Feel like I'm not getting anywhere...

[Nicola M]

Went for a hospital appointment last week to talk about CGMS results. Overall I'd say it looked awful. I was taken off nighttime Lantus because it dropped my blood sugars to the 2.2 mark for 4-6 hours and I wasn't waking up. And my morning levels slowly go up no matter how much insulin I do. So I was moved to Levimir, which to be honest is not having the desired effect either. They don't want me to use any other basal insulins because of my nighttime low troubles. I almost feel stuck, last time they spoke about maybe giving me a pump but that seems to have gone out the window in favour of trying to sort the morning highs in other ways, which isn't working. It just seems as though it's never going to get better!

On a plus note my diabetes team said my carb counting is really good, yay!

 

[jack412]

well done on good carb counting ..I read on the forum about a lot of people have trouble with it.

it may take a bit of time to find your levels, have you got a nurse phoning you every few days or are you doing self titration?

 

[catriona92]

I have this problem too, low during the night and high in the morning, apparently it's called the dawn phenomenon. At the moment I'm just trying out a few things such as testing through the night and doing carb free days to see how my lantus is working but it looks like I'll be going on to using it twice a day half my normal dose in the morning and a little less at night. Trial and error is generally the only way these things can be figured out, yes it's frustrating as hell but because we are all different it just takes time. Just thi n k when it is sorted and you finally have something that suites your body, how happy will you be! You'll get there

 

[Jaylee]

Hi, just out of curiosity.. What aproximate time do these hypos/lows occur in the night with the Lantus?

 

[catriona92]

Around 3am

 

[Jaylee]

Around 3am

If you were to dodge that bullet & hypo in the morning? Around 5 to 6am?

 

[jack412]

I have this problem too, low during the night and high in the morning, apparently it's called the dawn phenomenon. At the moment I'm just trying out a few things such as testing through the night and doing carb free days to see how my lantus is working but it looks like I'll be going on to using it twice a day half my normal dose in the morning and a little less at night. Trial and error is generally the only way these things can be figured out, yes it's frustrating as hell but because we are all different it just takes time. Just thi n k when it is sorted and you finally have something that suites your body, how happy will you be! You'll get there

they say carb free days isn't the best way to basal test because half the protein turns to glucose
http://www.diabetes-support.org.uk/info/?page_id=120

 

[catriona92]

You still take insulin dependant on proteins , I'm just going by what my dsn has taught me , and it's been working for me so far

 

[iHs]

Went for a hospital appointment last week to talk about CGMS results. Overall I'd say it looked awful. I was taken off nighttime Lantus because it dropped my blood sugars to the 2.2 mark for 4-6 hours and I wasn't waking up. And my morning levels slowly go up no matter how much insulin I do. So I was moved to Levimir, which to be honest is not having the desired effect either. They don't want me to use any other basal insulins because of my nighttime low troubles. I almost feel stuck, last time they spoke about maybe giving me a pump but that seems to have gone out the window in favour of trying to sort the morning highs in other ways, which isn't working. It just seems as though it's never going to get better!

On a plus note my diabetes team said my carb counting is really good, yay!

Hi..

What time during the night are yr bg levels dropping? Mine always dropped around the 2-3am mark and to prevent the hypo feeling, i either made my bg levels higher before going to bed by adjusting the eve meal carb ratio or by eating a carb snack before getting into bed. Although eating carb before bed was an inconvience, it was a compromise that I was willing to make

 

[himtoo]

Went for a hospital appointment last week to talk about CGMS results. Overall I'd say it looked awful. I was taken off nighttime Lantus because it dropped my blood sugars to the 2.2 mark for 4-6 hours and I wasn't waking up. And my morning levels slowly go up no matter how much insulin I do. So I was moved to Levimir, which to be honest is not having the desired effect either. They don't want me to use any other basal insulins because of my nighttime low troubles. I almost feel stuck, last time they spoke about maybe giving me a pump but that seems to have gone out the window in favour of trying to sort the morning highs in other ways, which isn't working. It just seems as though it's never going to get better!

On a plus note my diabetes team said my carb counting is really good, yay!

hi nicola
from this post i would say you need to press your case for a pump - with NICE guidelines you would certainly qualify with CGM proving you are having night time hypos that are disabling ( not waking up ).
i don't know if you are a forceful character but if you keep in your mind it is YOUR life -- not theirs and you speak with conviction and keep putting on pressure , and talk to your dsn as well. don't let them off the hook !!!!

 

[Nicola M]

Hi, just out of curiosity.. What aproximate time do these hypos/lows occur in the night with the Lantus?

