So about 4 weeks ago, I posted here how my nightly BGs kept running up in to the 250s by 5am (for like 3-4 months). I could not figure it out. One of the members suggested upping my basal at night, and lowering it in the morning to a 33/66 split, vs 50/50. This worked great for about 4 weeks. I would go to bed and wake at 7am, almost totally flat.
Well here I am 4 weeks later and I'm totally out of control again. Literally over the course of the last 6 days, I went from flat to 220, 220, 220, 260, 265, 220, mid-nightly numbers. Monday I went to bed at 118, 4 hours later I was 265
I'm so mad, because I justed upped the nightly, now what? Even adding two extra units at night, has done nothing. I suppose, I'll just keep adding, until its gets level again. I guess what I don't understand is for 4 years, I was relatively flat on 24 units per day, now I'm at 35, and now, again, I need to add more. No slight rise, just straight back in to the mid 200s.
Thanks for listeneing.
Sorry you're having problems! I'm a little confused by what you mean when you say you "lowered it in the morning to a 33/66 split vs 50/50". Are you talking about your basal and bolus ratio? If so, that's pretty much irrelevant. That ratio is based on lots of things like how much carbs we eat, for instance. What's important is that you have the basal you need at the time you need. How many different "time zones" do you have? If you have figured the period of time when you start to go high (sounds like the first four hours after you go to bed?). Then create a time zone for that period and raise it slowly until you get where you want. Keep experimenting and testing during the night until you have created time zones with the right hourly rates. Just FYI I have 8 different time zones over the 24 hours. It isn't just "raising at night" and "lowering in morning" but breaking it down to hourly rates. Remember that you have to change the time about 2 hours before the problem. So let's say you start going high at 2AM, then you up the basal rate at midnight.
Finally if you eat late and/or eat high fat foods, you may be seeing a late peak from your dinner. What you can do about that is use a combo bolus or eat lower fat meals. The worst offenders for delayed spikes are high fat and high carb meals like pizza or lasagna.
Thanks Zoe, Yeh, the 33/66 thing is my basal split - 12units at 8am, 23 at night. I'm not using a pump, so its harder for me to split the basal rate in to time zones. The thing that is the most frustrating is for 4 weeks, I was flat, now its back to out of control numbers. Anyways, I'm going to keep adding to the basal until it flattens again.
You know, on the delayed response, thats what I thought it might be for the first few nights because of the holiday foods. But then like last night, I had, baked chicken, green beans, and a little stuffing. After wards I was 210 which aggrevated me, but took a correction, which generally knocks me don 70-80 points at night. Not last night, 230, 3 hours later. This is the same thing I was experiencing before, where nightly corrections did little to nothing.
Take Care, Jason
Sorry, Jason, I gave you totally irrelevant information..lol. I thought when you were talking about "more at night, less in the AM that you were on a pump. Yes, it does make it harder to get a smooth basal. If you're taking the night time dose close to bed, you might try taking it earlier, say at 8PM (12 hours apart) so it's "Peaking" in those late night hours when you most need it. And yes, all you can do is keep adding a unit at a time until you get better results. I would suggest staying with each change for 2-3 days to see a pattern. If you still don't get results, you might want to consider switching basals (I found, as many do, that Levemir was smoother than Lantus, some people seem to find the opposite). Bottom line too is to consider a pump. It really helps with basals.
I agree it's totally frustrating when things are going along smoothly and then they go all to hell. At four years you might have lost your last production of insulin, or it could be something temporary you're unaware of like fighting an infection of some kind or added stress...anything. I've learned (keep learning) that getting hung up trying to understand why is useful only up to a point and beyond that it helps to just "treat what is". Hope it resolves soon.
Oh yes, and you might want to see if your ISF needs changing as well. For me, when my basals change my ISF often does as well.
Jason - Has your weight changed during the last four years? Even a little. My experience my not be relevant at all to you, but it does affect many of us.
I was going along for many years with decent BG control but then it started slipping. My A1c numbers started increasing and I couldn't figure out why. Looking back, it seems clearer to me now. Slowly, over the years, I had been gaining a few pounds a year. With that weight gain I started to become more resistant to the insulin I was taking. What alarmed me the most was taking a correction dose and not seeing any effect on my BG, something you also reported.
Once I started exercising more regularly (walking 30-45 minutes every day) and losing just a few pounds I saw an improvement in all my numbers. I also failed to change my ISF, as Zoe suggests, while I was gaining weight so my corrections were not aggressive enough. Insulin sensitivity also affects basal insulin needs.
For some reason, being a Type 1 diabetic, I did not realize that, like T2's, we could become insulin resistant too.
I don't know if any of this applies to you but thought I'd raise it in case you share some of my experience. It's easy for T1's to gain weight if they are closely observing their BG's. Correcting high BG's can sometimes lead to low BG's and extra carb consumption.
Finally, I hope that you are logging all of your insulin dosing, timing, and any other pertinent info. Being too close to all the data can sometimes blind us to the larger picture. Good luck with this!
You, know, I have weighed myself in a few weeks, but I haven;t been quite as active recently because its dark and cold when I get home.
With my daughter got a situation smilar to yours these weeks. It came out her daily basal ended a little sooner than before, so doing the night basal at midnight left an uncover period and her BG rose quickly.
Now we do the nightly basal at 21:30, 2 hours after last bolus and she's "flat" again.
Try taking you nightly basal a little sooner.
I whish you good luck !
Hi, Thank you for your response. I am going to try this tonight. I usually take my nightly does at 11, but tonight, I'm going to try 9:30. I've heard that it can take an hour or two to peak, and you're right, if my morning does is done by 8-9pm, I could be going with no coverage for a afew hours.
I could be wrong as it's been awhile since I used long-acting, but I actually believe the peak is at 5 hours, though it does begin to work after an hour or two.
I hope taking it earlier helps your coverage.
Do you think you might have an infection or otherwise be sick? That can cause a dramatic change in basal needs. Even if you feel fine, there might be something lurking, like a periodontal infection.
I'm not sure. I suppose its possible, been dealing with a little sinus issue the last month or so, buts I've usually always got a sinus issue.
I know the standard response is to just keep increasing your basal.
However, there is one situation you need to be aware of - that if you have TOO MUCH basal, then you could be getting low at night and getting a rebound, waking up high, then knocking this down with extra breakfast insulin.
The best way to check for this is to lose some sleep (dammit!), I recommend testing every 2 hours overnight, to see when the rise occurs. For my daughter, when we found her high in the morning, the doctor's suggestion was ALWAYS to increase basal. But instead, I found that her dinner time Lantus given at 6pm was making her very low at 8:30pm, and us testing at 9pm, 9:30pm, 10pm would only see her 'on the way up', but not high enough for us to suspect anything.
This seems weird about the Lantus. It is not supposed to peak for 5-6 hours. It seems odd that your daughter would have a low from a basal injection so quickly after injection.