3 a.m. Hypo. Suggestions as to why?

Hi MountainTom,
The short answer to your question is: INSULIN.

So please let us first hear about your insulin regime, before we dwell into the more technical explanations where the moon phases might also have a role to play. Any chance you also are a vampire or have ancestors in Transylvania, then please provide all relevant details?

mountaintom said:

Hi Celsus,
Haha!
Ok, diagnosed 9th Jan this year, aged 37. I’m currently on Toujeo 9 units at 9pm every day and usually 3+ units of Novorapid before each meal, depending on carb count, of which I am sticking to as strictly as possible, i.e. working out carbs for each meal. I snack on almonds and occasional rice cakes with peanut butter. Drink about 6 cups of coffee a day (which don’t appear to have any effect on my bg’s). I started a Lantus regime in hospital but changed to Toujeo after painful injections and lumps and blood from Lantus. Toujeo took about a week to settle down. This last week has been fantastic, waking at 7.0 and going to bed at 7.0 (or thereabouts).

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Excellent MountainTom,
I understand then that you are a hyper insulin sensitive T1 like myself!

And I do actually then still stay on the insulin regime you just recently abandoned yourself, as I am still happy and on the NovoRapid 5+3+3 units and Lantus 11 units regime. But from Lantus and to the Toujeo model is not that big a step, though I do recognize of course its like 3 times more concentrated in terms of serum effect per unit. BUT, the biggest difference is the serum onset time difference between these two glargine insulin types!
The onset time (to max peak serum effect) is around 2 hours for the Lantus, while it is around 6 hours for the Toujeo. Which fits perfectly for your 9pm injection time and then "BAM!", your 3am hypo...

I used to be on more or less the same old style regime as you follow now and when changing to the long 24h acting kind of insulin, one was negligent to think any peak really would appear or matter at all. Its a flat curve for 24 hours, right?
Well, no not 100% accurate actually.
So I personally switched many years back to take my one daily shot of the long acting insulin at the same time as I take my morning insulin. This way you are always awake and have an active day during all the 'small peaks' that your different insulin shots may throw at you. And the onset peak of the slow acting is now just a small bump on the big one you already get from your fast acting insulin you take for your breakfast.

And I have not had one single night episode of hypo since I changed to take my long acting in the morning.
I would strongly recommend it to anyone who like you and me only need one daily shot of the long-acting insulin for Type1.

PS: I just sent you a private message as I noticed your proportionally high level of active basal rate insulin units versus your daily intake of bolus insulin units. Typically they should compare almost 1:1 !
All readers here may not be aware that the Toujeo is a concentrated glargine, that has 3 times the serum effect per unit versus the Lantus glargine. So your daily rate of inulin intake looks like this:
Fast acting: 9 units.
Long acting: 27 units.
That to me looks very surprising, all except if you eat almost no carbohydrates in your food?
And would also add to explain your night hypo issue.

mountaintom said:

Wow that’s fantastic help. Thank you so much. Now, how to move my Toujeo dose forward 10hrs? Have a night of high?

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Yeah, prefer a night a bit high versus a day of permanent low. As compromise during transition, take 1/3 of your normal dose at 9pm and then kick in with full dose next morning. And be ready to eat a bit extra snacks in-between to compensate during time till dinner time that day, until that 1/3 dose from the night before fades out.

mountaintom said:

So I was driving home after not eating my dinner and pull over with hot sweaty legs. 3.3 on the strip meter. As Celsus has kindly pointed out my basal needs adjusting. I’ve treated my hypo and need to eat a meal now (beans on toast). What should I do? Bolus as normal? Should I lower my Toujeo tonight? I usually take Toujeo at 9pm. My dsn recommends adjusting basal by two units each time.

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It certainly still points towards that your basal is too high. Your Toujeo insulin pen easily accommodate adjusting just one unit up/down as you need, so I see absolute no reason why your DSN 'recommends' you only to adjust by 2 full units if having to change your regime...?
Actually, as you are a high insulin sensitive person like myself and currently only taking 9 units of the Toujeo every day, then adjustments of just 1 unit either up or down can be a big difference in your therapy. Aka personally right now I take 11 units of Lantus every morning (actually done that for 10+ years by now). I have at short tests tried either to take 10 - and I go too high as a result, or take 12 units of Lantus and during that day I will repeatedly go too low several times between each meal and also during the next night when I sleep. If I had to try out taking 13 units of Lantus and it would be total havoc, especially during the following night as I would even dare to go to sleep as the bg would keep bottoming out every couple of hours after I keep stuffing myself with stupid senseless sugar goodies.

From your description MountainTom, it doesnt sound like your basal rate has really been set well by a thorough and systematic process, which is really required as first step for good control and an easy (an easier..) life with Diabetes Type1.
You have some great guides on this forum how to acomplish that task.

I too take small amounts of Toujeo. Found 9 every day too much and 8 not enough. Was hoping for half unit pens, but they don’t do them. Have compromised with 9 one day 8 the next. It is working well. (Consultant on board)

mountaintom said:

Hi all,

Hope you are all well today.

Last night was the first time since my January diagnosis (that I’m aware of) of having a night time hypo.
I woke from a terrifying dream (the content of which I cannot remember) and couldn’t move my legs at all and was sweating.
Somehow I went back to sleep (had been having an awful time actually trying to get to sleep that night so was pretty shattered). Woke at 6.30/7 as normal and scanned my libre to find a massive dip between 3 and 4 a.m. Not a major hypo though - probably low to mid 3’s.
I had done nothing different yesterday from every other day this week. And I’ve had such a fantastic week numbers wise, waking at around 7.0 and going to bed around the same number. And when I tested my bloods with a strip before my breakfast it read 9.0. Higher than normal.

Any idea as to why? I’m half expecting some elaborate and mad explanation to follow: that the liver sucks away glucose on the 16th of January every year because of the moon phases or if the air pressure outside drops it can affect your bloods.

Thanks in advance.

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Have you woken up at 3am with a hypo? Did the Libre catch the low and did you sleep through it?

I'd have to guess at the honeymoon period as the most likely reason at the moment, but I'd guess most folk will still have the odd night time one how ever many years on, I tend to eat a Weetabix with milk if my bloods look trending downwards.

Was it one of those hypos with the cold clammy sweat soaking you, your bedding and mattress? As mentioned, gluco gel is a good fix, enough to let you get switched on anyway.