Help With Evening BI

11 posts, 5 contributors

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derekh1965 DAFNE Graduate
Western General Hospital, Edinburgh
90 posts
Sun
02/02
Time 07:42 08:30 09:02 13:02 16:42 18:25 20:00 21:15 23:16
CP - - 3 3 2 3 - 1 -
BG - 14.5 - 4.7 4.8 8.7 - 8.3 6.0
QA - 0+7 6 3 2 5 - 2 -
BI 14 - - - - - 10 - -
Ratio (QA:CP) - - 2:1 1:1 1:1 1.5:1 - 2:1 -
QA Site - - - - - - - - -
BI Site - - - - - - - - -
Type BI CORR BFAST LUNCH SNACK DINNR BI SNACK BED
Ketones - - - - - - - - -
Mon
03/02
Time 07:30 14:32 18:32 19:00 19:57 21:58 22:45
CP - 3 - 3 - 0+2 1.5
BG 13.6 6.8 12.5 12.3 - 4.1 4.3
QA 0+6 3 0+4 5 - - 2
BI 14 - - - 12 - -
Ratio (QA:CP) - 1:1 - 1.5:1 - - 1.5:1
QA Site - - - - - - -
BI Site - - - - - - -
Type CORR LUNCH CORR DINNR BI HYPO BED
Ketones - - - - - - -
Tue
04/02
Time 03:01 07:33 08:09 13:24 18:16 20:00 21:53 23:08
CP - - 2 3 2.5 - - 1.5
BG 7.6 11.2 11.3 8.7 9.4 - 12.8 9.6
QA - 0+4 4 5 4 - 0+6 2
BI - 12 - - - 12 - -
Ratio (QA:CP) - - 2:1 1.5:1 1.5:1 - - 1.5:1
QA Site - - - - - - - -
BI Site - - - - - - - -
Type NIGHT BI BFAST LUNCH DINNR BI CORR BED
Ketones - - - - - - - -
Wed
05/02
Time 02:16 07:02 08:10 13:00 18:00 19:30 22:00 22:57
CP - - 3 2.5 3 - 1.5 -
BG 6.0 10.4 8.7 4.7 5.5 - 4.9 5.7
QA - 0+3 6 3 5 - 2 -
BI - 14 - - - 14 - -
Ratio (QA:CP) - - 2:1 1:1 1.5:1 - 1.5:1 -
QA Site - - - - - - - -
BI Site - - - - - - - -
Type NIGHT BI BFAST LUNCH DINNR BI SUPP BED
Ketones - - - - - - - -
Thu
06/02
Time 06:01 09:32 13:08 20:00 23:00
CP - 2 3 - 1.5
BG 12.6 8.6 5.0 - 11.2
QA 0+4 4 3 - 2+4
BI - - - 10 -
Ratio (QA:CP) - 2:1 1:1 - 1.5:1
QA Site - - - - -
BI Site - - - - -
Type CORR BFAST LUNCH BI BED
Ketones - - - - -
Fri
07/02
Time 07:45 09:00 13:51 15:29 19:08 20:00 21:00 23:16
CP - 3 0+2 3.5 3 - 2 2+1.5
BG 9.5 12.6 3.7 6.1 8.0 - 6.3 3.9
QA - 6+4 - 4 5 - 3 2
BI 12 - - - - 12 - -
Ratio (QA:CP) - 2:1 - 1:1 1.5:1 - 1.5:1 1.5:1
QA Site - - - - - - - -
BI Site - - - - - - - -
Type BI BFAST HYPO LUNCH DINNR BI SNACK BED
Ketones - - - - - - - -
Sat
08/02
Time 08:05 13:56 14:13 18:40 19:30 23:33
CP - 0+2 3 4 - 1.5
BG 12.8 3.2 3.8 12.2 - 8.4
QA 0+5 - 3 6 - 2
BI 12 - - - 12 -
Ratio (QA:CP) - - 1:1 1.5:1 - 1.5:1
QA Site - - - - - -
BI Site - - - - - -
Type CORR HYPO LUNCH DINNR BI BED
Ketones - - - - - -
Sun
09/02
Time 03:32 07:32 09:00 13:52 18:45 20:00 21:52 23:24
CP - - 3 2 3 - 1.5 -
BG 9.6 10.7 13.1 8.2 9.3 - 9.6 8.7
QA - - 6+5 2 5 - 2 -
BI - 12 - - - 12 - -
Ratio (QA:CP) - - 2:1 1:1 1.5:1 - 1.5:1 -
QA Site - - - - - - - -
BI Site - - - - - - - -
Type NIGHT BI BFAST LUNCH DINNR BI SNACK BED
Ketones - - - - - - - -
Mon
10/02
Time 07:25 08:54 12:31 14:00 18:00 20:00 22:25 23:23
CP - 3 0+2 3 2 - - 1.5
BG 10.7 13.3 3.6 5.6 10.3 - 13.9 11.5
QA - 6+7 - 3 3 - 0+4 2
BI 12 - - - - 12 - -
Ratio (QA:CP) - 2:1 - 1:1 1.5:1 - - 1.5:1
QA Site - - - - - - - -
BI Site - - - - - - - -
Type BI BFAST HYPO LUNCH DINNR BI CORR BED
Ketones - - - - - - - -
Tue
11/02
Time 03:01 07:18 08:30 13:27 18:00 20:00 21:57
CP - - 2 2 3.5 - 1
BG 8.8 10.5 11.7 8.5 6.5 - 8.2
QA - - 4+4 3 5 - 1
BI - 12 - - - 13 -
Ratio (QA:CP) - - 2:1 1:1 1.5:1 - 1:1
QA Site - - - - - - -
BI Site - - - - - - -
Type NIGHT BI BFAST LUNCH DINNR BI BED
Ketones - - - - - - -
Wed
12/02
Time 07:30 14:10 17:55 20:00 21:48 22:11 23:04
CP - 2.5 3.5 - - 0+2 1.5
BG 14.7 11.3 10.7 - 5.8 3.9 5.9
QA 0+7 2.5+4.5 5+3 - - - 2
BI 12 - - 10 - - -
Ratio (QA:CP) - 1:1 1.5:1 - - - 1.5:1
QA Site - - - - - - -
BI Site - - - - - - -
Type BI LUNCH DINNR BI AFDIN HYCHK BED
Ketones - - - - - - -

