Type 1 Hypo at night despite snack

[tvnerd]

I take 9 units of lantus at night. I usually eat a snack that has about 20g of carbs before bed. I still have hypos at night (have a CGM). I have already reduced my lantus from 12 units to 9 over the past month. Have also reduced my mealtime insulin.
1. How can I avoid hypos?
2. Should I change my snack?
3. Any ideas for night time snacks? ( Currently eat biscuits with some peanut butter and jam).

 

[Kristin251]

I use lantus ONLY to keep me starship through the night and humalog for food. My rule is if I drop 20 (US) I I drop one unit lantus per 20 point drop. If I rise 20 I raise lantus one unit per 20. I don't like feeding insulin. I like using lantus for the sleeping time and humalog for food.

 

[tim2000s]

@tvnerd - are you hypoing at roughly the same time each night, and if you are, please can you let us know when that is? Also, can you tell us when you take your Lantus? Unfortunately, insulin interactions are often a little more complex that just one thing, so if you can give us some details we may be able to provide better advice.

@Kristin251 - regardless of how you use your Lantus, it will be lasting longer than overnight, as that's the way the insulin works. I'm pleased you've found a way that works for you!

 

[Miffyrascal]

Hi. I used to suffer with night hypos even after having a snack ( cereal ), before bed. I cut my Lantus by half (over a period of time) which helped massively. I'm not suggesting you cut it that much but reducing it gradually may help.

I'm now on a pump and don't have a snack before bed which is great, as you don't always fancy eating just before you go to bed . I know it's a case of having to at the moment for you , but that may change over time.
Good luck.

 

[iHs]

I always eat a snack before going to bed to stop going into hypoland when using mdi but I kept to eating a lower amount of carb for my evening meal so that eating a carb snack at bedtime would not cause me any weightgain.
Using Lantus once daily at night was not wonderfully good and I needed loads of bolus for meals. Levemir twice daily with a bolus was more like using twice daily mixes and I needed less bolus for meals. A doctor spoke recently about basal insulins and was of the opinion that most diabetics should be using levemir twice daily or use Tresiba because it has a smoother effect

 

[catapillar]

@tvnerd have you confirmed the night time hypos that your CGM is showing with finger prick testing? Just be aware that the CGM can show hypos falsely through compression lows - if you're lying on the sensor if might incorrectly show you as low. It's worth confirming if hypos are actually happening with blood tests.

You shouldn't need to feed your basal insulin. If you are having to do this that suggests your basal dose is too high as the point of basal insulin is to keep blood sugars flat when not eating or bolusing.

You might want to do a bit of basal testing to see if you are on the right basal dose - https://mysugr.com/basal-rate-testing/

 

[tvnerd]

@tvnerd - are you hypoing at roughly the same time each night, and if you are, please can you let us know when that is? Also, can you tell us when you take your Lantus? Unfortunately, insulin interactions are often a little more complex that just one thing, so if you can give us some details we may be able to provide better advice.

@Kristin251 - regardless of how you use your Lantus, it will be lasting longer than overnight, as that's the way the insulin works. I'm pleased you've found a way that works for you!

I hypo around 2am every night till about the time I wake up which is 5:30. I take my lantus at 10pm. I reduced my carbs at dinner as well as my novorapid just in case that was driving the hypos.

 

[tvnerd]

@tvnerd have you confirmed the night time hypos that your CGM is showing with finger prick testing? Just be aware that the CGM can show hypos falsely through compression lows - if you're lying on the sensor if might incorrectly show you as low. It's worth confirming if hypos are actually happening with blood tests.

You shouldn't need to feed your basal insulin. If you are having to do this that suggests your basal dose is too high as the point of basal insulin is to keep blood sugars flat when not eating or bolusing.

You might want to do a bit of basal testing to see if you are on the right basal dose - https://mysugr.com/basal-rate-testing/

I’ll confirm it with a finger test too but I have recently started having lows (verified with a finger test) right after my meals or if I tend to walk a little after my meals. This has now been followed by night time hypos

 

[tvnerd]

Hi. I used to suffer with night hypos even after having a snack ( cereal ), before bed. I cut my Lantus by half (over a period of time) which helped massively. I'm not suggesting you cut it that much but reducing it gradually may help.