They start at around 2am and stay at that level until 8am (that's when I get up and can treat it) I have no idea I'm low until getting up for the day which is scary.

 

[Nicola M]

Hi..

What time during the night are yr bg levels dropping? Mine always dropped around the 2-3am mark and to prevent the hypo feeling, i either made my bg levels higher before going to bed by adjusting the eve meal carb ratio or by eating a carb snack before getting into bed. Although eating carb before bed was an inconvience, it was a compromise that I was willing to make

They drop at 2am and stop that way until I wake up at 8am to get ready. I've tried rising my sugars before going to bed by having something to eat but my sugars still drop to the 2.2 mark.

 

[noblehead]

They drop at 2am and stop that way until I wake up at 8am to get ready. I've tried rising my sugars before going to bed by having something to eat but my sugars still drop to the 2.2 mark.

It can only be that your basal insulin is too high Nicola.

A pump would certainly be beneficial to you, but you should ask your team if they are aware of the new basal insulin called Tresiba, it has a much flatter profile than other basals and its said to help reduce nocturnal hypo's.

 

[iHs]

They drop at 2am and stop that way until I wake up at 8am to get ready. I've tried rising my sugars before going to bed by having something to eat but my sugars still drop to the 2.2 mark.

What time do you give yourself the eve dose of Levemir? If its at bedtime, then you could try changing the timing to eve meal and just adjust the carb ratio for the bolus. That way, Levemir's action on controlling the nightime bg levels will have less impact.

Like others have stated, if you have problems with the low bgs despite adjusting the amounts and the timing of the basal, then you should be able to get yr hospital consultant to justify a need for yr CCG to fund an insulin pump on the grounds of anxiety caused through worry about going low. You dont have to reveal that you have had 3rd party help to get one. Look at the NICE TA151 guidelines and print them off. You can get a pump on just 1 or 2 grounds if your consultant is supportive of pump therapy. If they are not, then contact INPUT and they should be able to help you.

 

[Jaylee]

They start at around 2am and stay at that level until 8am (that's when I get up and can treat it) I have no idea I'm low until getting up for the day which is scary.

What time do you eat evening meal.. & what are your BS levels running like before supper..?
I'm looking at Jack412's graph comparing the tail off of the Levemir to the Lantus, then wonder if you possibly "overcompensate" with the bolus for the evening meal for any high pre meal reading which clashes with the peak of the Levemir during sleep...? I do Lantus. Just a wild thought...!??

 

[iHs]

They drop at 2am and stop that way until I wake up at 8am to get ready. I've tried rising my sugars before going to bed by having something to eat but my sugars still drop to the 2.2 mark.

I used to be exactly the same using Lantus before bed back in 2002, even with eating a snack. Told my consultant about getting up low in the morning like yrself and he said ....well...although you are low, you are able to get up so havent gone really hypo in the night needing help.
He had a point but to be low for many hours is not really good and I think advice and opinion would now be different.

 

[Nicola M]

What time do you eat evening meal.. & what are your BS levels running like before supper..?
I'm looking at Jack412's graph comparing the tail off of the Levemir to the Lantus, then wonder if you possibly "overcompensate" with the bolus for the evening meal for any high pre meal reading which clashes with the peak of the Levemir during sleep...? I do Lantus. Just a wild thought...!??

My last meal is between 4:30 and 5pm. Before I go to bed my sugars levels range between 6 and 8. They stay that way for a couple of hours and then they suddenly start dropping at the 2am mark.

 

[iHs]

My last meal is between 4:30 and 5pm. Before I go to bed my sugars levels range between 6 and 8. They stay that way for a couple of hours and then they suddenly start dropping at the 2am mark.

As yr bg drops at the 2am mark, it wont really hurt that much if you go to bed a bit higher than 6-8mmol but try altering the timing of the Levemir to see what effect that has.

 

[Juicyj]

It can only be that your basal insulin is too high Nicola.

A pump would certainly be beneficial to you, but you should ask your team if they are aware of the new basal insulin called Tresiba, it has a much flatter profile than other basals and its said to help reduce nocturnal hypo's.

Completely agree with Noblehead here - press your team to try Tresiba, only one injection a day and flatter profile, it is recommended to reduce nighttime hypos, good luck

 

[iHs]

I think that what is happening is that through certain hours of the night, bg levels change with or without any influence of basal. On a pump, my basal need is low at midnight to 3am and then changes slightly at 4am onwards to slowly rise up so that is why I always needed to eat some carb before bed to prevent the low when using twice daily and bolus/basal regimes.