I seem to have developed a bit of a problem, and I’m at a loss about what to do about it. Hopefully, someone here might be able to help!
Firstly, the basics:
- Type 1
- On MDI, not pump
- NovoRapid and Tresiba
- Libre and MM as CGM
- I:C ratio tends to be around the 1:10 to 1:15 range depending on meal
I have developed in the last few weeks a real resistance to insulin in the evening. This usually happens fairly late in the evening (after 9pm) and will continue until morning where its as if everything resets.
Tonight for example, I injected 11u of NovoRapid, and it had no effect whatsoever for about 90 minutes. This was a little earlier than usual, but I was going to inject then eat 15 minutes later than usual, but with nothing happening with my BG level I decided to wait. In the end I went for a 10 minute walk to see if I could kick start the insulin into action, and it worked slightly but then BG started rising again.
The above is a bit of a one off and extreme example, but the below is fairly typical of what happens;
Eat evening meal around 7pm, inject NovoRapid on about a 1:12 or 1:15 ratio depending on what I’m eating, BG rises as expected, then falls as expected about 2 hours later. Then around 10:30/11pm BG shoots up - it will go from 6.5 mmol (117 mg/dl) to 12 mmol (216 mg) and I’ll inject 2u NovoRapid to try and stop that rise. Usually that doesn’t do anything and it’ll continue to rise, so I’ll inject more. Keeps going up to 15, 16, 17, 18 mmol (270 - 325 mg)
Quite often I can inject more insulin than I had with my evening meal, and it will have no effect and bear in mind, I have had nothing to eat or drink since 7pm.
When I wake up in the morning its not uncommon for my BG to still be in double digits (in mmol), usually around the mid-teens so if I take a corrective dose at breakfast time (but without actually eating) I can get myself back down to ideal levels with no fuss.
I’ve spoken to my consultant and specialist nurses about it, and they don’t seem too bothered. I’m getting very frustrated by these unexpected spikes and it is causing me a whole load of stress and anxiety, especially since they don’t really seem to understand what is happening or how to deal with it. But I’m also getting next to no sleep as I’m still up at 2 or 3 am trying to get my BG down to acceptable levels with little luck, or sleeping high and feeling like crap (sleeping high feels like sleeping drunk to me, and waking up with that heavy hangover head)
It is a very recent thing (started happening in the last few weeks) and nothing has changed. No other stress in life like kids or work. I’ve previously done some basal calculations and I’m pretty confident I have my Tresiba at the correct dose, but I’m at a complete loss as to what is happening and why.
Does anyone have any pointers, tips, experiences of this kind of thing? Why would I become super resistant to insulin just between the hours of 10pm and 7am?!