Serious night time hypos

[erinkirby]

Hi all,

I've been a Type 1 diabetic for about 31 years now and on the whole I have good control. Lately I've been experiencing very bad night time hypos and my husband has had to revive me with Dextrose glucose tables on a few occasions now, luckily I'm conscious enough to eat them although it takes him a long time to get me to do so, as I deny to him that I'm having a low. I'm sure some of you can relate to this!

Last night I tested before bed and I was 10. Normally I would give myself a small correction dose of 1 unit which would bring me down to about 7, but last night I decided against it given that I've been experiencing night time lows and didn't want to exacerbate the situation. At 2.30am I woke up and couldn't get back to sleep which often for me is a sign of a hypo, so I tested and sure enough I was 2.5. I took 4 Dextrose tablets which normally sees me right, and went back to sleep. Next thing I knew my husband was trying to bring me round by feeding me more Dextrose which he finally managed to succeed with, and I came round. This was 6.45am. He gave me 8 tablets and by the time I was conscious enough to test myself the result was 2.8.

Anyway, I'm not sure exactly what I'm after except perhaps for some views from other people who might have gone through this and can give me some ideas of what they did to resolve it. I've tried lowering my Lantus, I was taking 13 units before bed but have lowered this to 12, and don't really want to lower it much more as this will affect my levels during the following day. I also carb count and therefore take my insulin according to what I eat. I walk about 5 miles every day but that hasn't increased lately so it's not exercise that's causing it.

I want to go onto the insulin pump as I've heard good things about how that can stop the severe hypos - is that correct? However, I raised this with my diabetic specialist at my last appointment in May but he told me a pump wouldn't suit me because my control is too good. When I said I'm starting to lose my hypo awareness and maybe a pump would help, he just told me the DVLA won't let me drive if I tell them that. Good response doc - not!

Do pumps help with the problem I'm experiencing? Does anyone think it would be worth me pursuing this or would it be a lost cause?

Any advice greatly appreciated!

Thanks.

 

[Engineer88]

Firstly I would drop your lantus to about 10 to start, you may need more novorapid the next day but dont worry about that - remember highs arent life threatening lows (esp nighttime ones) are!

you dont say what ratio your on, I would consider dropping tea time and doing 3am tests for a few days.

Good luck

PS 6 dextrose is 20g of carbs- also Cartoned fruit juice works quicker

 

[erinkirby]

Thanks Engineer88! What you say makes good sense, I guess there is no harm in dropping my Lantus to 10 for a while to see if it helps.

I take Humalog during the day rather than Novorapid, and my ratio changes depending on what time of day it is and whether I'm stressed, etc, which doesn't help I must admit! I'm usually about 1.5 units per 10g of carb, but that can go down to 1 or up to 2. I think I'll try the 1:1 ratio for my evening meal to see if that helps too.

I'll also keep some fruit juice in the house for my husband to use next time, that's a good idea too. Thanks!

 

[ivinghoe]

It was also quite warm/muggy last night (it was here in London anyways) so that may have had an effect?
Dropping your lantus would certainly be the best way to go especially if the warm nights persist

 

[erinkirby]

I've never related hypos to the warm weather but maybe I should! I too live in London, and yes, it was very muggy last night. I had to turn the fan on after my first hypo.

 

[noblehead]

No experience of the pump but by all accounts they do help with many insulin related issues. I tend to agree with Engineer that you should drop your lantus down to 10 units and see if this helps, for the next couple of nights you should carry out some basal testing just to see how your bg is behaving.

Good luck!

 

[Ambersilva]

It sounds as though you are an ideal candidate for a Continuous Glucose Monitor that has an alert facility when glucose levels drop too low. Can you present yourself to your diabetic specialist with readings including some night-time lows.

You can purchase liquid glucose which is easier to manage in your mouth. Dr Oetkers Liquid Glucose is sold amongst the baking products in Supermarkets.

As you know it is really important to try to prevent lows at night that require the help of paramedics to bring you round especially if you are a car driver...

 

[Engineer88]

I would suggest lucozade or fruit juice over liquid glucose, you need to drink more than you would expect for 2cps. Also when treating a night hypo dont forget to back it up with long acting food or like youve shown you'll drop back into hypo.

Like yourself Im a long term diabetic (23 years) and suffer with night hypos. Only problem is I live alone so Have to be ver cautious about them.

 

[Stefano]

Hi, the pump will definitely help....at least it did in my case which was similar to yours. I'm 33 years diabetic. Don't know why but in the last 5 years lantus became unpredictable in the way it worked in my body especially in the evening & night. For the fear of night hypos I reduced it too much but then I didn't have enough basal in my body. I then moved to levemir but after some months exactly same pattern as lantus. Fortunately my hospital in London admitted they didn't know why it was happening and they suggested me to use an insulin pump. I never wanted one but last October I decided to give it a try and it's been the best choice ever.
I can go to sleep with 7 and wake up with perfect bg the morning after without any risk of hypo. The insulin pump delivers only fast acting insulin so the way it works is much more predictable and you can't have too much insulin at the same time in your body unless your basal calculation in your pump was originally wrong. I strongly suggest you try a pump. I still got my driving licence and my London hospital never told me there was s risk of loosing it. It is actually proved that with the pump hypos reduce drastically.


