Hi, I am 32 and I've had Type 1 diabetes for more than 20 years. I have moved overseas to live and work on a temporary basis, but I know I need the NHS in the UK, so I can't leave the country permanently. My diabetes has been well controlled for about five years (previous to that I did myself a lot of damage by not properly accepting the fact I had the condition when I was in my teens and early 20s). However, over the past three months I have lost all control of my diabetes, and it seems to be due to night hypos. My BG levels suddenly went crazy in the mornings, and, after contacting a specialist nurse in the UK, I was told my BG level was falling during the night, and that I was waking up with a BG level of over 20 because my body had produced its own sugar to compensate. Previously, the symptoms of a hypo had always woken me up, and I don't understand why they no longer are all of a sudden. I have tried, as advised, to keep my BG level above 6 before bed, to give it room to fall safely, and this has not worked. When I make sure my BG level is even higher than that (12, say) to pre-compensate, I then wake up with my BG level even higher. I also feel scared when I go to bed with my BG level at 12 anyway, because this seems far higher than the safe average. I'm struggling to wake myself up at 3am every night to check my blood sugar, because this is making me very tired at work the following day. I have also been keeping my Novorapid dosage below that of my Lantus, as I've also been advised, but it still isn't helping. The problem is now badly starting to affect my eyes, and I have burst blood vessels affecting my vision in my left eye. I have made an appointment to see my specialist in the UK in February, but I am hoping to find a way to better control these night hypos in the meantime. Has anyone else experienced this problem and found a better way of dealing with it than setting the alarm clock for 3am every morning? Has anyone been advised by a specialist to totally change their insulin regime or swap to a different type of insulin, for example? I was wondering if suddenly the insulin I take (Lantus and Novorapid) might no longer be working well for me, and whether this might be an option I can look at with my specialist when I'm home in February. This is getting frightening but I don't want to overreact and fly home immediately if there's a simple measure I could take to stop these night hypos from happening in the meantime. Many thanks in advance for any suggestions. Nicole.
Night hypos - advice appreciated
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Hi Nicole,
The only way of knowing what your bg is doing during the night is to test and test frequently over a few nights, yes it could be your going hypo in your sleep hence your morning high's but then it could also be your basal dose is too low and this is the cause of your waking/fasting high's.
Try and test when it's less inconvenient..... say when your not at work the the following day, what I do is set the meter alarm and test at 1,3 & 5am to get a bigger picture of what's happening throughout the night, basal/bolus doses do change over time..... much to the annoyance that it can cause!
Should you have no joy then certainly look at an alternative basal insulin, some people find levemir a better insulin but personally I'm happy using lantus.
The only way of knowing what your bg is doing during the night is to test and test frequently over a few nights, yes it could be your going hypo in your sleep hence your morning high's but then it could also be your basal dose is too low and this is the cause of your waking/fasting high's.
Try and test when it's less inconvenient..... say when your not at work the the following day, what I do is set the meter alarm and test at 1,3 & 5am to get a bigger picture of what's happening throughout the night, basal/bolus doses do change over time..... much to the annoyance that it can cause!
Should you have no joy then certainly look at an alternative basal insulin, some people find levemir a better insulin but personally I'm happy using lantus.
Dillinger
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Hello,
There are 2 things that might be happening - firstly a night time hypo with a liver dump which is raising your morning blood sugars - this is the 'Somogyi Effect' -
http://en.wikipedia.org/wiki/Chronic_Somogyi_rebound
Secondly, you may be suffering from the 'Dawn Phenomenon' this is where your liver releases glucose into your blood stream in 'preparation' for you waking up, which is not much good if you are Type 1 -
http://en.wikipedia.org/wiki/Dawn_phenomenon
You haven't said what your blood sugars are when you wake yourself at 3:00 am though?
The Somogyi Effect would tend to be much higher than the Dawn Phenomenon in terms of blood sugar levels, so your levels of 20 are a possible indicator of that but it's not conclusive; it could be a stress response or your Lantus is tailing off for instance?
So, you need to think about what you are eating in the evening (in terms of carbohydrate) when you are taking your insulin and review if you are on the right basal (Lantus) dose. Try skipping lunch and not taking any Novorapid and see what happens to your blood sugars; ideally they should be stable.
Make sure you are clear on the 'action' of both insulins i.e. when they reach peak effectiveness and how long they last. As I recall Lantus will claim that it lasts 24 hours, but frankly I think that's rubbish; more like 18 at best.
Personally I used Lantus for a long time and then it started failing on me; it certainly wasn't working for 24 hours. So I changed to a split dose of Levemir (1 evening, 1 morning dose) and things have been much improved.
What you could do is try moving around when you take your Lantus and see if that has any effect?
I also take Metformin (due to possible insulin insensitivity) and that has a beneficial effect on the Dawn Phenomenon by stopping the liver dumping glucose.
