BS dropping rapidly at tea time then a rebound

[Pumper_Sue]

I am going very low straight after my evening meal at 6.30pm and then rebounding to stay high during the night.

Last night's profile is representative of the phenomenon.

At teatime I'm at 14mmol and take 6 units of Novorapid before eating fish/veg/small potatoes/cheese.
Basal too high. Need to learn to carb count as obviously far to much insulin for a correction and the few carbs you ate.
Within an hour i see my BS falling sharply and down to 5mmol I eat half an apple but still it's falling so half an hour later eat the other half.
This again points to to much insulin for the carbs eaten Quick acting carbs as in 3 or 4 JB's rather than an apple.
It bottoms out around 3.8mmol and then at 8pm it starts a steady rise up to 10 mmol
This again I suspect is a basal problem

10pm-midnight a rise up to 15mmol
Basal again
Midnight-3am I'm at 15mmol before a gentle slide down.
Basal again
6am I'm back to 10mmol my usual start to the day.
Basal again is not enough. In theory you need to be waking up at the 5 - 6mmol.

It's a lot easier if you just bite the bullet and do a basal test. (There's one in the pump forum 🙂 )
Once you basal is sorted you can then move on to your carb ratio. Do not try sorting basal and bolus out at the same time.

 

[sololite]

I am going very low straight after my evening meal at 6.30pm and then rebounding to stay high during the night.

Last night's profile is representative of the phenomenon.

At teatime I'm at 14mmol and take 6 units of Novorapid before eating fish/veg/small potatoes/cheese.
Basal too high. Need to learn to carb count as obviously far to much insulin for a correction and the few carbs you ate.
Within an hour i see my BS falling sharply and down to 5mmol I eat half an apple but still it's falling so half an hour later eat the other half.
This again points to to much insulin for the carbs eaten Quick acting carbs as in 3 or 4 JB's rather than an apple.
It bottoms out around 3.8mmol and then at 8pm it starts a steady rise up to 10 mmol
This again I suspect is a basal problem

10pm-midnight a rise up to 15mmol
Basal again
Midnight-3am I'm at 15mmol before a gentle slide down.
Basal again
6am I'm back to 10mmol my usual start to the day.
Basal again is not enough. In theory you need to be waking up at the 5 - 6mmol.

It's a lot easier if you just bite the bullet and do a basal test. (There's one in the pump forum 🙂 )
Once you basal is sorted you can then move on to your carb ratio. Do not try sorting basal and bolus out at the same time.

Great advice Sue. You were right. I did a basal test overnight and the drop from 10.6mmol to 7.6mmol tells me (if I understand my DAFNE course notes) that I am carrying too much basal overnight. I am going to reduce my evening dose by 20% and retest next week. Once I am happy with that I will look at daytime dosage. Regarding Libre vs finger prick there was generally no more than .2mmol difference across 7 readings apart from one which was 2mmol difference. Thanks for your help , your support means a lot to me. Regards, Chris

 

[SimonP]

10pm-midnight a rise up to 15mmol
Basal again

Being MDI, overnight BG trend is the important thing, so this rise should IMO be fixed with bolus. I think this is probably delayed effect from the evening meal anyway rather than a liver induced (basal) issue. i.e. split dose for supper and check bolus insulin requirements rather than use basal changes for this.

Midnight-3am I'm at 15mmol before a gentle slide down.
Basal again
6am I'm back to 10mmol my usual start to the day.
Basal again is not enough. In theory you need to be waking up at the 5 - 6mmol.

This one I definitely disagree with - while the numbers are too high (which is IMO caused by bolus requirements the previous evening), the fact that BG is dropping overnight points to basal being too high.

Great advice Sue. You were right. I did a basal test overnight and the drop from 10.6mmol to 7.6mmol tells me (if I understand my DAFNE course notes) that I am carrying too much basal overnight. I am going to reduce my evening dose by 20% and retest next week. Once I am happy with that I will look at daytime dosage. Regarding Libre vs finger prick there was generally no more than .2mmol difference across 7 readings apart from one which was 2mmol difference. Thanks for your help , your support means a lot to me. Regards, Chris

I agree, reduced overnight basal is what I would do.

I would probably also do an early evening (well before bed, with plenty of time to see where it ends up) correction dose to try to fix the overnight high too. Avoid having any correction bolus IoB to confuse the picture when looking at the overnight behaviour that you're currently tweaking.

Bad form to twiddle more than one thing of course, but if you can separate them in time.....

P.S. There's lots of ways to skin the proverbial cat, flat BG overnight is only one of them, and to achieve this may result in requiring bolus at other times of day to correct things that with a pump would be handled by basal rate changes. I think a decreasing trend overnight is generally not favoured though as you could end up hypo, a gradually increasing trend would be ok so long as you don't suffer from dawn phenomenon. Flat is the easy compromise, then using additional bolus during the day to tweak the shape.