Basal insulin at night

[mum2westiesGill]

Someone mentioned it on my Tresiba moving the dose time thread so I thought I would ask the question on a new thread.......

Why is basal insulin (any basal insulin not just tresiba) best taken at night?

 

[Lucyr]

I believe it’s more applicable to insulin’s lasting less than 24hrs but eg I take lantus, and it doesn’t quite last 24hrs. If I took it in the morning, the insulin would be running out when my blood sugar is naturally rising in the morning. Instead I take it at 6pm ish, because my most hypo prone type of day is about 5-7pm, so it makes more sense to have my lantus run out when I’m naturally on the low side not the high side.

 

[everydayupsanddowns]

I have no idea why this is the standard recommendation, but I’ve always wondered if it’s to do with onset time from things like Lantus. They can take an hour to get going, and I wonder if night time was felt to be the time when having a potential slight gap (if the previous dose is running out) might be best, rather than, say, the morning when you might have a liver dump going on (Dawn Phenomenon etc).

In my experience the best time may not be the night time at all. I’d had overnight lows off and on for years, some of them pretty nasty, and it was only after joining forums that I learned about basal checks and considered splitting or moving my basal to a different time of day.

Lantus at night for me was not a good time as it turns out. I was *much* better taking it at breakfast time.

 

[Inka]

When I first swapped to MDI, I remember the advice was to take the regular insulin pre-meals and the isophane or other basal in the evening to cover the night. This was an adaptation of the original two injection regime, so I wonder if the ‘take the basal in the evening’ came from that?

Two injections was fast/slow a.m, with the slow kicking in later to cover lunch
then a second lot of fast/slow p.m, the fast being to cover the evening meal and the slow to cover the night.

Original MDI was fast before each meal, then one slow (basal) to cover the night.

I was on normal human insulin then (ie not analogue) and maybe that pattern worked better with the regular (non-analogue) insulins because the fast lasted longer so could cover the daytime basically.

 

[khskel]

I take my levemir split doses at 07::00 and 17:00. Seems to work fine for me and usually get a nice flat line over night.