Morning hypos...

[imalittlefishy]

Hello folks,

I'm looking for a bit of advice with my overnight and morning levels. After a rocky 6 months at the end of last year and the beginning of this one, where my diabetes was completely sidelined and I ended up with a HbA1c of 13, I've taken it in hand and got it down to a much better 8, though I still have a way to go. My main problem is that unless my bs is at 12+ before I go to bed, and sometimes even at this level, I wake up in the morning or sometimes during the night under 4. I don't particularly like having to force my blood sugar up in the evenings just to get a reasonable result in the morning. I'm on lantus and novorapid, and when I've tried reducing my basal, it just sends the results for the rest of the day shooting upwards. My DSN has suggested reducing the novorapid I take with my evening meal, but this seems to me just another way of getting it up so I don't drop way back down?? I've always had issues with going low in the mornings, even when I was on two mixed injections a day. Anyone any ideas? Might I be better off trying a different basal?

Thanks
xx

 

[Margi]

I used to have exactly the same problem and solved it by splitting the Lantus into two doses. If you are taking it only at night, that could be the reason for your morning hypos. It is now recognised by most diabetes doctors that Lantus does not actually last the full twenty-four hours, so splitting it works.

I take more Lantus in the morning than at night, so the split is not 50/50, but I find that works to keep me stable overnight and not going high by day as I used to.

I tried swapping my lantus from night to morning to prevent the morning (often small hours) hypos, but that simply made the morning BS much too high, because the Lantus had run out before morning. When I discovered that, I split the dose. Result: brilliant! I had to experiment with different amounts and proportions, but got there in the end. It has taken me a very long time to realise that I no longer need a bedtime snack. I really don't! I'm still afraid to go to bed without one because I needed it for way over 25 years before I discovered the 'split the Lantus' trick. One day I'll learn not to eat at bedtime. I'm even so obsessed with the 'need' (which isn't a need any more) that I will eat and inject Humalog for the snack!! :shock: :shock: :shock: How daft is that? Old habits...

If you haven't done it already, give it a try and see what happens.

 

[ebony321]

I would definately try splitting your basal insulin so you can adjust the later dose so you aren't having to go to bed high and risking going low. As Margi says, it does take some tweaking. not everyone has the dose split 50/50 and 12 hours apart. But if you persevere you may get results like Margi too.

If you do decide to split your insulin, it's best to let your diabetes specialist know that you are doing so.

Also remember when tweaking lantus you should wait 3 days between tweaks to see a definate change.

And finally well done on getting your hba1c down, 8% may not be ideal but it is a very good improvement, if you could get around going to bed with raised BG's i'm sure this would help you lower it more

 

[noblehead]

No expert by any means but I wouldn't reduce your novorapid just yet if you are going to bed on 12mmol, by the looks of things your basal insulin is too high and this is causing your bg to crash through the night. A split dose may be better or perhaps a change of insulin could be the answer, either way it's important that you seek guidance from your dsn on how best to do this.

On the basal/bolus regime there should be no reason to snack if you don't want to, I use both novo and lantus and just stick to 3 meals a day without the need to snack, the exception to this is if I am out walking in countryside then I'll have a small snack to keep my bg stable.

Not sure if you have heard of the DAFNE course for type 1's (dose adjustment for normal eating) but it covers all the issues which you are currently dealing with, ask your dsn if they run one in your area.

Nigel

 

[silvarbullet1]

I used to have exactly the same problem and solved it by splitting the Lantus into two doses. If you are taking it only at night, that could be the reason for your morning hypos. It is now recognised by most diabetes doctors that Lantus does not actually last the full twenty-four hours, so splitting it works.

If you haven't done it already, give it a try and see what happens.

+1


I had the same problem, I tried various options including changing to giving Lantus in the morning, splitting the dose etc. It seemed to me to work to a degree, but after a few months I found the hypos came back. However, I have had various changes in routine over the months and this obviously affects things, especially what time I go to bed and get up.

I have an appointment to be assessed for an insulin pump next week and am hoping that firstly they let me have one, and that this will be one of the things that it may help with, as you can adjust the background level every hour.

Hope you get it sorted! Let us know how it goes.

 

[type1diabetic39]

If you are using Novorapid with your evening meal are you sure that 4 hours have elapsed before going to bed? It could still be working when you are testing before going to sleep and your blood sugar could still be dropping. If you are sure that it is not that, it has to be the Lantus.

Also if you have the opportunity try the DAFNE course as stated earlier. Its Brilliant.

 

[imalittlefishy]

Thanks for all the suggestions guys! I did do a similar course to DAFNE a few years ago now, however I did it just before I went off to uni which was pretty bad timing as with all the upheaval and changes in routine I never really got to grips with it. I understand the theory and do estimate my carbs for each meal but not sure how accurate I'm being...should definitely go back to that. My evening novarapid is almost always 4+ hours before I go to bed so I don't think that's the problem.

Nigel I think that my DSN was suggesting lowering my evening novarapid instead of having to snack in the evenings rather than both...but to me it's just using different methods to get the same result (too high before I sleep to avoid dropping) so I don't think that's the best way to go...

I'm pretty rubbish at testing between meals, but I've done a few over the last couple of days and my hour readings have been surprisingly high compared to my pre meal readings, so I've got a theory that my overall insulin is about right, but my basal is too high and my boluses too low...I've going to do a few days of more comprehensive testing and see if it goes along with that, if so I'm thinking reduce my lantus down and try a more insulin:carb with my meals and see if that makes a difference. If not then I think splitting would be the next plan. Thoughts?

xx

 

[type1diabetic39]

Splitting sound like it may be the way to go.

Just dont over test your blood sugar (Hourly readings as you stated) it will make you worry.

Test in morning, just before meals and before bed (Obviously also if you feel hypo). Dont estimate food if you are eating at home. Know for sure. Measure your food and/or check labels. Its the only way to successful control.

You control the diabetes it does not control you.

All the best, I hope you find a solution.

 

[imalittlefishy]

Ooops that was meant to say *2 hour readings! Thanks type1diabetic39
xx

 

[Margi]

Even two hour readings are too much really. The only time they are necessary is if something in your life has changed dramatically such as new job, therefore levels of activity, or new kind of insulin and you need to see how it's working - although, come to think of it, that's pretty much what you're dealing with now - etc.

DAFNE says not to test between meals, as someone above said, it will only worry you. The important thing is that the BS is right before meals and stays right overnight; it will always go up a bit after a meals and so long as it does not go too desperately high, or stay high till the next meal then it's ok. It really does sound as if the basal dose is your problem. Good luck.