Advice please

Good morning,
I have recently started on Toujeo Glargine 32 units once a day. Before this I was on Novomix 30 twice a day, taking 38 units in total.
The diabetes nurse at my GP practice has given me two target BMs, before breakfast (6-7 mmol) and before bed (8-9 mmol).
My bedtime BM varies but always above 9 and my before breakfast reading appears to be consistently around 4.2, occasionally falling to below 4 and rarely reaches 5 never mind 6. Thus I wake in a hypoglycaemic state.
The nurse didn’t seem to be concerned about the BM readings pre midday or pre evening meals as these can vary depending on how much strenuous exercise I do.
I do not know what to do to stabilise my blood sugar levels and are those target values realistic?
Any advice would be most appreciated.

In Response said:

NovoMix and Glargine are different types of insulin.
NovoMix includes both slow and fast acting insulin whereas the Glargine is only slow acting insulin.
The purpose of slow acting insulin is to keep your BG relatively stable in the absence of anything else that affects it like food and exercise such as overnight. Therefore, if your BG is falling from 9 to 4 overnight, it suggests to me (with the caveat that I have no medical qualifications) is too high.
Previously, the fast acting part of your NovoMix was covering you for the meals which is probably now being helped during the day by the "excess" Glargine. If you lower your Glargine to remain more stable overnight, your BG may become higher during the day.

Click to expand...

Thank you. I think I can cope if my BM is higher during the day, I’ll try reducing the dose by a couple of units and see what happens over the next few days, and titrate the dose accordingly.

Chris24Main said:

Are you type 1 or 2 ?

[removed by me, was a little too close to offering advice I probably shouldn't give] - I struggled for months over the same kind of question, what is it that I should be aiming for.. but we're all different, and it's a totally different game for a type 1 compared to 2...

If you are prescribed Toujeo, you should also have a CGM, is that correct?

Click to expand...

I am type 2 on Metformin and dapagliflozin. Levothyroxine for hypothyroidism and Sertraline. I don’t have and neither was I offered a CGM, only pre prandial and last thing at night BMs.

Chris24Main said:

Ok, thanks, and apologies if I came over as poking in some way.. I only ask because I was initially diagnosed as type one.. and when I was prescribed insulin, I immediately also got access to a glucose monitor.. essentially the dangers of over dosing insulin are much more severe (particularly for type 1) - I'm sure you know this, but it may be something to bring up with your GP.. if you understand what's going on with your blood sugar level on a minute-to-minute basis; first of all.. it's a wealth of knowledge you just don't get from a pin-prick test, you're much better able to accurately dose yourself, and you get to understand your body - which will be reacting to things uniquely.

Click to expand...

Don’t worry, any thoughts, experiences or advice is most welcome and appreciated, whether from a type 1 or type 2 perspective.