I'm now on a pump and don't have a snack before bed which is great, as you don't always fancy eating just before you go to bed . I know it's a case of having to at the moment for you , but that may change over time.
Good luck.

Is a pump easier to use than injections? Do you need to have stable glucose levels for a pump? I was diagnosed 2 months ago so my levels are still fluctuating a lot.

 

[tvnerd]

@tvnerd have you confirmed the night time hypos that your CGM is showing with finger prick testing? Just be aware that the CGM can show hypos falsely through compression lows - if you're lying on the sensor if might incorrectly show you as low. It's worth confirming if hypos are actually happening with blood tests.

You shouldn't need to feed your basal insulin. If you are having to do this that suggests your basal dose is too high as the point of basal insulin is to keep blood sugars flat when not eating or bolusing.

You might want to do a bit of basal testing to see if you are on the right basal dose - https://mysugr.com/basal-rate-testing/

Also my premeal insulin is around 2-3 units

 

[Deleted Account]

If I remember correctly, you have been trying to lose weight through diet and exercise.
Both of these could impact your insulin requirements - if you are eating less carbs, you will need less insulin with your meals; exercise makes your body more efficient at using insulin and uses up some of your "reserve glucose in your liver" which is what the Lantus is used for.

 

[iHs]

I hypo around 2am every night till about the time I wake up which is 5:30. I take my lantus at 10pm. I reduced my carbs at dinner as well as my novorapid just in case that was driving the hypos.

Get yourself on to an insulin pump and then you'll be able to adjust your midnight basal rate downwards so that you dont go hypo at 2am.

 

[slip]

This could well be your pancreas spluttering back in to life after having a 2 month break, the joys of the honeymoon period?

Confirm that the lows the CGM is reporting with a blood test is correct, and if so keep gradually reducing your basal until you're happy, remember keep with a change for 2-3 nights to make sure you're not reacting to 'one-offs'.

Edited to add the chances of getting a pump 2 months post diagnosis is probably low.

 

[Kristin251]

@tvnerd - are you hypoing at roughly the same time each night, and if you are, please can you let us know when that is? Also, can you tell us when you take your Lantus? Unfortunately, insulin interactions are often a little more complex that just one thing, so if you can give us some details we may be able to provide better advice.

@Kristin251 - regardless of how you use your Lantus, it will be lasting longer than overnight, as that's the way the insulin works. I'm pleased you've found a way that works for you!

Haha. Starship. Autocorrect of course.

I got that formula of 20 points one way or the the other to adjust basal out of Think Like A Pancreas. It works for me. Sounds like @tvnerd basal is too high. I agree with @catapillar to not feed insulin as well

 

[mytype1.life]

I agree with the comments above especially re: exercise and a change in diet. I had been upping my exercise (5-6 times a week rather than he average 3) recently and noticed hypos pretty much every night despite my BS holding before, during and after exercise. I then started to feel like I was running on empty and was fighting a hypo constantly as though my body didn't need as much insulin as it had so definitely consider your exercise patterns and change in diet.

 

[tvnerd]

Thank you everyone for your help! Will do a 7 point test for the next few days. Hopefully this will stop soon

 

[sweetbloodsher]

I take 9 units of lantus at night. I usually eat a snack that has about 20g of carbs before bed. I still have hypos at night (have a CGM). I have already reduced my lantus from 12 units to 9 over the past month. Have also reduced my mealtime insulin.
1. How can I avoid hypos?
2. Should I change my snack?
3. Any ideas for night time snacks? ( Currently eat biscuits with some peanut butter and jam).

What worked for me (at least for now) was slowly reducing my basal, taking it in the morning, changing my carb ratio at dinner so that I took less bolus, and I continue to have a night snack. I like yogurt with chopped nuts, or a cup of high protein cereal with almond milk. Good luck to both of us!