How would you approach this?

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I've had issues in the past with overnight levels but this seems different. Doesn't seem to matter what I have for dinner, the results are the same. I'll have a very small peak and then go low after an hour and half (I've tried reducing the meal bolus a bit too). At first I was using a larger correction of carbs when going low and thought maybe that's the issue so I dropped them. But even with 5g of carbs as soon as I fall asleep I'll start heading up to between 8 and 10. If I correct with 1 unit I'll come plummeting down and then go in a rollercoaster until morning. If I leave it the levels will either stay that high or come down themselves. Its like my body has decided to start digesting half of my meal later. Its made evening exercise difficult because I usually drop the bolus for the dinner following. Been more sleepless nights than normal. Does anyone not eat dinner? I'm always back home from work around 7ish most nights and so by the time I exercise and cook its near to 9pm I eat dinner. I hated this even without diabetes but now its awkward. Of course issue is I'd have to add the calories on to the rest of the day.

Thanks
 
What basal insulin are you using and when are you taking it?
I ask because some (such as Lantus) do not have a completely flat profile or runs out before the next dose.

The other thing I would check is whether your injection sites are ok. Insulin absorption rates can be affected by lipohydrotrophy. You could try injecting in another area.
 
@helli levermir. One dose of 5 units at 10pm and 4 units at 10am. Adjust each depending on what I'm doing. Jog in the evening usually needs adjustment though this is all bit skewed in a way now with whats happening when I sleep.

Ah interesting. I literally just posted on a thread about how I rotate my injection sites. I always thought I was managing it okay but guess I could be wrong. Might explain why I've saw my post meal peaks rise over all for breakfast and lunch.
 
Do you pre-bolus your evening meal? I was going hypo exactly 1 hour after my pre-bolused evening meal, so I'd treat the hypo, then my BG'd sky-rocket (up into the teens) - like you say, as if my body was delaying digestion. So I started mid-bolusing (ie bolusing between main course and pud) and also making sure I had the same amount of carb before and after bolusing (eg main 20g carb, pud 20g). Frustratingly, at first, this sometimes did work and sometimes didn't work, but I stuck with it because nothing else fixed the problem. Eventually, it started to work almost all the time.

I'm now using a pump and the problem has disappeared. I have to pre-bolus all my meals now.
 
@Bloden interesting. Sounds similar. Yes I generally pre bolus 10 mins before or eat straight away at dinner because I tend to have slowish carbs like sweet potato , brown rice etc but this just seems to be a persistent problem recently. And reducing insulin for the meal just makes matters worse. My carb total would usually be round 75g.
 
I have gastroparesis caused by long term diabetes which means that some of my food digests after the meal and the rest digests later in the night. I usually eat my main meal around 8-9pm. To help the blood sugar with this problem I have a multiwave bolus which I’ve set up so some of the bolus goes in upfront and the rest is delivered over six hours. I had to experiment with the amounts and times to find a way that suited me. However if you’ve got delayed digestion it will be made worse by high fibre foods. I have to have low fibre foods which I know is counterintuitive to what I was taught many years ago about Type 1 diabetes.
 
Not sure if it's relevant here, but I learned to my cost that it is important to take into account the amount of fat and/or protein in each meal, especially dinner (since this is usually the one with the highest carbs of the day). Meals high in fat take longer to digest and meals high in protein have a second 'kick' 2-3hrs after eating. The former can cause a hypo shortly after eating, while the latter can cause a hyper 3hrs or more after eating. Thanks to advice received on this forum, I learned to factor fat and protein into my dinner carbs calculations. Since I did that, my evenings blood sugars have flattened a lot. Just thought I'd mention this in case it's relevant in your case.
 
@AJLang unfortunately I don't have a pump. Which means the likes of a takeaway are difficult for me. Pizza last night I dosed so much upfront then a correction 3 hours later of 2 units. My levels went down to 5 and stayed put for hour and half but then went back up again. If I had of gave 3 units I'd hypo then have to fix and still go up anyway. Problem with MDI is you have to be patient and select the best time to inject the corrections and there could be multiple doses for one meal.

@littlevoice359 may well be. Though I tend to have the same meals and I know the fat and protein content. Possibly things have changed with the way I digest them. I started to add fat and protein into meals more because I saw a smaller post meal peak plus I needed to find extra calories without piling on more carbs. But that comes at a cost. Any thing you did in particular to manage the fat and protein ?
 
I was a professional developer for many years, so when I was originally diagnosed with T1D 4yrs ago, I started working on my own software to help me manage the condition. After receiving advice from members on this forum about how FPU's are calculated, I baked that calculation into my meal planner. Also, following advice received here, I moved my basal injection from bedtime to approx. 2hrs after dinner. If my evening meal has more than 3 FPU's, when I'm taking my basal injection, I take an additional 2-3 units of NovoRapid to counteract the (now anticipated) rise from the fat/protein in my evening meal. This usually keeps things pretty flat for the rest of the evening, though, as with everything T1D-related, it can be a balancing act at times. Not sure if this will work for you, but for me it has helped flatten the evening portion of my AGP graph quite a bit.

