This is most apparent after the big / higher carb dinners, right?
Yes, I believe so. Higher carb with fat. I think in addition to the basal adjustment he just made, he needs to inject some upfront, and then use an extended bolus over the course of, like, six hours. Because it’s really in the middle of the night that it’s an issue. I need to pull the data and look at it, but December is busy running me over.
I know what is happening there. It’s something we should discuss and create a topic for. There are a lot of things at work on this. It isn’t just the food getting delayed from the fat. It is the liver storing things up, and then once it is full, the rest being dumped. It is like a queue for the liver glycogen, and once it is done, the rest is not going to be stored so it is released. And it happens in the middle of the night because normally during the day, your liver glycogen is continually being used. But at night when you are sleeping, there is not much activity, so the liver glycogen can become totally replenished at that point. Particularly after a big meal.
Split the thread.
I have had this problem after a high fat dinner, like a big juicy steak and baked potato. To counteract, I take a moderately large correction bolus at about 9pm before going to bed, even though Bg is normal (90-120).
Then a couple hours later I’m low, sometimes critically, until the carbs catch up a couple hours later, and I end up going high.
The only solution I’ve come up with is to wake up at 3am and take the bolus.
Anybody got a better MDI idea?
In the olden days, we were instructed to put it in the same syringe as the regular insulin, and do a single injection. In hindsight, that was probably pretty stupid and messed up both of the insulin types in the syringe. Doing it in a syringe by itself has shown it to be much more predictable.
If you haven’t used NPH in many years, give it another try. It isn’t covering your entire basal like it used to in the 70’s. Having it just cover a little higher amount later at night is pretty useful.
Like everything else, it’s all timing and amount. I hit it around 11pm on MDI nights.
Try different amounts and different times until you find a good combo. Even if you don’t take the perfect amount to completely cover it, it’s better than nothing. I mean, a 150 is better than a 250…
Would Metformin also help with something like this?
I think so. But with very high carb meals there would be a limit to what metformin could do. If you eat a lot of carbs, they have to end up somewhere. I imagine it would help reduce the effects, but there is a limit at some point.
I think one of the simplest things to do for this is to focus more of your daily carbs in the morning and lunchtime, and have your dinner more protein focused, with not as many carbs.
The only problem with doing it that way is if you workout in the evening.