Lowest safe BG before bed?

[SilverK]

Hi, it’s taken three weeks but my blood sugar is finally in single figures . My readings drop throughout the day and I’m now looking at numbers below 6 at bed time. Tonight is 4.9 (3 hours after dinner). It may well drop further. I usually wait 4hrs after dinner but I was a little late eating tonight. I’m tired and I want to go to bed now.
How low is too low??

 

[Rokaab]

Not sure whether you're type 1 or type 2 or what insulins you are on, but if you have your bolus with your dinner, then it probably still has time left on it as most bolus's last about 4 hours, in which case if it was me I'd probably want a small snack to get my sugar levels a little bit higher.
Also the answer also depends on what your sugar level normally does overnight, go up, go down, stay level.

 

[kandj]

I would agree and have something to eat, I have been advised to be at 8 for bedtime, but I take 4 injections daily. Everyone is different. Hope you get a good nights sleep

 

[DCUKMod]

Hi, it’s taken three weeks but my blood sugar is finally in single figures . My readings drop throughout the day and I’m now looking at numbers below 6 at bed time. Tonight is 4.9 (3 hours after dinner). It may well drop further. I usually wait 4hrs after dinner but I was a little late eating tonight. I’m tired and I want to go to bed now.
How low is too low??

SilverK, I'm not and never have been an insulin user, but what I have seen suggested in similar circumstances is that whatever you decide to do before bed, that you set an alarm a couple of hours in, to wake and test your bloods, to see what has happened.

Obviously, this isn't a strategy you'd want to be doing every night (!!), but maybe whilst you're really getting to understand how insulin is working for you and the impacts of various things, it could be very useful.

If you can afford it, it could be really useful to invest in one or two Libre sensors, so that you could see what happens to your blood glucose 24/7 for a couple of weeks (for each sensor). That could give you a really useful insight.

The Libre sensors are c£50 a shot, plus you'd need a compatible phone, or a reader (at another c£50) to be able to access the data, but I deliberately chose to use the word investment, as in your shoes, I might be inclined to see it that way.

Of course, it isn't for everyone, but something to consider if the coffers can stand it.

 

[ert]

Depends if you are on insulin or sulfonylureas and experiencing regular hypos. If so, your consultant may suggest you run your BS's higher at bedtime. I have an MM which alarms at 4.3. I also eat berries or cherry tomatoes at bedtime and take less of my split dose basal and set an alarm for 4 hours time if I'm worried.

 

[SilverK]

Thanks for the replies guys.
I didn’t have a good night last night. I was in a lot of pain so I didn’t really sleep. (I used to just give up on sleep on bad nights or try to knock myself out with hot milk and pain killers but can’t really do that now.) My sugars were okay. Wobbled a bit but didn’t go any lower.
This is all still very new for me. I’m really pleased (and relieved!) that my sugars are down, but it does make me nervous. I’m on fixed doses of novorapid and lantus at the moment. I’m waiting for a phone call from the dietician. I’m hoping they’ll let me start adjusting my insulin to what I’m eating. I haven’t eaten much in way of carbs since I was a teenager (49 now) so the concept of having to eat a little bit of something carby every meal is messing with my head. I know that LCHF seems to be the way to go for a lot of people on the forum but as I had a heart attack three weeks ago and am taking enough pills to sink a ship, I’m reluctant to go against the consultant (and the cardiac team!) right now. Not sure they’d sign off on the high fat bit!
As to which type I am, well the jury is still out on that one. They’re hedging. More tests on Nov 17th - unless it gets cancelled!
Thanks again for all the support.

 

[SilverK]

SilverK, I'm not and never have been an insulin user, but what I have seen suggested in similar circumstances is that whatever you decide to do before bed, that you set an alarm a couple of hours in, to wake and test your bloods, to see what has happened.

Obviously, this isn't a strategy you'd want to be doing every night (!!), but maybe whilst you're really getting to understand how insulin is working for you and the impacts of various things, it could be very useful.

If you can afford it, it could be really useful to invest in one or two Libre sensors, so that you could see what happens to your blood glucose 24/7 for a couple of weeks (for each sensor). That could give you a really useful insight.