Hi

I am in dire need of help with my evening BI. Time to inject and amounts.
As you can see by my diary I am constantly high upon waking, despite being ok during night and before bed (mostt times)

Thanks

Derek

derekh1965 DAFNE Graduate
Western General Hospital, Edinburgh
90 posts

Sorry, I am using levermir insulin and humalog.

Warwick DAFNE Graduate
Diabetes Australia-Vic, Melbourne, Victoria
389 posts

Hi Derek,

Your readings look like a classic case of dawn phenomenon. From about 3 am, our bodies produce a whole bunch of hormones, some of which increase insulin resistance. We need more insulin to counter that over that period of time.

The problem is that looking at your diary, if you increase your evening basal to cope with that, you will hypo overnight before the hormones get released. It is an area where pumpers have it over us MDI-ers because they can increase their insulin dose between the troublesome period and wake with great BGLs.

If it was any other time of day, it could be treated with some QA, but DP happens at the worst time when we want to be asleep, and not waking up to inject QA to cover it.

There is a thread here with some practical suggestions:

http://dafneonline.co.uk/forums/1/topics/1668

If you type "dawn" into the forum search tool, it returns 8 results and there will be further helpful information in those threads.

I find that when I am exercising most days per week, that I have little trouble with it, but if I am on holiday and not exercising for more than 3 days, I see my BGs increase considerably in the mornings. If you aren't already exercising regularly, then it may be worth considering.

Cheers,
Warwick.

Phil Maskell DAFNE Graduate
Nottingham University Hospital & QMC
194 posts

Just to agree with Warwick, I find I have slight DP, but insulin sensitivity is increased with exercise, which is just enough to help the background insulin to help with this, so much so that on heavy training weeks I have to lower BI due to overnight/early morning hypos!

