Some advice needed...

[freesia]

Since being off work then finishing, my levels have been all over the place. Mostly, through the morning to mid afternoon, things are ok but then just before dinner levels start to spike and despite corrections often don't come down until overnight, then the same thing happens the next day.

I've been on Tresiba for a few years now and can usually adjust it when needed (eg school holidays when less activity or depending on season) however i've tried this lately (giving time for it to show what happens) and i just seem to swing between hypos and high spikes. My TIR is a real mess atm.

I thought i might need to do a basal check and started this today with the morning 6am-12pm. Levels held between 6.8/8.4. I need to try again at other times but i'm also wondering something else....

Could this not be related to the basal but actually needing a change in meal ratios? I'm confused because my lunch ratio seems fine but spikes 4-5 hours after and my dinner ratio just does nothing. Also as Tresiba is so long lasting, i shouldn't be getting dips in the day when its not working should i?

I haven't got a DSN to ask as i was discharged back to GP care during Covid and have never had a consultant.

Any ideas or advice?

 

[Proud to be erratic]

Our basal needs fluctuate across a single 24 hr period and my perspective is that no basal can provide appropriate (ie pretty well right) basal cover for each of those hours from a single daily dose.

Also, the basal test where you fast and have no bolus on board for 8 or even 12 hour periods is not particularly relevant to anyone on a single basal dose. It can tell you a fair bit more about what your basal is doing during those fasting periods but that information is not really relevant if those periods are not actually times when you would normally be fasting and with no bolus on board.

So, I know that during late evenings and then the night, my early evening NovoRapid has become effectively nil and I'm fasting with minimal activity. Thus from such nights I can do no more than look at my CGM graphs and see whether my Tresiba is holding me steady and level. If it is, my basal is right; if my BG repeatedly and steadily drops through the night I know my basal needs reducing a little; conversely if my BG is rising steadily my basal needs increasing a little. One night alone is not good enough evidence for me; I like to see at least 3 similar graphs, having discounted (ignored) those nights where obvious circumstances have changed my fasting parameters.

If the steady graph is higher than I want to be at, I'll take corrective action - including a late bolus as I go to bed and would normally see from the graph that bolus correcting me to where I want to be, then the Tresiba holding me steady for the rest of the night. Likewise if I'm a little low a very modest snack nudges me up and again I will invariably see that lift then a nice flat line thereafter.

Now, knowing my Tresiba is keeping me steady by night, once awake I have bolus, food and activity to use as my daytime BG management tools. The important thing is that whatever effects my Tresiba is having during the day is what it is. I can't alter it and actually I don't want to alter it. I don't even need to consider it because my night time graphs have confirmed that Tresiba is releasing steadily for long periods and so is doing what it should be doing - providing a background insulin. This leaves me to review / question / interrogate what bit of the bolus/ activity/ timing/ carb count have I got wrong. There is enough in those tools to make that a challenging puzzle, without adding confusion about whether my Tresiba can somehow also be changing the rules!

For reference or comparison, for what that might be worth, my Tresiba doses are 7.5 units daily in the summer months from up to 9 last winter. During a period of illness a couple of months ago I noticed my night time graphs were consistently rising and my day time BG was all over the place. Once I'd temporarily increased my Tresiba to 9 units, in half units every 2nd day, my daytime management noticeably improved. That needed over 3 weeks at the higher doses before I reduced back to 7.5 units with daily half unit reductions.