Below/attached is a recent example:
1661015063722.png
 
littlevoice359 said:
I was a professional developer for many years, so when I was originally diagnosed with T1D 4yrs ago, I started working on my own software to help me manage the condition. After receiving advice from members on this forum about how FPU's are calculated, I baked that calculation into my meal planner. Also, following advice received here, I moved my basal injection from bedtime to approx. 2hrs after dinner. If my evening meal has more than 3 FPU's, when I'm taking my basal injection, I take an additional 2-3 units of NovoRapid to counteract the (now anticipated) rise from the fat/protein in my evening meal. This usually keeps things pretty flat for the rest of the evening, though, as with everything T1D-related, it can be a balancing act at times. Not sure if this will work for you, but for me it has helped flatten the evening portion of my AGP graph quite a bit.

Below/attached is a recent example:
View attachment 21842
Click to expand...
Im intrigued to know what meal you made with those ingredients 🙂
 
@littlevoice359 I'd try anything to see if it helps. My approach for a while has been to count the carbs , dose for the meal as a whole depending on what happened before. Do I need less or more pre bolus time , a spit dose and so on. I read that protein only comes into it when there is very little carbs in the meal or there is a significant amount. For all I know my carb ratio isn't quite right and I need to test it by having a very low fat and protein meal with plenty of carbs. I imagine your method wouldn't work without having fairly accurate insulin to carb ratio to begin with. I think I'd have to look up these fpus , not too sure what you mean. Definitely feel like I've been making alot of notes and not really coming away with a solid solution like the one you have
 
Jenny65 said:
Im intrigued to know what meal you made with those ingredients 🙂
Click to expand...
Nothing complicated. Just a curry with mackerel as the protein. The potatoes and carrots I cook in an airfryer.
 
My intent in passing along that link was to help you figure out how to calculate FPU for a given meal. What you do with that information is entirely up to you. Perhaps if you go back and do the calculatio for previous problem meals, it might tell you whether fat and protein is even a factor in your case? Just a thought.
 
littlevoice359 said:
Perhaps this link might help? https://www.katiebartel.ca/2021/08/12/calculating-fat-protein-math-for-type-1-diabetes/
Click to expand...
Compared to my experience, that is grossly simplified calculation.
I found it was not about calculate the insulin ratio for protein. I had to work out the different insulin ratios for salmon, prawn, cheese, nuts, tofu, etc. I don’t eat meat but have heard from others who try that there is another set of insulin ratios for chicken, pork, beef, …

For me, it was all too complex so I reverted to a normal carb diet and an easier life.
 
phil90 said:
I've had issues in the past with overnight levels but this seems different. Doesn't seem to matter what I have for dinner, the results are the same. I'll have a very small peak and then go low after an hour and half (I've tried reducing the meal bolus a bit too). At first I was using a larger correction of carbs when going low and thought maybe that's the issue so I dropped them. But even with 5g of carbs as soon as I fall asleep I'll start heading up to between 8 and 10. If I correct with 1 unit I'll come plummeting down and then go in a rollercoaster until morning. If I leave it the levels will either stay that high or come down themselves. Its like my body has decided to start digesting half of my meal later. Its made evening exercise difficult because I usually drop the bolus for the dinner following. Been more sleepless nights than normal. Does anyone not eat dinner? I'm always back home from work around 7ish most nights and so by the time I exercise and cook its near to 9pm I eat dinner. I hated this even without diabetes but now its awkward. Of course issue is I'd have to add the calories on to the rest of the day.

Thanks
Click to expand...
Hi,
I suggest to eat an early dinner at about 18:00, so that you have a long time to observe your levels before bed and act accordingly. Early dinner also is good for diabetes control especially with intermittent fasting. Good luck
 
helli said:
Compared to my experience, that is grossly simplified calculation.
I found it was not about calculate the insulin ratio for protein. I had to work out the different insulin ratios for salmon, prawn, cheese, nuts, tofu, etc. I don’t eat meat but have heard from others who try that there is another set of insulin ratios for chicken, pork, beef, …

For me, it was all too complex so I reverted to a normal carb diet and an easier life.
Click to expand...
Well, I'm a relative newbie to T1D (only 4yrs) so, in my innocence, I took the really simple approach and just totted up the grams of protein in fat in each meal, then used the simplified calculation to come up with an FPU number. Mostly, I just wanted a way of comparing meals with a view to being able to anticipate when a corrective dose of insulin might be needed 3-4hrs after eating. What I did works for me, most of the time and that's good enough for me.
Sorry I wasn't able to be of more help. Best of luck figuring out a solution to your dilemma.
 
@Mariam Agha as explained unfortunately I don't get home from work until late. I could try it on the weekend though, not a bad idea thanks .
 
helli said:
Compared to my experience, that is grossly simplified calculation.
I found it was not about calculate the insulin ratio for protein. I had to work out the different insulin ratios for salmon, prawn, cheese, nuts, tofu, etc. I don’t eat meat but have heard from others who try that there is another set of insulin ratios for chicken, pork, beef, …

For me, it was all too complex so I reverted to a normal carb diet and an easier life.
Click to expand...
Wow really ? More ratios. I don't think my head can take much more to be honest
 
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