It's not clear to me though which of the possibilities is happening to you and you need to get a handle on it; you certainly don't want to be consistently having hypos in the night.
Perhaps do a full night's test one Friday or Saturday - i.e. test every 2 hours and see what's going on?
It's a pain in the neck but you'll get a handle on it; having had similar but not so severe problems in the past I find now that I'm in the happy position of my blood sugar in the morning being pretty much what it was when I go to bed.
Best
Dillinger
There are 2 things that might be happening - firstly a night time hypo with a liver dump which is raising your morning blood sugars - this is the 'Somogyi Effect' -
http://en.wikipedia.org/wiki/Chronic_Somogyi_rebound
Secondly, you may be suffering from the 'Dawn Phenomenon' this is where your liver releases glucose into your blood stream in 'preparation' for you waking up, which is not much good if you are Type 1 -
http://en.wikipedia.org/wiki/Dawn_phenomenon
You haven't said what your blood sugars are when you wake yourself at 3:00 am though?
The Somogyi Effect would tend to be much higher than the Dawn Phenomenon in terms of blood sugar levels, so your levels of 20 are a possible indicator of that but it's not conclusive; it could be a stress response or your Lantus is tailing off for instance?
So, you need to think about what you are eating in the evening (in terms of carbohydrate) when you are taking your insulin and review if you are on the right basal (Lantus) dose. Try skipping lunch and not taking any Novorapid and see what happens to your blood sugars; ideally they should be stable.
Make sure you are clear on the 'action' of both insulins i.e. when they reach peak effectiveness and how long they last. As I recall Lantus will claim that it lasts 24 hours, but frankly I think that's rubbish; more like 18 at best.
Personally I used Lantus for a long time and then it started failing on me; it certainly wasn't working for 24 hours. So I changed to a split dose of Levemir (1 evening, 1 morning dose) and things have been much improved.
What you could do is try moving around when you take your Lantus and see if that has any effect?
I also take Metformin (due to possible insulin insensitivity) and that has a beneficial effect on the Dawn Phenomenon by stopping the liver dumping glucose.
It's not clear to me though which of the possibilities is happening to you and you need to get a handle on it; you certainly don't want to be consistently having hypos in the night.
Perhaps do a full night's test one Friday or Saturday - i.e. test every 2 hours and see what's going on?
It's a pain in the neck but you'll get a handle on it; having had similar but not so severe problems in the past I find now that I'm in the happy position of my blood sugar in the morning being pretty much what it was when I go to bed.
Best
Dillinger
I suffered the Somogyi Effect quite a few years ago now (diabetic since 1987) when i was on actrapid and ultratard, the quickest method my diabetic clinic preformed was to rule out what insulin was causing the problem. firstly if possible take a few days off work.
Day one (night, Before bed) don't take your normal lantus dose, have supper and check blood sugar before bed and use novorapid to bring blood sugar back to normal (novorapid starts acting within 20 minutes peaks about the two hour mark and is completely depleted at approx 4 hrs) set your alarm before popping off to sleep to 4 .5 hours later, check blood sugar, have and glass of milk or something sweet that would make you take at least 4 units of novorapid, set your alarm to another 4.5 hours later and repeat.
By this time it will probably be morning, take your normal breakfast and enough novorapid to bring your blood sugar back to normal, 4.5 hours later do the same as above, the general idea here its to use only short acting insulin for meal times and background basal requirments but remember that novorapid only lasts approx 4 hours. if you find that everything went ok and blood sugars look normal and you have not had an episode repeat for another day, just please be careful with the 4 hour rule.
The logic is to always take at least 4 units of novorapid weather you need it or not (hence the glass of milk or something sweet) every 4.5 hours.
If after day two you still have not had an episode, lets bring lantas back into the equation, (but one thing about lantus you have to understand. it is not a totally long acting insulin, it has some fast acting quality's, which in my experience lasts from the time i take the injection till about two hours later) i would decrease your lantus dose by 6 units and take two blood sugars during the night to see how things are going. if things went ok but your a bit high in the morning increase the lantus dose 1 unit per night untill you get a good fasting blood sugar and tighter control. if things did not go well and you had a night time hypo again reduce your lantus another 2 units and repeat till you find balance, everyone is different it just takes a bit of tinkering.
But you problem does sound to me like your taking to much lantus.
One thing i only replied to this thread because your out of the country and have no clinic for support, as i am not a healthcare professional i'm just a guy who has had diabetes for 24 years and have had to sort some of my own problems out due to similar circumstances to yourself.
i hope everything works out for you, and lets us know if anything needs explaining better abd if you get balanced out lol
Basel
Day one (night, Before bed) don't take your normal lantus dose, have supper and check blood sugar before bed and use novorapid to bring blood sugar back to normal (novorapid starts acting within 20 minutes peaks about the two hour mark and is completely depleted at approx 4 hrs) set your alarm before popping off to sleep to 4 .5 hours later, check blood sugar, have and glass of milk or something sweet that would make you take at least 4 units of novorapid, set your alarm to another 4.5 hours later and repeat.
