My BGs - lots of drops here

I take 18u of lantus & am considering doing a split which is ok with my practice nurse who looks after my diabetes. Don't know whether to do a couple of night basal checks first. Any help would be greatly appreciated.

12/08
Bedtime 15.3 > 8.3 13/08 - dropped 7mmol

13/08
Bedtime 14.8 > 7.7 14/08 - dropped 7.1 mmol

14/08
Bedtime 8.8 > 3.8 15/08 - dropped 5mmol

15/08
Bedtime 6.7 < 7.9 16/08 - rose 1.2 mmol

16/08
Bedtime
no test - 8.6 teatime > 5.0 17/08 - dropped 3.6 mmol

17/08
Bedtime 17.6 > 4.6 18/08 - dropped 13mmol

18/08
Bedtime 19.1 > 16.7 19/08 - dropped 2.4mmol

19/08
Bedtime no test - 13.7 teatime > 9.6 20/08 - dropped 4.1 mmol

20/08
Bedtime 10.0 > 5.4 21/08 - dropped 4.6 mmol

21/08
Bedtime 10.5 < 12.3 22/08 - rose 1.8mmol

22/08
Bedtime 14.8 > 10.7 23/08 - dropped 4.1mmol

With the high readings, did you take correctional doses to bring them down, or did they drop naturally? In general, it is much easier for us to give advice if you can share your DAFNE diary with the thread. Just enter the dates that you want to share with the thread and it will post those to this thread. We can then see what is happening during the course of the day too. With just the night to morning results, I don't think anyone would be brave enough to suggest a course of action. We need to know what is happening during the day too.

Hi Warwick, thank you for your reply. Here is my shared DAFNE diary with the dates from 12/08 - 22/08

It's pretty difficult to see a pattern. Sometimes, your BGs aren't changing much, indicating that your BI is correct, other times they drop a lot, like on 13/8 when half a unit of QA dropped your levels overnight from 14.8 to 7.7. Usually half a unit of QA would only be expected to drop your BGs by about 1.5, so that is a surprise.

What BI and QA are you using? I don't think that splitting your BI will help your overnight differences. You may want to split your BI though if your BGs are consistently rising between dinner and bedtime as that would be a sign that your BI is running out. There is some evidence in your diary to indicate that this may be occurring. Splitting may fix that, and if that gets fixed, then it may also lead to an improvement in overnight stability.

I split at the beginning of last year because I was constantly getting a rise between dinner and bedtime. Increasing my dinner time QA led to hypos, so it became obvious that my BI (Lantus at the time) was not lasting the full 24 hours.

Hi Warwick,
Thank you for your reply.

What BI and QA are you using?
BI - lantus and QA - Humalog

I don't think that splitting your BI will help your overnight differences.
Ok

You may want to split your BI though if your BGs are consistently rising between dinner and bedtime as that would be a sign that your BI is running out. There is some evidence in your diary to indicate that this may be occurring. Splitting may fix that, and if that gets fixed, then it may also lead to an improvement in overnight stability.
Ok but don't know whether to do a couple of nights basal testing first or do a split straight away. Splitting is absolutely fine with my practice nurse who looks after my diabetes.

The only real disadvantage to splitting is that there is an extra injection each day. However, if you have ever forgotten to take basal insulin before, the benefit of splitting is that your BGs shouldn't rise quite so much if that happens as there will still be some in your body from the previous injection.

Splitting is reasonably easy, just drop a unit at night and add one each morning. You may find that your overall basal insulin needs will increase if your basal has been running out, so do keep an eye on that. I went from 18 units nightly, to 2 x 10 unit injections morning and night. I lost the spikes between dinner and bedtime though so I found it was worth it.

You may want to monitor your BGs for another week or so before you decide. If you do that, try to avoid eating anything after dinner, and just take correctional doses if required before bed. If you have good BGs before bed, then schedule a 3 am test to see if they are holding, dropping or increasing.

The only real disadvantage to splitting is that there is an extra injection each day.
- This wouldn't really bother me because I already have x4 injections

However, if you have ever forgotten to take basal insulin before, the benefit of splitting is that your BGs shouldn't rise quite so much if that happens as there will still be some in your body from the previous injection.
-

Splitting is reasonably easy, just drop a unit at night and add one each morning. You may find that your overall basal insulin needs will increase if your basal has been running out, so do keep an eye on that. I went from 18 units nightly, to 2 x 10 unit injections morning and night. I lost the spikes between dinner and bedtime though so I found it was worth it.
- Yes all understood

You may want to monitor your BGs for another week or so before you decide. If you do that, try to avoid eating anything after dinner, and just take correctional doses if required before bed. If you have good BGs before bed, then schedule a 3 am test to see if they are holding, dropping or increasing.
- Maybe a good idea to monitor for another week or so. Also I'm only going to do bedtime tests at least 4/5 hours after dinnertime to give a truer reflection of bedtime tests. I sometimes eat dinner at 7:30pm - 8pm ish then bedtime test is only 2 hours after which doesn't give a true reflection of my bedtime tests does it?

I do bedtime tests at 10:30pm ish because this is when I take my BI as a way of remembering to take it.

Humalog's action time is 3-4 hours, so you are right that a bedtime reading only 2 hours after your evening meal will not accurately reflect what is going on as only about 2/3 of the insulin will be used up. I struggle with that too. I tend to eat quite late, then try and still be in bed by a reasonable time. After 3 hours, 90-95% of the QA will be used, so you would probably be OK with that reading.

Thanks Warwick .

Please watch this space for more diary sharing

You may want to monitor your BGs for another week or so before you decide

- not quite a week yet but here we go with a few more BGs