Hypos during the night

[grahamrb]

Recently my wife has had several hypos (3 last night) during the night for no apparent reason even though the reading before she goes to bed is quite good at about 10.

In our house 10 is good even though a bit high.

After the hypo she takes the jelly babies or coke then waits 10 minutes to have a biscuit then has to get up to clean her teeth by which time she is wide awake finally gets off to sleep then the alrm goes off telling her she is low agin.

Does anyone know what causes these hypos since it it is not doing her any good.

 

[Antje77]

Sounds like her basal insulin is too high. Please have her contact her diabetes nurse to discuss her doses.

 

[In Response]

Sorry to read about the problems your wife is having @grahamrb
You mentioned that her low alarm goes off so I am going to assume she has a CGM.
Does she check the CGM reading with a finger prick?
The reason I ask is because "Compression Lows" are a problem with CGMs. This is when pressure applied to the CGM such as when you lie on it when asleep can cause it to report an incorrect low. Therefore, it is important to always check lows before treating (unless it is very obvious).

 

[RobertJ]

I would also agree the basal is likely to be too high. Going to bed on 10mmol is unnecessarily high – it is better to go to bed on 6–8. As long as the basal is the correct level, this will not cause lows.

 

[Hopeful34]

Sorry your wife is having so many hypo's @grahamrb
Has she done an overnight basal rate test recently? If not, that's a good place to start.
If her basal rate is correct, then it may be that her insulin:carb ratio is off depending on what time she last ate before bed, or had she given any correction doses of insulin in the evening?
Is she checking with a finger prick test that her levels have risen sufficiently after a hypo before going back to sleep?

 

[JMK1954]

Repeated hypos during the night are exhausting and demoralizing. I speak from experience. How much time is there usually between her fast-acting with her evening meal and the basal taken, I assume, last thing at night ? What time do the hypos start ? My problem was partly caused by my evening meal being rather late, sometimes 8pm, because my husband was driving thirty odd miles to get home and I sometimes worked late to fit in with the bus timetable and eat with him.. My mealtime insulin was not 'played out' when I was going to bed, so hypos were the result. The DSNs suggested solution was to move house to be nearer work !!!

 

[grahamrb]

Thank you for your responses.
She takes her basal injection every morning not in the evening.
What is a basal rate test?
Tonight her reading is 17 which she is very happy with since she won’t get a hypo in the night
We have taken off the libre2 this afternoon to see if that helps
And are just using finger pricks
We have not done a finger prick test to see if the libre low reading is correct we will try that the next hypo

 

[EllieM]

We have not done a finger prick test to see if the libre low reading is correct we will try that the next hypo

Does she get recognisable symptoms when hypo? Before the days of cgms most people would wake in the night if they went hypo. Cgms are marvellous things, but not when they give you false hypo alarms.

 

[grahamrb]

Yes she certainly knows when a hypo is coming even without the libre

 

[EllieM]

Yes she certainly knows when a hypo is coming even without the libre

That suggests that the night time hypos are real, assuming she is feeling hypo then.

I too suspect you may need to adjust the basal, but how long after her evening bolus and meal is her bed time? Is it possible there is still some bolus in her system then? That could be pushing her down after she's gone to bed though multiple night time hypos suggest to me that the basal may be too high. If you're not confident to adjust it yourself then you should urgently talk to your team.

I hate night time hypos with a passion. (Well, I hate all hypos, but night time seem the worse.)

Good luck.

 

[becca59]

Just a heads up @grahamrb I had a discussion with dentist about night time hypos and teeth cleaning. He said don’t. Apparently unless we leave a fair amount of time before washing teeth you just brush the sugar in and create more problems. Just have a glass of water by bed and swill round mouth a couple of times.

 

[grahamrb]

Just a heads up @grahamrb I had a discussion with dentist about night time hypos and teeth cleaning. He said don’t. Apparently unless we leave a fair amount of time before washing teeth you just brush the sugar in and create more problems. Just have a glass of water by bed and swill round mouth a couple of times.

Thanks Becca

 

[grahamrb]

That suggests that the night time hypos are real, assuming she is feeling hypo then.

I too suspect you may need to adjust the basal, but how long after her evening bolus and meal is her bed time? Is it possible there is still some bolus in her system then? That could be pushing her down after she's gone to bed though multiple night time hypos suggest to me that the basal may be too high. If you're not confident to adjust it yourself then you should urgently talk to your team.

I hate night time hypos with a passion. (Well, I hate all hypos, but night time seem the worse.)

Good luck.

Guess what, we didn’t use the libre last night , no hypos
Some time ago one of the nurses said that I was being too scientific, I now realise that she was correct,

I have now come to the conclusion that dealing with type one is an art form!!

We have dinner anytime between 6pm and 8pm, depending on what we are doing
Bedtime is normally 11.30 to midnight so there is normally 3to 4 hours after dinner.
Tonight’s reading was 23 so there won’t be hypos tonight
Why it was 23 is anyone’s guess we’ve both stopped worrying since there is no point
My wife recently had a fall and hurt her hip and is suffering pain

Would this have an effect on the readings?

