Hello
@Lisa999, has your son been on Tresiba all the time or has he previously experienced any other basal?
I find Tresiba very helpful for my circumstances and I don't need to vary my dose often. I certainly increase in the autumn and decrease in the spring; and I sometimes need to alter it once or twice at other times - for example if I am experiencing a lengthy bout of illness. But I am the wrong side of 70 and am finding that age is interfering with my ability to bounce back from other ailments!!
In principle I aim to get steady BG throughout each night and I can use the evidence from my CGM graphs to confirm that. If I'm falling over a series of successive nights then I will reduce my Tresiba - a little (typically from 9 to 8.5 units) and then wait at least 48 hrs, then reassess over the next few days. If I'm habitually rising over a series of successive nights then I'll increase my Tresiba dose. I simply don't alter my Tresiba doses from the evidence of a single night; there are so many other factors that can affect our BG that it would be unreasonable to assume that a trend from one night is reliable evidence.
But certain caveats are really important with Tresiba:
1. Each day's dose lasts about 40 hrs, so today's dose is topping up yesterday's dose. Dose changes need time to take effect.
2. If your son is regularly eating meals late in the evening, then monitoring basal (Tresiba) performance overnight can't really start before the digestion of that food has reached his bloodstream and any bolus taken has fully dissipated. NR would normally last 4 hrs for me. Tresiba works best when a certain amount of regular and consistent lifestyle is in place.
3. Once I've got my Tresiba keeping me steady each night (and when it doesn't I can usually identify why - eg: a big routine change, an exceptionally active day, a late night out wining and dining .... ) then I regulate my BG through each day and into the evening solely by my NR bolus along with snacks if going low or exercise and activity if going high. I do not expect to use my basal to influence or alter my BG during the day.
I can imagine that a 19 Yr old who is not generally sharing with his parents about his daily D management might well also not be looking after himself as much as we might expect or hope. I certainly felt invincible when I was a teenager and my behaviour, in hindsight, could have been wiser and better. Alcohol can, and usually does, interfere with digestion; our body sees alcohol as a poison and diverts all its resources into dealing with that poison. So metabolism gets held up and its likely that conversion of food into blood glucose doesn't get completed until after any bolus is no longer effective - hence the glucose arrives after the insulin has finished and one's BG steadily rises. Incidentally while a rise through the night from 5 to 15 is far from ideal it isn't horrendous - particularly if its falling back to 5 during the day. Over a very long period it's not good and I understand that Glycaemic Variability can lead to longer term problems; but this is a secondary aspect. The main thing right now is to try and identify why your son's BG management is adrift and get that stabilised.
