Changed to lantus and DN says my bs should be between 8 and 9 before bed

[MargaretK]

Hi everyone,
I was diagnosed 7 years ago with Type 1, and was on Novorapid and levemir, anyway a couple of months ago I was noticing my bs was high in morning a lot, around 9.. But I could be sitting at 6ish before bed, so DN says perhaps the levemir is spiking and causing raised sugars in morning. So changed me to lantus 24 units at night, still on Novorapid but now trying carb counting, seems to be working, my Hba1c was 7.9 in September and now 6.8....my question is this, my DN says I should be between bs of 8/9 before bed, I feel weird doing this as sometimes I'm at 5.3 or 6.2 so have to eat, the reason they say, is so that you don't hypo during the night! Don't get me wrong, if I go to bed at those numbers my bloods are 5.6( like this morning).. But I'd rather not be 8/9 at night,never my consultant said he thought that was a bit high, but if that's what they are suggesting now then to go with it...should I try lowering amount of lantus, rather than eating more carbs ? Thanks for your help

 

[robert72]

It would be worth doing some overnight tests to see if you are dipping during the night. If not then ask you DSN about reducing the Lantus a little. You shouldn't need to be feeding your insulin.

 

[MargaretK]

That's what I thought too...will give that a try, thanks

 

[novorapidboi26]

That is just standard advice for safety reasons for people who are just learning the basics and it seems you fall into that category............

a lot of diabetics even long term diabetics on an MDI regime, can feel anxious about going low overnight too....

you don't NEED to be between 8 and 9 before bed because if you basal dose is correct then the pre bed number should hold steady.......

until you get the basal correct though it would be wise to stay higher......

 

[noblehead]

If your bg was 5.6 this morning and you went to bed with a bg level of 9 then that means it's dropped by 3.4 overnight, really if your basal dose is set at the right dose it shouldn't fluctuate by much more than 1.7mmol.

So if you wanted to go to bed on levels of between 6-7 then you'd need to reduce your dose slightly so that it doesn't fall too low overnight, if you didn't then a 3.4 drop would result in night-time hypo's, if your Consultants agrees that it's too high then try reducing the dose and do some bg checks throughout the night, this way you can see which way your bg is heading and take pre-emptive action if necessary.

 

[LucySW]

Can you try a Libre? They're far from perfect, but they do show you what is going on at night so they make it much easier to get basal right.

The startup cost is £130 for reader plus one month's supply. A lot of us meant to try it for only a couple of months, tho we've all got addicted now.

 

[robert72]

Can you try a Libre? They're far from perfect, but they do show you what is going on at night so they make it much easier to get basal right.

The startup cost is £130 for reader plus one month's supply. A lot of us meant to try it for only a couple of months, tho we've all got addicted now.

In the UK, they are not accepting new customers until Feb 2015

 

[MargaretK]

Thanks will take a look at the libre

 

[Diamattic]

8/9mmol/L before bed is a bit high, I agree. The goal of a correctly set basal is to keep your sugars steady for long periods without food or exercise. You can check out my last youtube video in the link in my signature, its about basal rates.

The goal would be to go to bed at 6mmol/l and wake up at 5mmol/l (IMO). So if you are going up throughout the night, it could be that basal insulin isn't working a full 24 hours, but your treating it as it is (ie - taking it at 9pm every night) doing this would leave a period of a couple hours where your body has no basal insulin, allowing your sugars to raise.

Ideally you should want a routine you can trust. So you can go to bed at any reading and know you'll wake up 8 hours later 1mmol/l lower. This may be cause for some experimentation. I was also told that lantus takes about an hour to kick in, so you have to take it every 23 hours, so that by the 24th when your last wears off your new dose is full strength (if it actually lasts all 24 hours, which is probably doesn't for everyone).

 

[himtoo]

agree with Diamattic-- i always aim for bedtime of 6.2-6.8

 

[ElyDave]

8-9 before bed? Load of ****.

The intention for your basal should be that absent any extraneous factors like alcohol, caffiene, active bolus etc you should be stable overnight.

Question is do you want to wake up at 8-9? If not why go to bed at that level. Sounds like a lazy DSN who can't be ***** to help you get your levels right and your basal right. If they won't, you need to do it yourself.

My target (where I disagree with diamattic) is that I would aim to go to bed at >5, aim to wake in my target zone of 4-6

 

[SamJB]

Hi Margret,
If your basal is correct, then your BGs should remain mostly static throughout the night. If I were you, I'd buy the book by Gary Scheiner, called Think Like a Pancreas. It teaches you all about basal dosing (amongst many other things). The method is, if your overnight BGs change by 1.6 mmol/l, then you should adjust your basal by 10% accordingly.

I change my basal on an almost daily basis and this method works perfectly for me. It's one of the main reasons why my HbA1c is in the low 6s. Getting your basal dose corect is THE foundation for good BG control, If it's incorrect then calculating your carb:insulin ratio correctly is nigh-on impossible.

 

[MargaretK]

Thanks everyone, really helpful info, went to bed at 6.8 last night so only took 16 units lantus instead of 24 units my bs was 7.4 this morning, think I will need to take a bit more tonight ...trial and error just now..

 

[robert72]

You're pretty much on target with that - only 0.6 change overnight. Personally, I'd leave it for a couple of nights before thinking about changing dose again.

 

[MargaretK]

Never thought of that..it isn't much of a change really..will leave it then and if I go to bed a bit lower than 6.9 a wee rise overnight will be Ok, thanks Robert

 

[nicdavcamb]

I have been a diabetic for over 57 years and in the early days keeping blood sugars low and manageable was not really happening. De[ending on your work and amount of exercise, The usage could change daily and there is always a risk of a Hypo. When I go to bed my sugar levels are at 13 or during the night they drop drastically and most nights now have to get up and have a drink or something to eat. So as we all know or should do no diabetics are alike and different needs do apply so best work with what you feel happy with and keep testing to keep to a level best suited.