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[erinkirby]

Thanks for all your answers and advice everyone, it's much appreciated and very helpful!

 

[Glucohero]

A pump would probably help from what you're saying as it is possible to set different basal rates on an hour to hour basis. This would enable you to have sufficent basal during the day and a much reduced dose during the night. Basal is pump terminology for lantus, long acting insulin
.
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[unityjon]

would it not be easier to inject your long acting insulin in the morning, that way its wearing off during the night and virtually gone by the morning which should keep your blood sugar slightly raised until morning when the cycle starts over again ?

Its how i controlled mine until i started doing lots of extreme exercise now i need to review it as i started to get low about 3:00am :evil: ..... no idea if its right or wrong, but each person to their own, there are no rules.....

 

[erinkirby]

Thanks for your suggestion unityjon, much appreciated. Since posting my original message I've tried lowering my Lantus to 11 units at night which, for now, seems to have done the trick. I've only had one night time hypo since then and it was mild enough (2.8) for me to wake up and treat myself.

I will definitely consider your suggestion though if the hypo's continue, but hopefully I've nailed it.

I'm also going to raise the pump issue at my next diabetic hospital appointment but that's not until May 2014.

 

[jrussell88]

It sounds like your overnight blood glucose is on a falling trend and you need to cut your basal dose to keep it stable i.e. constant overnight. If your fasting daytime sugars are stable at the moment then they'll probably change to a rising trend as you reduce the night-time dose.

The action of insulin does appear to change over time - I found the basal dose was acting increasingly quickly, and my daytime basal dose needs to be higher than my night time dose so I was getting increasing numbers of early morning hypos - some severe. My consultant seemed quite aware of this issue but apparently not everyone is.

His solution was to split the basal dose into two smaller doses twelve hours apart. I started with an equal split, which was an improvement, and adjusted gradually until it's now 2/3 am and 1/3 pm which is giving me stable fasting sugars overnight and during the day.

I prefer to achieve this without an insulin pump if possible as there are some small risks associated with those which injections avoid.

Glucogel is available on prescription - 80ml bottles containing 32g of carbohydrate or 3x25ml tubes each containing 10g carbohydrate. Ask your GP for it. By the way I've tried most things for hypos and glucogel is very good - it was designed for exactly that purpose - disgusting if you don't need it but otherwise the elixir of life. It is very concentrated and partly absorbed in the mouth without being swallowed so your husband can put some in your mouth and it will start to work very quickly, much faster than fruit juice and less to swallow.

You could also ask for a Glucagon kit and make sure your husband knows how to use it, and can test your blood sugar - it's what ambulance crews use on unconscious hypoglycaemics.

Note that the DVLA may not give you a licence if you have several hypos in I think 12 months where you need external assistance - I recently renewed and that was a new question for me; there weren't any questions about pumps though.

You should discuss the options with your consultant and if altering the night time dose doesn't sort things out I wouldn't wait another year - call and ask for an appointment as you've got a serious problem.

 

[Claire2332]

I would take a red bull to bed with u takes u up in About 3 mins flat


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[michaeldavid]

You could try changing your insulin regimen entirely. However you may well have difficulty persuading your GP about the wisdom of such a radical idea.

My approach is thoroughly unorthodox. But my HbA1c readings are always excellent. And nowadays, unlike a few years ago, I hardly ever have hypos at all.

Aside from a very small amount of long-acting insulin I take last thing at night - to stop my blood-sugar rising while I sleep - all the insulin in my system is exhausted by the time I go to bed. Accordingly, I have no fear of night-time hypos.

I don't 'count carbs' because I simply don't need to.

I don't take basal/bolus insulins.

I don't do DAFNE, because to me it's clearly daft: if you're insulin dependend, it's unrealistic to attempt to eat normally and to expect not to have problems with hypos and/or high blood-sugar. I don't have problems with either.

Instead, I simple 'feed the insulin' I take. Eating dark, rye bread throughout the morning and into the late afternoon is crucial to doing this safely. My rye-based dietary regimen has a profoundly moderating effect on my blood-sugar: it never CRASHES - I always get time to react.

Crucially also, I test my blood-sugar a lot: 15-odd times per day. But mostly I use the highly economical visually read strips, which can be cut with scissors, and cost just a few pence per test. (I only tend to use meter-read sticks last thing at night and first thing in the morning.)

Betachek Visual are on the UK Drug Tariff, but there is currently no UK based supplier. They can be purchased here: http://www.betachek.com/uk/store

So my proposed solution to your problem is very simple: if you have practically no insulin running in your system when you go to bed, then it's practically impossible for you to have a night-time hypo. But for this, you will need to change your insulin regimen.

 

[mary doll]

I would suggest lucozade or fruit juice over liquid glucose, you need to drink more than you would expect for 2cps. Also when treating a night hypo dont forget to back it up with long acting food or like youve shown you'll drop back into hypo.

Like yourself Im a long term diabetic (23 years) and suffer with night hypos. Only problem is I live alone so Have to be ver cautious about them.

Daughter finds glucogel best and I find it easier to give her that than anything else .It works quickly.

 

[Leeroy1303]

Ive been type I for 28 years and like yourself only recently been having night hypos ive put it down to weight loss ive split my lantus dose in two half in evening and the other half at breakfast works fine for me