The Libre sensors are c£50 a shot, plus you'd need a compatible phone, or a reader (at another c£50) to be able to access the data, but I deliberately chose to use the word investment, as in your shoes, I might be inclined to see it that way.

Of course, it isn't for everyone, but something to consider if the coffers can stand it.

Thanks for the info.

My DN was talking about getting me one of those. I’ll see where she is with it.
When I do get back to work my job involves a lot of running around, a lot of driving and a lot of stress. I already feel like a pin cushion so it would really help!

If I need to fund it myself then I probably will.

 

[DCUKMod]

Thanks for the info.

My DN was talking about getting me one of those. I’ll see where she is with it.
When I do get back to work my job involves a lot of running around, a lot of driving and a lot of stress. I already feel like a pin cushion so it would really help!

If I need to fund it myself then I probably will.

SilverK, your profile is pretty blank, which can lead to lots of repetitive questioning about medication etc.

You don't have to, but it really would be helpful to members trying to make valid suggestions if you could update it with the fact you are now using insulin, and the sort of insulin you are in (mixed, fixed doses, or variable fast and slow acting).

To do that, you just go to your account settings, in your browser (not the App) and update from there. If you're struggling with it, but want to do it, just send a PM to myself or any other Mod and we can update it for you.

I just want to stress you don't have to if you don't want to.

 

[TashT1]

I find my libra invaluable & well worth the money. Your DN probably will not be able to give you a libra until your confirmed as T1. Mine got into a bit of trouble for giving me one very early on & then the antibodies came back negative.

Personally I like my BG to be within the target range before bed the low end of which is 5.3. If I’m lower I’ll have a small snack to nudge it up. I also take my basal in the morning so don’t have to worry about that.

I can be a light sleeper so I often wake up & test at 3 or 5am but again with a libra that is super easy & less distributive to sleep.

 

[SilverK]

I have a face to face appointment with the consultant on 17th November. I don’t know if my BG will have settled down a bit by then but I’m due to go back to work around the same time. At the moment I’m bouncing around with no discernible pattern. Today and yesterday I’m between 14 and 8 but for two days before that I was dipping into the 4s and was having to raise it before driving. I’m not doing anything differently. It’s frustrating now, it’s going to be unmanageable when I’m back at work, chasing around after kids, carting PPE everywhere and driving between up to three schools a day. I’m hoping they’ll take that into account when I see the consultant and consider giving me a libre. Looks like I’m going to have to wait if I want a confirmed T1/T2 diagnosis. My hospital has stopped all but essential blood tests due to supply shortages. I don’t know which tests were done when I was in but as I’m on insulin now anyway I’m guessing more tests can wait.

 

[TashT1]

Good luck with going back to work, I can imagine it is a very active role. You might find you need to adjust insulin/ eat more carbs depending on how much your on your feet.

All you can do is not be too hard on yourself if you go too high or too low. If you can keep a record it will help you find the right balance between activity, insulin & carbs.

If there’s anyway you could send fund a Libra it would really help you see what’s going on, especially when your daily routine changes.

 

[DCUKMod]

I have a face to face appointment with the consultant on 17th November. I don’t know if my BG will have settled down a bit by then but I’m due to go back to work around the same time. At the moment I’m bouncing around with no discernible pattern. Today and yesterday I’m between 14 and 8 but for two days before that I was dipping into the 4s and was having to raise it before driving. I’m not doing anything differently. It’s frustrating now, it’s going to be unmanageable when I’m back at work, chasing around after kids, carting PPE everywhere and driving between up to three schools a day. I’m hoping they’ll take that into account when I see the consultant and consider giving me a libre. Looks like I’m going to have to wait if I want a confirmed T1/T2 diagnosis. My hospital has stopped all but essential blood tests due to supply shortages. I don’t know which tests were done when I was in but as I’m on insulin now anyway I’m guessing more tests can wait.

SilverK - Are you on fixed doses of insulin? If so, are you varying your meals?

