Advice please re hypo's in the night

[KCub]

My mother is a type II insulin dependant - and is in her late 80's. She tends to have hypos in the night, and have found out that my dad is testing her before they go to bed, and with a reading of 14, (which I think is too high) is saying that it is low and she will not last the night without a hypo, so gives her a sandwich. This sounds so wrong to me, as in my mind it is setting her up for large swings in blood sugar rather than aiming for a constant level, but am interested what your thoughts are before I tackle this with them!
Many thanks for your time in reading this

 

[Deleted member 527103]

I would agree with you that this does not sound right. Eating a sandwich to avoid a hypo when blood sugars are in the teens suggests something is wrong.

A few things to consider are
- what do you parents think of as a hypo? If your mother is used to running her levels in the teens, she may feel like she is having a hypo even though it is above 4mmol/l. The only way to overcome this is to train your mother's body to be used to lower numbers.
- how does your father know about the hypo? Is it from symptoms, a finger prick or a from a CGM/Libre. CGMs are prone to compression lows - they read low when pressure is applied. This is common at night when we lie on our sensors. The graphs will show a dip but it is a problem with the sensor not our blood sugars.
- what insulins does your mother take. With Type 1, it is common to take a background, basal insulin once or twice a day and a fast acting, bolus insulin with our meals, If our blood sugars are falling when we are not exercising or eating, the basal is usually too high. However, I understand it is not uncommon for people with Type 2 to take mixed insulins twice a day. I am unfamiliar with how these may be adjusted as they require a fixed daily regime.

I recommend investigating what is happening in more detail and, potentially, talking to your mother's doctor to change her medication.

 

[NicoleC1971]

My mother is a type II insulin dependant - and is in her late 80's. She tends to have hypos in the night, and have found out that my dad is testing her before they go to bed, and with a reading of 14, (which I think is too high) is saying that it is low and she will not last the night without a hypo, so gives her a sandwich. This sounds so wrong to me, as in my mind it is setting her up for large swings in blood sugar rather than aiming for a constant level, but am interested what your thoughts are before I tackle this with them!
Many thanks for your time in reading this

I appreciate that it must be hard for your dad not to worry about hypos since anyone is insulin is always warned to be fearful of them and he may have had experience of her having a genuine one.
I'd ask him what the blood glucose is like during the 'hypo' and first thing in the morning after going to bed high (normal is 4-7 four hours after her last meal ) then with 30-40g carbs to sleep on?
If she is going low without the sandwich then her insulin or other medications need adjusting (quantity and timing possible) unless she particularly likes a late night sandwich.
If she is high in the morning then she may have been running high all night which isn't good for her overall health and wellbeing (too much insulin and glucose). Perhaps she could drop to half a sandwich with sweet biscuits on standby to see how that goes if he is really anxious.
I like the above suggestion of investing £48 (or free sample if you can) in a Freestyle Libre monitor just to see what typically happens over the course of 2 weeks but that is up to your parents and you to see if they can interpret the results. If they do have a helpful nurse at their surgery (diabetes specialist) that would be idea.

 

[KK123]

My mother is a type II insulin dependant - and is in her late 80's. She tends to have hypos in the night, and have found out that my dad is testing her before they go to bed, and with a reading of 14, (which I think is too high) is saying that it is low and she will not last the night without a hypo, so gives her a sandwich. This sounds so wrong to me, as in my mind it is setting her up for large swings in blood sugar rather than aiming for a constant level, but am interested what your thoughts are before I tackle this with them!
Many thanks for your time in reading this

Hi there, normally I would say 14 is too high as mentioned above but my Mum was also in her 80s and whenever she went to bed with a reading in the low teens, you could almost guarantee that her levels would plummet (often to the extent they would have to call an ambulance), on many, many occasions in the night. To cut a very long story short, no matter WHAT they did with her regime/diet and everything else they simply could not stop this happening regularly. Consultants all over the place tried different things over the years (she was even mentioned in various papers!!). They called her a 'brittle diabetic'. Following all of this they accepted that her levels were going to be higher than wished but at her age, and the impact of numerous ambulance call outs & hypos and hospital admissions, running her higher was the best thing for her compared to the toll this was taking. I appreciate many will say was this, that or other tried and it's dangerous to run high with all the potential complications, but in this case and in these particular circumstances, it was the right (if not only) thing we could do to keep her out of hospital and conscious. I don't know the general health or regime of your Mum, maybe your Dad who lives with her does. Is he testing her in the night to show whether she actually is hypoing or is this just a fear of his that she will? What are her levels like during the day? x

 

[EllieM]

Hi @KCub and welcome to the forums.
Some very good points made by the previous posters.
I think the first thing I would ask is whether her diabetic team has been consulted about this?

 

[Daibell]

Hi. This sounds all wrong. It's important that your Mother's Basal insulin is balanced and has the tight amount of Basal injected before meals. Someone going to bed with a BS of 14 will not go hypo unless the insulin is badly wrong.

 

[KCub]

Thanks for your replies. I think I am going to have to try and speak to my mums diabetic nurse, but this is complicated by me not living close by, so will have to try the phone! She does have real hypos - blood levels down to 2 or 3 quite often, but then quite often up to 12 or 14, her pattern sounds quite like KK123's mum. Mum was in hospital for a non connected matter in Jan, and they did really struggle to get her levels under control in the hospital, and I know she does eat a lot of bread - her go to snack - which I have so far been unable to convince her to change! I am going to have to be a bit pushy I think to get some answers, and then get her bless her, to change!

 

[KK123]

Someone going to bed with a BS of 14 will not go hypo unless the insulin is badly wrong

In my Mum's case it DID happen regularly and no matter how much they changed her insulin regime over many years, the principle remained the same. I think for some people (probably very few), the administering of insulin has very complicated and opposing issues. I think we all know the importance of balancing insulin and getting the dosage right (impossible anyway) but I don't think it's always as simple as saying if you do, you won't go hypo from a level of 14.

 

[KK123]

Thanks for your replies. I think I am going to have to try and speak to my mums diabetic nurse, but this is complicated by me not living close by, so will have to try the phone! She does have real hypos - blood levels down to 2 or 3 quite often, but then quite often up to 12 or 14, her pattern sounds quite like KK123's mum. Mum was in hospital for a non connected matter in Jan, and they did really struggle to get her levels under control in the hospital, and I know she does eat a lot of bread - her go to snack - which I have so far been unable to convince her to change! I am going to have to be a bit pushy I think to get some answers, and then get her bless her, to change!

Hi KCub, it's not always easy I know and no doubt your poor Mum (and Dad) are being looked at in exasperation by the diabetes team, they would say to my Mum, 'If only this, that and the other' and look upon us suspiciously. It wasn't until they spent months and months trying to do it themselves over the years in and out of hospital that they gave up essentially, realising that if she ever went much below 10 she could expect to end up in a hypo coma, and I mean an actual coma. . Of course as said above, there may be things your Dad can do to help her (and you as do sound like a good daughter) but maybe start off with finding out your Mum & Dad's exact routine! x