t1 long-acting insulin - when to inject?

[void]

For the past 20 years or so I've injected the long-acting insulin in the morning.

But the morning is when I have the usual liver dump common to even the non-diabetic.
I can readily detect this now due to the libre sensors.

Now, because the long-acting is 24 hrs or so duration, so implicitly would be tailing off activity around that time,
would it not make more sense to take long-acting in the evening so there is plenty of long-acting-derived
activity in my system when my liver does its thang in the morning?

Or do I risk my liver looking at the long-acting, saying "lol" and dumping even worse?
I believe this is down to cortisol release which is in turn down to circadian rhythms.

I'm interested in hearing from anyone who has encountered this issue and what
worked (or doesn't) for you.

some background:
Overnight my bg goes from a starting point of say 6 or 7mmol to around 3.8-4.1-ish.
Ideally I'd like the morning peak to be around 7 ish. Right now it'll peak 12-13-ish.
The morning is when I have the least amount of active insulin in my system.

Before diabetes, I'd just have a ciggy for breakfast. I've not smoked since diabetes
started. These days I have a 0-carb breakfast, like an egg, and a couple of mugs of coffee
(with a dash of milk) to properly wake up. Total carbs in the milk for the 2 cups
is around 5g.

thanks in advance for any input you can share

 

[Robin]

My overnight Libre graph looks like a slack washing line, @void . The minute my head hits the pillow I start dropping, then from 4am I start the long slow dawn rise. I swapped from Lantus to Levemir, so I could split the dose, and I take about a third of my daily dose at bedtime, and the rest in the morning. I also put a couple of units of novorapid in first thing when I wake up, irrespective of what I’m going to have for breakfast, to act as a boost before the Levemir gets going.
Not that I’m saying this will work like a dream for you, it’s just what happens to work for me. What I am saying is, I swapped to a basal I could split, and then I fiddled around with the uneven split until I’d got the ‘best fit' It’s still not perfect, and a lot of the time I see a little dip into the red overnight, but not as often as when I was trying to manage on one daily dose of basal.

 

[DaveB]

If you use Levemir then splitting it is a good idea as it doesn't last 24 hrs. Find the best morning to evening ratio that suits your profile.

 

[helli]

I now use an insulin pump and it is very handy wrt DP.
However, when I was on MDI, I would take my long active insulin in the evening before going to bed.
This was mainly because I found it was not lasting a full 24 hours. Therefore, I wanted to be awake so I could “top up” on short acting with my evening meal to fill the long acting gap.
This also gave me confidence that I was not running low during DP.

I was taking Lantus which could be split but doing so wasn’t as common as it is now. If I had to return to MDI for a prolonged period, I suspect I would request Levemir to give me the flexibility I need.
However, if your life is more regular than mine (I exercise 4 or 5 days a week and need to lower my basal afterwards), Tresiba may be a better option because it lasts longer than 24 hours.

 

[Lucyr]

I take my Lantus in the evening for exactly this reason, to avoid making morning DP worse

 

[rebrascora]

Another big Levemir fan here. I independently developed the same technique as @Robin with split dose Levemir but my night time dose is much much less than the daytime dose. Normally 22u and 3u but currently just needing 20u in the morning as soon as I wake up and before I get out of bed along with my breakfast bolus plus 2 extra units of Fiasp to deal with Foot on the Floor Syndrome. I am quite lucky in that I rarely get Dawn Phenomenon as such but the moment I swing my legs over the side of the bed and stand up I get a very strong liver surge which can raise my levels 6mmols in an hour, so getting that Levemir and Fiasp into my system asap is important. At the moment I am quite physically active so not needing any Levemir at night and my levels stay low often in the red at the moment until I wake up.
If you are on a very long acting basal Like Tresiba, then when you take it either morning ot night or lunchtime will make little difference because it lasts over 30 hours so gives you very even cover because the doses are constantly overlapping.
What you need to understand is that it depends which basal you are using as to how you use it and when you take it. I generally take my Levemir as soon as I wake up (7am ish )and when I go to bed (11pm ish) but sometimes I need to bring my evening dose forward as I get odd spells where my levels start to rise in the evening from about 7pm, but as I said, at the moment I am frequently having nocturnal hypos with zero evening basal even right up to 6am, my levels will continue to drop after eating JBs which is very odd because by then there is no active insulin in my system at all, but I do have thirsty legs! 🙄

 

[SimonP]

I think if you're already running near to hypo overnight then taking your basal before bed is not going to improve that.

I'd be tempted to start by splitting it equally before bed and before breakfast, which is what I did to prevent overnight lows post-exercise. I use Abasaglar, similar to Lantus, and felt no need to swap, but my BG does otherwise behave similarly to how @Robin describes and I also use a few units in the morning to hit foot-on-the-floor on the head.

 

[void]

What you need to understand is that it depends which basal you are using as to how you use it and when you take it. I generally take my Levemir as soon as I wake up (7am ish )and when I go to bed (11pm ish) but sometimes I need to bring my evening dose forward as I get odd spells where my levels start to rise in the evening from about 7pm, but as I said, at the moment I am frequently having nocturnal hypos with zero evening basal even right up to 6am, my levels will continue to drop after eating JBs which is very odd because by then there is no active insulin in my system at all, but I do have thirsty legs! 🙄

My basal is toujeo. I try to get it to 7mmol at bedtime. It'll fall by 3mmol or so overnight, sometimes more, depending on everything really. I seem to be able to "get on" with about 6 1/2 hrs sleep. But I can sleep for 7 3/4 hrs. If the latter happens, I'm guaranteed a liver dump that I'll either just tolerate with normal breakfast rapid (small amount, hardly any carbs) or wait till cortisol subsides and get it back down from its peak with rapid, the peak occurring roughly 2-3 hrs after waking up. If I wake up earlier, have the breakfast & insulin, the liver dump is a lot less.

maybe the solution is to just have 6 1/2 hrs sleep! I think maybe the ultimate resolution might be "don't secrete a lot of cortisol" 😉

 

[rebrascora]

I don't know if it is because I worked rotating shifts for a lot of years but my levels almost never rise until I get out of bed ie Foot on the Floor syndrome, regardless of what time of day it is or how long I have slept, which I feel is quite helpful because it means I can inject Fiasp before I get up and that deals with it. If I suffered from Dawn Phenomenon where it rises with the sun and can start at silly o'clock, it would be harder to deal with, but keeping my insulin pens under my pillow means I reach for them and jab before I even sit up in bed and that sorts it.

 

[void]

I don't know if it is because I worked rotating shifts for a lot of years

I've worked shifts nearly all my working life. My bg also doesn't majorly increase till I'm out of bed.
My sleep pattern is kind of broken compared to a regular person. Sort of extreme night-owl, lol.
I think (but i'm not sure) that cortisol is regulated at least in part by sleep length rather than daylight.

I'm wondering about the wisdom in knocking the bg rise back down so early. People are least responsive to insulin (think this is down to cortisol) shortly after they wake up and maybe for a couple of hrs after.