Overnight Hypos

[Europa01]

My partner has type 1 and uses a Libre 2 monitor. Regularly she will have a hypo overnight - typically her blood glucose will reduce in a more or less straight line at around 2.2 to 2.4 mm/l per hour. To avoid a hypo she effectively has to go to bed with a reading of up to 20mm/l. She carb counts and splits her long acting morning and evening.
Given the continuous rate of glucose reduction I can't see compression effects on the Libre sensor being relevant or an effect of her last short acting injection. I assume this points to the number of units of long acting she is taking in the evening but she's only taking half the daily amount and reducing by 1 unit makes no difference.
I'd be very grateful for anyone else's views or experience

 

[EllieM]

Hi @Europa01 and welcome to the DCUK forums.

The first recommendation I would make is that she contacts her medical team urgently. This is the sort of issue they should be advising on.

What kind of long acting insulin is she using?

 

[jaywak]

I used to have quite severe nocturnal hypos until I changed from giving my long acting insulin at night to when I wake up in the morning , I haven't had a night time hypo for over 5 years now .

 

[Europa01]

Hi @Europa01 and welcome to the DCUK forums.

The first recommendation I would make is that she contacts her medical team urgently. This is the sort of issue they should be advising on.

What kind of long acting insulin is she using?

Hi EllieM - thanks very much for your quick response - she's using Levemir but about to be moved to Glargine. Your advice is noted and I'll have a serious word with her.

 

[Europa01]

I used to have quite severe nocturnal hypos until I changed from giving my long acting insulin at night to when I wake up in the morning , I haven't had a night time hypo for over 5 years now .

Hi Jaywak - thanks for the prompt advice - as she's going to be moved to Glargine a single morning injection may suit what I understand to be its 'long tail' effect.

 

[Fairygodmother]

Hi Europa01,
I feel for your partner and their frequent nighttime hypos! When I was using Levemir, which I liked, I found that my nighttime dose was less than my daytime dose.

 

[Circuspony]

I had to change to Tresiba to stop overnight hypos

 

[EllieM]

Hi Jawak - thanks for the prompt advice - as she's going to be moved to Glargine a single morning injection may suit what I understand to be its 'long tail' effect.

I would argue that if you are getting hypos you need to reduce the insulin acting at the times you are getting them. Some people need drastically different amounts of basal at different times of day and they really need an insulin pump to give them the flexibility they need. (I was moved to a pump because I didn't get on with lantus/glargine and had too many hypos).

I'm not saying that this is the case for your partner but she really needs to consider her options because going to bed with ultra high bg is not a sustainable solution (in my opinion.) Would she consider joining the forums with her own account?

Good luck to you both. Hypos are horrible for partners as well as diabetics.

 

[Europa01]

I would argue that if you are getting hypos you need to reduce the insulin acting at the times you are getting them. Some people need drastically different amounts of basal at different times of day and they really need an insulin pump to give them the flexibility they need. (I was moved to a pump because I didn't get on with lantus/glargine and had too many hypos).

I'm not saying that this is the case for your partner but she really needs to consider her options because going to bed with ultra high bg is not a sustainable solution (in my opinion.) Would she consider joining the forums with her own account?

Good luck to you both. Hypos are horrible for partners as well as diabetics.

Hi Ellie,
Thanks for your advice and kind words. I do get your point about different amounts of basal at different times of day. This makes me wonder if Glargine with its long flat effects profile / long tail would be counterproductive as I believe it's supposed to give a more constant rate. She is on the waiting list for a pump but they are resource / funding limited where we are and self funding appears to be non-starter here too. I'm nudging for a consultation with the diabetes team to get her some compelling advice.