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Late night highs

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Hi @Mandydg

What you describe about the issue around being high in the night and then hypo during the day was my main reason for changing to Levemir. By splitting this I was able to change the night time dose without impacting the daytime one or visa versa. However if you have already tried it I am not sure what others to suggest.

I was refused a pump first time I asked so I gathered the criteria and then collected data from my readings to address each of these. This was before Libre was around. I think the output from the Flash GM will make this easier. It took me a year to get there but it did make it a lot easier and dropped my HbA1c by 10. Hope you have success with this. If you are happy to do the work it does make life a lot more flexible, especially as your needs are clearly not flat throughout the day.
 
Levemir doesn’t work for some people because of the way it disperses, I believe. Was that your issue (it didn’t seem to work at all basically) or are you saying it did work but you couldn’t get the evening dose right to control the highs during the night? Did the Levemir control your blood sugar earlier in the night

Have you tried one of the older basal insulins - ie human not analogue? Their duration is not dissimilar to Levemir but they don’t rely on a response to the dispersal method of the analogues like Levemir.

Sorry for all the questions/suggestions. I’m trying to understand your highs in the early part of the night. A morning rise could be DP but being high earlier in the night suggests not enough basal to me.
 
Inka said:
Levemir doesn’t work for some people because of the way it disperses, I believe. Was that your issue (it didn’t seem to work at all basically) or are you saying it did work but you couldn’t get the evening dose right to control the highs during the night? Did the Levemir control your blood sugar earlier in the night

Have you tried one of the older basal insulins - ie human not analogue? Their duration is not dissimilar to Levemir but they don’t rely on a response to the dispersal method of the analogues like Levemir.

Sorry for all the questions/suggestions. I’m trying to understand your highs in the early part of the night. A morning rise could be DP but being high earlier in the night suggests not enough basal to me.
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For some reason at approximate 10pm my levels start to rise whilst I'm sleeping, at the moment the sensor alarms at anything over 13.3 at which point I have started to give myself 1 unit of novorapid, this then shows a drop until approx 5am when I start to rise!
Levemir morning and evening did not lower my A1c and so I was changed to lantus 3 year ago, and now on Tresiba since Feb 21. I hadn't been asked to check levels during the night on the Levemir, it has only been since using sensor for past 7 days that the trend of night time highs been noticed.
 
It sounds likely that the Levemir could have been adjusted to lower and prevent these night time highs if you had had Libre then and been able to see these rises and adjust the evening dose to prevent them. That is one of the main benefits of Libre that you can see what is going on between the finger pricks and adjust basal insulin to deal with it. Most people manage to reduce their HbA1c as a result of using Libre, so my view would be that the combination of Libre and Levemir would enable you to manage your levels much better and lower your HbA1c but that the profile of activity of Tresiba is not suiting your body's needs.
 
I agree with @rebrascora Tresiba clearly won’t work if you need more insulin at night because you can’t adjust the night without altering the day too and potentially causing hypos. Levemir and similar insulins can be split unevenly and that’s their benefit IMO. So, you could have 8 units of Levemir a.m and 16 p.m - ie twice as much for the night (I’ve just made those figures up as an example). Same with the older Isophane insulins which I’m sure you remember.

It seems to me that it would be sensible to clarify whether you have one problem or two problems. That is, are you just high overnight full stop, or do you have a high early in the night and then a ‘different’ high because of DP? Would eliminating your 10pm+ high automatically sort out you being high in the morning?

Personally, I’d try a twice daily insulin again and adjust the evening dose to stop the highs early in the night with the hope that would then sort out your morning high. If it didn’t, and you’d adjusted the time of your evening insulin, and the amount, and checked your injection sites, then you’d at least know you definitely had DP. As @rebrascora says, you’d have the Libre data to show you what was happening.
 
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This thread is now closed. Please contact Anna DUK, Ieva DUK or everydayupsanddowns if you would like it re-opened.
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