 

[EllieM]

Guess what, we didn’t use the libre last night , no hypos
Some time ago one of the nurses said that I was being too scientific, I now realise that she was correct,

I have now come to the conclusion that dealing with type one is an art form!!

We have dinner anytime between 6pm and 8pm, depending on what we are doing
Bedtime is normally 11.30 to midnight so there is normally 3to 4 hours after dinner.
Tonight’s reading was 23 so there won’t be hypos tonight
Why it was 23 is anyone’s guess we’ve both stopped worrying since there is no point
My wife recently had a fall and hurt her hip and is suffering pain

Would this have an effect on the readings?

Yes, both pain, stress and infection can push the readings up.

I don't think wearing the libre will cause hypos, but it may be giving you false alerts... Though of course, with a starting reading of 17 you would hope not to go hypo anyway.

While I agree that life is probably too short to stress about high bgs, when mine go that high they make me feel ill, so it's probably worth trying for a happy medium which is lower...

Is managing T1 an art or a science? Sometimes to me it feels like both.

Good luck.

 

[Dobsfidge68]

Hi.

Just a quick response.

I got my Libre 2 after 40 years of dealing with this “pain in the ****” disease from 13 years old.

I ate at 6-7 in the evening to make sure my Humalog was not acting before bed which would work for you hopefully.

I tried to get my readings at 11-12pm between 5-10mmol before bed.

I then set my low alarm to 4.5mmol and monitored.

I was getting alarms regularly but woke up in a state where I could deal with it and monitored until I had the correct amount of Glucose tabs and rich tea bics to not go over 10mmol. This took some doing as the Libre has a timelag on the readings.

This was impossible as the amount of alarms per night was too much being in a full time job.

I eventually, after a week of reducing my 24 hour Lantis Glargine reduced my intake by 10 units. Then the dips started disappearing so the insulin was dealing with my bodies glucose production without driving me down. My daytime readings during this time I cared not a jot.

I don’t have breakfast but still had to inject 2 units of Humalog quick acting insulin to deal with the gap where my long acting was wearing out and the newly injected long acting was taken.

My best readings are now from 11pm to 11am.

I am trying to deal with the rest of the day now but the reaction times of Humalog v Food is so inconsistent that unless you live the most boring of lives and eat a little food over the whole time the insulin is working, you are never going to get to the gold standard of 7.5.

I have lived my life for the last 40 years and have only just been given a piece of kit that proves that most of the advice I was given 40 years ago, “you’re average should be 5.6”and 20 years ago, “your average needs to be closer to 6” was unrealistic.

I hope you get things to a position where you are able to just feel healthy and are able to live life to the full.

Good luck.

Ok, not such a short response.

 

[grahamrb]

My wife had a fall in August and after two X-rays and two MRI scans have finally discovered that she has two prolapse discs in her spine. This explains why she has been in so much severe pain over the last few weeks.
Only this week we have some nerve painkillers Pregabalin and this is zonking her out.
Because of this, although we are making sure she has her long acting insulin 18 units every morning, the mealtime doses are a bit hit and miss.
Because of being zonked her food intake is erratic
The blood sugar levels are higher than 13 for 61% of the time and in target for 4% the remainder being above 10% and currently no hypo’s
The nurses have told us to keep a record of the insulin intake but to me this seems a waste of time since the medication is not always the same
She has an operation on her spine on Tuesday next so we will continue to play it by ear until then
Because of the pain she more or less immobile apart from struggling to the downstairs toilet

 

[grahamrb]

The 4% above should read 8%

 

[EllieM]

I don't know what to advise here. Pain and illness both push blood sugars up so her levels aren't that surprising.

Are your team giving you any help?

Lots of virtual hugs and I hope the operation goes well.

 

[letsgo182]

How are you determining she is having a hypo? The only reason I raise it is because my Libre gives me false low readings at night all the time. It turns out this is common and called “compression lows”. If you are trusting the libre then it might be leading you astray.

Other advice; make sure your wife hasn’t injected fast acting insulin for atleast 4 hours before bed. This is the time it roughly takes for it to be out of her system.

 

[grahamrb]

I don't know what to advise here. Pain and illness both push blood sugars up so her levels aren't that surprising.

Are your team giving you any help?

Lots of virtual hugs and I hope the operation goes well.

Dear EllieM
The operation seems to be successful, after initial pain immediately after the operation it is now decreasing and my wife can now walk indoors without crutches, which is great.
She is still on medication but we are reducing it each day.
This of course has played havoc with her blood sugar levels but hopefully we can get back on track.
I emailed the nurses but after discussing with them they agreed with me that it is pointless to change the insulin doses.
Many thanks for your hugs.
Ps It is only 6 days since the op so she is doing well