By this time it will probably be morning, take your normal breakfast and enough novorapid to bring your blood sugar back to normal, 4.5 hours later do the same as above, the general idea here its to use only short acting insulin for meal times and background basal requirments but remember that novorapid only lasts approx 4 hours. if you find that everything went ok and blood sugars look normal and you have not had an episode repeat for another day, just please be careful with the 4 hour rule.
The logic is to always take at least 4 units of novorapid weather you need it or not (hence the glass of milk or something sweet) every 4.5 hours.
If after day two you still have not had an episode, lets bring lantas back into the equation, (but one thing about lantus you have to understand. it is not a totally long acting insulin, it has some fast acting quality's, which in my experience lasts from the time i take the injection till about two hours later) i would decrease your lantus dose by 6 units and take two blood sugars during the night to see how things are going. if things went ok but your a bit high in the morning increase the lantus dose 1 unit per night untill you get a good fasting blood sugar and tighter control. if things did not go well and you had a night time hypo again reduce your lantus another 2 units and repeat till you find balance, everyone is different it just takes a bit of tinkering.
But you problem does sound to me like your taking to much lantus.
One thing i only replied to this thread because your out of the country and have no clinic for support, as i am not a healthcare professional i'm just a guy who has had diabetes for 24 years and have had to sort some of my own problems out due to similar circumstances to yourself.
i hope everything works out for you, and lets us know if anything needs explaining better abd if you get balanced out lol
Basel
Dont stop taking your normal lantus dose as was mentioned by a previous post. You will not learn anything this way.
The only way to know for sure is to test your BG before going to bed. Then set your alarm clock for every 2-3 hours and check it during the night. I know its not convienent but is the ONLY way to know for sure.
Do it for a few nights to see if there is a pattern of when it increases or decreases, and adjust your insulin from there. Otherwise it is just guess work.
Hope it works out.
The only way to know for sure is to test your BG before going to bed. Then set your alarm clock for every 2-3 hours and check it during the night. I know its not convienent but is the ONLY way to know for sure.
Do it for a few nights to see if there is a pattern of when it increases or decreases, and adjust your insulin from there. Otherwise it is just guess work.
Hope it works out.
In addition to all above, all I'll say is don't take too much notice of the "advised" Lantus to novorapid ratio. Despite being told over & over that my ratio was wrong & that I should be aiming for a balance of around 50/50, fasting tests have proved that I need, on average, 30% basal & 70% bolus. Perhaps I have a high carb diet, but I need around 14u basal insulin per day regardless of what I eat (average 20-25u bolus insulin) any more basal & I'm hypo overnight & before meals. So you could try cutting down your Lantus by 1u at a time until the hypos subside yet you still don't wake up high.
When I was on Lantus I was told to take it as late in the evening.g as possible too, so that it doesn't really get active until getting on for breakfast time.
Good luck with it all.
When I was on Lantus I was told to take it as late in the evening.g as possible too, so that it doesn't really get active until getting on for breakfast time.
Good luck with it all.
maria030660
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Hi
I had this for a while as i moved from Europe to the middle east. I was on Lantus and Aprida. Important thing is that you dont stress out and keep on testing frequently. Also i would find out in your area if they have good diabetes clinics. In the middle east they are great as many people there are diabetic and many american hospitals like mayo clinic are represented out there. I have been working all over the world as a type I diabetic and learned to trust specialist outthere. Remote assistance is ok for a while but not long term. I solved the night hypo's in the end by changing insulin. I am on Levemir/Novorapid and doing very very well. If you keep struggling you also might to consider using an insulin pump which will give you greater freedom and a better way of adjusting insulin all through the day/nite.
But dont despair and keep smiling!!!
I had this for a while as i moved from Europe to the middle east. I was on Lantus and Aprida. Important thing is that you dont stress out and keep on testing frequently. Also i would find out in your area if they have good diabetes clinics. In the middle east they are great as many people there are diabetic and many american hospitals like mayo clinic are represented out there. I have been working all over the world as a type I diabetic and learned to trust specialist outthere. Remote assistance is ok for a while but not long term. I solved the night hypo's in the end by changing insulin. I am on Levemir/Novorapid and doing very very well. If you keep struggling you also might to consider using an insulin pump which will give you greater freedom and a better way of adjusting insulin all through the day/nite.
But dont despair and keep smiling!!!
