I started Tresiba some weeks ago and have found that it works much better over night keeping my blood sugar flat overnight. When I was on a split injection of Levemir I had to struggle with much more of a varying blood sugar profile overnight where my blood sugar would rise at like 3am. Now, it just is steady. But increasingly the problem is that it just sits there. With Levemir if I went to bed a little high the Levemir would beat down that blood sugar overnight. Not so with Tresiba.
So when I go to bed with a high blood sugar I’ll just stay high overnight. I’m thinking I need to correct high blood sugars before bed but it makes me nervous. I do have a CGM which provides some protection against a low, but it isn’t perfect. What do others do? Do you correct before bed? Does it make you nervous?
I would correct a 150 before bed. Especially since you know that the Tresiba is not going to drive it down, too. Maybe you could just be conservative and give half or three quarters what you would give when you’re awake. Another option would be to give a full correction and set an alarm to check. This is where Afrezza shines. It’s never driven me too low when sleeping. I looks like your Tresiba is doing a good job for you.
Took the words out of my mouth Terry. If I’m higher than 130 before bed I will correct with Afrezza and have no worry of a low overnight. Before Afrezza, I did a half correction before bed just to be safe.
I remember this same thing when I switched from lantus. At first I found it a little frustrating-- but the more time went by the more I embraced it as the basal working correctly instead of having learned to work around the sloppiness of lantus / levemir.
I would just correct (maybe a little more conservatively than otherwise) before bed… Some of the fears of correcting can be alleviated by what you described yourself, that with a good basal like tresiba, the basal itself isn’t going to continue driving your bg lower after the bolus wears off…
Or of course like mike and terry say you could just get some afrezza and never worry about it again…
I’ve not tried Tresiba, but have extremely stable BG’s overnight with my pump (except for some DP lately, that happens near-to or just after I wake up). My overnight BG is stable enough, that I never worry about going to bed even as low as 75. I do have a CGM to wake me in the event something does happen, but over the last few months, it has not given me a low alarm AT ALL other than the occasional false alarm - usually the first day of a new sensor.
So… to avoid making a short story even longer , I correct any and all elevated BG’s before bed without concern.
I’ve never tried Tresiba either and don’t have a CGM to check BG closely. But I’ve taken enough readings at various times of the night to have a good idea that the 8 units Lantus I take at 6 PM keeps me quite level until DP starts around 3 or 4 AM. So I correct any BG’s over 100 at bedtime.
With a correction factor of 34 or 42 (depending upon which bolus insulin I’m using), and insulin pens that require injections in full units only, that just means that if my BG is somewhere between 101 and 134, I take a small snack to make up the difference, along with one unit of insulin. Usually peanuts or cheese as a snack. Since I target a BG of 100, that allows for 30 points of error due to higher than usual insulin sensitivity caused by exercise or some other factor without going hypo in the night. Following this routine I’ve only gone low in the night twice in over three years, the lowest of those was a 52. I usually wake up to a number between 85 and 110 if I get up around 4:00 or under 140 if I sleep in as late as 10:00.
I should note, though, that I try to take my bedtime reading at least four hours and preferably five hours after my dinner bolus, to make it as accurate as possible. Taking that bedtime reading too soon can really mess up the calculations. I noted a few weeks ago that my BG dropped 65 points between readings 3.25 hours after bolus and 4.3 hours after dinner bolus of 8 units - enough for 64 grams carb.
I use Lantus at bedtime and tend to have a drop (“adjustment”?) about 3 am so I tend not to correct at 140. My correction factor is more reliable now that I don’t take Metformin so I feel more comfortable correcting a higher high BG…unless I’ve had a lot of exercise or some vino. Like you, I can only correct in full doses so I tend to be more cautious. Next time it happens I am going to give the Afrezza samples ai have a try.
ETA: The family wanted to eat at the new Vietnamese place tonight. I figure, no problem, I have Afrezza to correct if my bolus is off. Well, I needed a correction and got the samples out. Of course, wouldn’t you know, there’s NO inhaler! So down to the elliptical I go…
FWIW, since this stuff is so individual and time-variable . . . .
I use a split dose of Levemir, 10 PM and 9 AM. 120, give or take, is my pivot point. Much less and I will not correct. Much more and I will. I know my ratios and factors quite well, so I can dial in the right correction pretty reliably. Haven’t gotten into trouble yet. But of course that’s just one anecdotal case.