Night highs: temp basal with bolus

Tips, Tech & Gear Treatment
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It is our experience that the best way to have a good BG day is if the day starts comfortably in range. So the ability to treat small night highs with good odds of success is important to us. Many here have mentioned that they see significant insulin resistance at night. That is true for us: in many cases, a small bolus for a small high seems to have absolutely no effect. Waking up three times on a row to treat the same high with no effect can be really frustrating—to me at least :slight_smile: Even worse, if all three fail, then when you double the bolus and find yourself getting into a bad low it gets to be infuriating.

Over the past 6 months, we have been using the same trick as @Kaelan’s hormone peak method to treat small night highs, although in a slightly different manner, with excellent results. By small night highs I mean highs between 120 and 160. To the right bolus (with an appropriate CF) we add a short temp basal, typically 1.5 hours, varying between 10% and 20%. Most of the time 10 or 15% is enough to induce a regular descent.

Statistically, without a temp basal, unless we risk using high boluses at night that frequently turn into lows, we often (about 70% of the time) have to inject 2-3 times in order to get rid of a low. With a temp basal to grease the way, the percentage of failed treatment goes down to 25% or below. For us it is a method that works really well!

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I have found similar results.

I started using the bolus correction + temp basal as it allows a cancel option, if bolus correction works too well.

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I also have this problem occasionally. And, yes, often go low due to the stacking for boluses which apparently don’t do anything for several hours, then a sudden downturn! To counter the downward bend, I used a temp basal to reduce my normal rate. How much depends on the bg and bend, but sometimes a 100% reduction. With this strategy, I, of course, still may pass into a low :frowning:

I like your strategy of adding a temp basal at the start. I may give this a try on my next persistent overnight high.

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I do something similar, with an upfront bolus + some amount of extended bolus. Basal-IQ will cancel the extended bolus for me if it works a little too well.

The main difficulty is getting myself to actually program the more sophisticated split bolus, because when I’m awakened by a high alarm I often want to just do a quick bolus and head back to sleep… they don’t usually end up doing the job though, so I should try to break the habit :sweat_smile:

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This just reminded me that my minimed pump has an option for dual wave bolus. It would be quicker if i started using it again !

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