Blood sugar rising in the evenings

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Pat91

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Hi all, any advice would be greatly appreciated. I have been slowly decreasing my tresiba night time dose as was waking up low. I'm on 17 units at night now. And my levels seem a bit better in the mornings. But my blood sugar is creeping in the evening. I normally take 1 unit for every 10 carbs but I'm currently take 1 unit for every 6 and I'm still going high.
 
Hi there, starts rising around 6.30 and I've normally finished dinner by 4/4.30.
 
Hmm, what a pain. I think you’ve had issues with your evening meal before? Do you usually eat supper? Could you try skipping your evening meal to see if you still go up? That might help see if it’s a basal or a bolus issue.

One thing I will say is that I find sitting down too long after a meal can mess my blood sugar up. I usually try to eat and then get up to move about the house a bit. If, for example, I eat and then sit and watch TV straight after my blood sugar will go up, but just moving about stops this and I get a more normal after meal result. I’ve noticed this right from the beginning after diagnosis. Just another thought.

Were you on Lantus before or am I getting muddled? I know Tresiba is touted as a great long-lasting insulin but, as with everything, it doesn’t suit some people through no fault of their own. You could try moving the time of your Tresiba but if that doesn’t work after a reasonable trial. I’d personally be considering a twice daily basal. So much more flexibility and usually an older insulin - a.k.a proven to work and not so engineered.
 
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Inka said:
Hmm, what a pain. I think you’ve had issues with your evening meal before? Do you usually eat supper? Could you try skipping your evening meal to see if you still go up? That might help see if it’s a basal or a bolus issue.

One thing I will say is that I find sitting down too long after a meal can mess my blood sugar up. I usually try to eat and then get up to move about the house a bit. If, for example, I eat and then sit and watch TV straight after my blood sugar will go up, but just moving about stops this and I get a more normal after meal result. I’ve noticed this right from the beginning after diagnosis. Just another thought.

Were you on Lantus before or am I getting muddled? I know Tresiba is touted as a great long-lasting insulin but, as with everything, it doesn’t suit some people through no fault of their own. You could try moving the time of your Tresiba but if that doesn’t work after a reasonable trial. I’d personally be considering a twice daily basal. So much more flexibility and usually an older insulin - a.k.a proven to work and not so engineered.
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Hi sorry for the slow reply, yeah was having the same issues with Lantus aswell. Thank you for the advice, will maybe look at doing a basal test to see if that is the culprit.
 
Type1Pat said:
Hi sorry for the slow reply, yeah was having the same issues with Lantus aswell. Thank you for the advice, will maybe look at doing a basal test to see if that is the culprit.
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My hunch would be that it’s a basal issue but with Type 1 there are so many potential suspects that it’s impossible to know for sure without a bit of investigation/experimentation.

The thing with basal insulin is that our individual needs can vary so much and vary throughout the day and night too. Often basal insulins are advertised as a kind of flat line release. That was how they pushed Lantus when it was first introduced. But the thing is that most of us don’t actually need a flat line release as our basal needs vary through 24 hours.

I think you switched to Tresiba because you were having night-time lows? That’s one of its selling points - reducing nighttime hypos - but its profile of action won’t work for everyone and for some the price of the reduced nocturnal hypos will be highs at other times. I know you’re probably thinking that two basal injections a day rather than one sounds crap, but it can be so worth it if your needs vary by day and night. When I take a break from my pump, I go back to injections and I always use a twice-daily basal. That way I can have much less basal insulin at night than in the day.
 
I have recently started to find that my levels start to rise on an evening from about 7pm when normally they would be at their lowest. Mine is definitely a change in basal needs because I eat at all times of the day and night and regularly skip meals so I can see it happening separate from any bolus insulin or food.
I am on split dose Levemir which I was taking first thing when I wake up in the morning and when I climb into bed, usually 11-12pm. The solution for me was to bring my evening Levemir forward to tackle the problem so I am currently injecting my evening dose at 7(ish)pm and that is definitely helping deal with it.

I totally agree with what @Inka explains above. A flat line insulin is not beneficial for many people because their basal insulin needs are not flat. I need much less insulin during the night than I do during the day, so if I was on a single dose long acting insulin I would either be hypo every night or very high during the day. My split dose Levemir enables me to cater to both situations and allows me a lot of flexibility to change the doses as I need to, sometimes on an almost daily basis. I love my Levemir!
 
Thank you both for taking the time to reply, I shall give the drs a ring and ask to be switched and see how I get on. Thanks again
 
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