My son has been a diabetic for 2 and a bit years and has frequently suffered nighttime hypos regardless of what his bedtime reading was so we were moved onto lantus instead of the split levimer approach, and fingers crossed its working. However I have always found with him his long acting insulin works best if he takes it in the morning. Maybe you could try that. Also when he does seem to be having them again I give him a bigger snack. Hope any of this helps.
Hi Nicole, 
Just to say firstly that all the advice people are giving is really great ,just dont be overcome by so many things all at once :? break them down and try individually and see what makes a difference for you. It seems the most important thing is to get your lantus dose sorted so you really need to do your much hated 3 am test :lol: .Id do it at a weekend so it wont affect you for work and it only takes a few mins to test so you can be back in the land of nod soon after :thumbup: What time do you take youre lantus at ? The reason i ask is i take novarapid and lantus and before i went on a DAFNE course i was having frequent hypos at 3 am in a morning and then would wake feeling rough and my blood sugars would be through the roof .I learnt a lot from DAFNE and have had only one serious hypo in the last 9 years since joining DAFNE
I moved my lantus times and split my dose as it only works for 21 hrs in my body so i needed the split dose . i would look forward to hearing how you are doing dafne jim
Just to say firstly that all the advice people are giving is really great ,just dont be overcome by so many things all at once :? break them down and try individually and see what makes a difference for you. It seems the most important thing is to get your lantus dose sorted so you really need to do your much hated 3 am test :lol: .Id do it at a weekend so it wont affect you for work and it only takes a few mins to test so you can be back in the land of nod soon after :thumbup: What time do you take youre lantus at ? The reason i ask is i take novarapid and lantus and before i went on a DAFNE course i was having frequent hypos at 3 am in a morning and then would wake feeling rough and my blood sugars would be through the roof .I learnt a lot from DAFNE
and have had only one serious hypo in the last 9 years since joining DAFNE I moved my lantus times and split my dose as it only works for 21 hrs in my body so i needed the split dose . i would look forward to hearing how you are doing dafne jim
Sarah walker BENNETT
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Hi Nicole
I hope you’re ok, I wanted to share my suggestion. The same thing happened to me recently and my diabetic clinic has put me on Degludac instead of Levimir which had been working fine until last year. Apparently some Basel doses say 24 hours but most rarely last that long, however Degludac is one that does and I noticed a difference almost immediately. I use Novarapid for fast acting.
I now also do the Basel dose in the morning and my sugars have calmed down. I had to go onto an ACE inhibitor because of the damage the raised sugars had done. But glad to say after starting the new regime the renal readings went back to safe levels within 4 weeks. I hope you are ok and have found your own solution
I hope you’re ok, I wanted to share my suggestion. The same thing happened to me recently and my diabetic clinic has put me on Degludac instead of Levimir which had been working fine until last year. Apparently some Basel doses say 24 hours but most rarely last that long, however Degludac is one that does and I noticed a difference almost immediately. I use Novarapid for fast acting.
I now also do the Basel dose in the morning and my sugars have calmed down. I had to go onto an ACE inhibitor because of the damage the raised sugars had done. But glad to say after starting the new regime the renal readings went back to safe levels within 4 weeks. I hope you are ok and have found your own solution
My consultant changed the timing of my lantus. I was taking it before bed and struggling with night time hypos. I now take it in the morning and it's made a huge difference.
This was happening to me. I was injecting 34 units of lantus and getting readings of about 30 in the morning. This does was too high and I now inject 28 units. I was having really bad sleep, waking up soaking wet from sweating and thought I was going through early menopause. Eventually after being referred to a specialist Nurse, she explained it was proberbly night hypos and told me to test in the middle of the night for at least 3 nights. I work and have a family to take care of, so found this very difficult. However after pushing myself I did it and could prove they were night hypos. Now my lantus dose is lower and so are my morning readings. Do the tests in the night, you will feel so much better when this is sorted.
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Hi @Li5a ,
Welcome to the forum.!
I found the danger zones for lows in the night with Lantus were 2/3am 5/6am with my dose before bed at 11pm.
Though this thread is nearly 6 years old. Never omit the basal.
Starting from the ground up with a basal test is always the first port of call. https://mysugr.com/basal-rate-testing/
TheBigNewt
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The only way to document a hypo during the night is to take your blood sugar at that time. Or have a CGM alert you (the Dexcom does Libre doesn't is what I've heard). You can't just assume you got low during the night and that's why you're high when you wake up, that's garbage advice IMO.
After how many hours of dinner do you test your sugar. If the value is 2oo mg after 2 hours of your dinner then you might have a normal sugar level in the morning. Check if after 4 hours of your dinner time, it definitely falls at that time as it happens to me. Night time we do not require insulin specially between 1 to 3 a.m as we do not have any activity. Doctors generally reduce the long lasting insulin dosage. Check for couple of days then you will know the reason and accordingly adjust your insulin dose.
