhythms.