It's all a juggling act, never been able to juggle and my BGs often show this Crying or Very sad

novorapidboi26 DAFNE Graduate
NHS Lanarkshire
1,800 posts

Take your evening dose of BI just before bed, this will mean your morning dose will likely run out in the evening, however the overlap between the evening and morning dose will help you in the morning.....

you can then compensate in the evening with a higher dinner time ratio.........

its a small price to pay if you find the dawn phenomenon is significant........

this helped a bit for me before I went on the pump, that and getting something to eat as soon as possible, a small yogurt worked a treat as it was low carb and low GI.......

getting the digestive juices flowing will tell the brain to stop releasing the hormones glucagon, cortisol etc.....and the BG will stop rising..

derekh1965 DAFNE Graduate
Western General Hospital, Edinburgh
90 posts

Hi

thanks for all your replies.

As far as exercise I've been diagnosed with MS and not reallyupo for exercise just now.

I have been taking my BI later as novoraqpidboi26 suggests and they have improved, 8 this morning.

derekh1965 DAFNE Graduate
Western General Hospital, Edinburgh
90 posts
Sat
15/02
Time 07:34 08:08 18:14 23:00
CP - 2.5 3 1.5
BG 8.5 10.1 9.6 6.7
QA - 5+3 5+3 2
BI 12 - - 12
Ratio (QA:CP) - 2:1 1.5:1 1.5:1
QA Site - - - -
BI Site - - - -
Type BI BFAST DINNR BED
Ketones - - - -
Sun
16/02
Time 08:30 09:18 12:02 14:05 17:45 18:30 23:00
CP - 2 - 3.5 0+2 3.5 2
BG 6.9 7.0 13.1 11.1 3.8 6.0 5.3
QA - 4 - 5+4 - 5 3
BI 12 - - - - - 12
Ratio (QA:CP) - 2:1 - 1.5:1 - 1.5:1 1.5:1
QA Site - - - - - - -
BI Site - - - - - - -
Type BI BFAST AFBF LUNCH HYPO DINNR SUPP
Ketones - - - - - - -
Mon
17/02
Time 07:02 07:56 13:10 17:56 21:50 22:05 23:05
CP 0+2 3 2.5 3.5 0+2 1.5 0.5
BG 3.7 5.7 7.3 5.5 3.4 - 5.1
QA - 6 5 5 - 2 -
BI 1 - - - - - 12
Ratio (QA:CP) - 2:1 1.5:1 1.5:1 - 1.5:1 -
QA Site - - - - - - -
BI Site - - - - - - -
Type HYPO BFAST LUNCH DINNR HYPO SNACK BED
Ketones - - - - - - -
Tue
18/02
Time 07:39 08:02 13:00 18:50 22:26 23:00
CP - 2.5 2+3.5 2.5 - 1.5
BG 9.0 7.5 3.9 8.2 10.3 9.0
QA - 5 4 4+1 0+3 2
BI 12 - - - - 12
Ratio (QA:CP) - 2:1 1:1 1.5:1 - 1.5:1
QA Site - - - - - -
BI Site - - - - - -
Type BI BFAST LUNCH DINNR CORR BED
Ketones - - - - - -

my past few days results

novorapidboi26 DAFNE Graduate
NHS Lanarkshire
1,800 posts

looks not bad overnight..........

you have been having some carbs at bedtime due to you either being low or being lower than you would like and this may be having unpredictable effects on the morning readings, but that's OK, as long as you test overnight and see a steady hold your pretty much there.......

after your happy you can go on and test your daytime BI dose......Smile

Garry DAFNE Graduate
North Lincolnshire
328 posts

Have you just missed a 2 off your Mon 17/02 07:02 BI?
Regards
Garry

derekh1965 DAFNE Graduate
Western General Hospital, Edinburgh
90 posts

yes, Garry, just noticed that.

BI is a lot better with taking it before bed.