 

[SilverK]

Hi, yes, I’m on 16 Lantus twice a day and 14 novorapid three times a day. The DN adjusts it (puts it up, basically) over the phone. Still waiting for a call from the dietitian. Feels like that’s the only hospital department that hasn’t phoned me! From what I can tell by the numbers, my lantus might need to go up but the novorapid could do with coming down, or at least it could be adjustable? I used to eat low carb and do intermittent fasting before this, so the instruction to “eat normally” is messing with my head! I’m eating around 20g of carbs at breakfast and lunch and about 45-55g at dinner (rice, protein and green salad). - I changed that up yesterday and had 25-30g at dinner and I was 8.5 last night and 14.6 this morning which is higher than I was on more carbs (?!?). I’m keeping a food diary and obviously tracking my blood sugar readings. I’m taking four readings a day but also testing when I get dizzy/light headed or have to drive. I can go from 15 to 5 in 30min while reading a book and then the other way just as fast. It’s confusing.

 

[SilverK]

Update
Evening Lantus is now 18. Still 16 in the morning and novorapid is the same.
DN is pleased with the direction my numbers are going. She said to ignore the odd random spike for now. She’s pretty sure I’ll get a libre, especially with my job involving so much running around. She said it’ll be easier to track the patterns and causes of spikes with one. I’m hoping she’s right, though I’ve seen a few posts on here with people saying they’re inaccurate, which is a bit worrying. Especially with all the driving I do.
I’ve got MyFitnessPal on my phone (- part of my new sideline as a Sugar Spike Detective), is there a different app out there that anyone recommends?

 

[SilverK]

Had my first hypo this evening. 2.9. I guess that’s a bit low before bed!

 

[TashT1]

I hope your feeling ok now. 2.9 will certainly give you some strong hypo symptoms.

Libra’s can be tricky for some people but not everyone. I’ve probably had 10 or more by now and only 1 faulty. I’ve only had one hypo in the 2’s & I put that down to being able to scan easily & catch it at 4.

Any ideas what caused your hypo? Too much insulin to carbs at tea?

 

[SilverK]

Hiya, yes, thank you, okay this morning. I woke myself up a couple of times to check my BG (5.1 and 6.9) so that’s okay. Still over 11 in the mornings at the moment but it comes down throughout the day.
Probably caused by a combination of things.
I’ve abandoned the whole “eat normally” thing. Normal for me always (pre lockdown!!) was LCHF. The novelty of eating bread and potato has worn off! I’ve pulled my carbs down to between 15 and 20 a meal. Not really low, I know, but the heart attack has made me reluctant to eat fat. Got an appointment with the dietician on Nov 9th so I’ll see what they say. - the Eat Well plate is NOT an option lol!
Unfortunately, my bolus insulin is still fixed so maybe my carbs are a bit low...?
Yesterday I’d done some exercise in the afternoon and then I’d hit the housework. After dinner I changed all the beds and for some reason decided to turn a double mattress around and flip it over. It did occur to me, when I had it up and balanced on its edge that it probably counted as heavy lifting and I shouldn’t be doing it on my own, but there you go! Maybe the extra energy expenditure pushed my BG down?? Still new enough that it didn’t occur to me that it might.
Even more concerned about going back to work now. And not just work. Other things in my normal life are pretty physical, - I’m a teacher, a silversmith and a musician. I really hope the libre works for me!!

 

[TashT1]

Glad to hear your doing ok now.

Yeh doing all that house work in one go would send me hypo as well so I tend to space it out. I also tend to go lower in the evenings & the nurse said it’s because my body is rebalancing after all the days activity.

It’s hard when your on the fixed bolus to get that balance right. Can’t remember if anyone has pointed you at the Bertie online course yet, which is great for learning about carb counting.

If you continue to have hypos in the evening you could call your nurse & discuss lowering your dose, they are probably assuming your eating more carbs than you want to.

 

[SilverK]

Had another one. 3.2 at 4pm. No exercise or housework so far today so can’t use that as an excuse. And I had a nap! Almost exactly the same to eat as yesterday, - maybe 2g more carbs at lunch today and a bit more protein.
I noticed I was very cold both times. I’m pretty sure the being cold came before the hypo. Does that sound right?? It isn’t listed as a symptom to watch out for.

 

[SilverK]

Is the Bertie course something you need a referral for? No one has mentioned it yet.