Type 1 Basal Dip

[Tasha_Wilkinson]

Hi there!

I was wondering if anyone could offer me any advice. Every night before bed my blood levels seem to be on the good side, at around 6-10mmol. Then once I do my basal and go to sleep, it drops in the night. I’ve tried eating a little before bed, but sometimes I still drop. If I eat more I go too high. I’d preferably not eat before bed because I’m trying to lose weight so the extra calories are a pain! Does anyone have any advice? Should I be lowering my basal dose? Or something specific I should eat?

Thanks!

 

[Deleted Account]

Please excuse my questions in response to your question
- How are you detecting the drop? Is this through finger prick tests or Libre or CGM? I ask because many people notice Libre and CGM report low readings when you lie on them during sleep.
- What basal insulin do you take? Whilst they should be constant, some, like Lantus, have a little rise at the start which could lead to a BG drop. For this reason, I changed the time of my basal to evening meal time so my BG remained ok as I slept.
- How many basal doses do you take? If you take one, reducing it to avoid night time hypos, may result in going high during the day. You may be able to avoid this if you split your basal doses.
- When do you eat your evening meal and take your bolus insulin? A short acting insulin like NovoRapid stays in our body for about 4 hours (for some it is up to 6 hours). If you are taking this less than 4 hours before your bed time reading, you may have some "insulin on board" (IOB) which will continue to drop your BG for a few hours. Depending on what you eat, eat you may be able to overcome this by taking your bolus a little earlier before your meal.

 

[Tasha_Wilkinson]

Please excuse my questions in response to your question
- How are you detecting the drop? Is this through finger prick tests or Libre or CGM? I ask because many people notice Libre and CGM report low readings when you lie on them during sleep.
- What basal insulin do you take? Whilst they should be constant, some, like Lantus, have a little rise at the start which could lead to a BG drop. For this reason, I changed the time of my basal to evening meal time so my BG remained ok as I slept.
- How many basal doses do you take? If you take one, reducing it to avoid night time hypos, may result in going high during the day. You may be able to avoid this if you split your basal doses.
- When do you eat your evening meal and take your bolus insulin? A short acting insulin like NovoRapid stays in our body for about 4 hours (for some it is up to 6 hours). If you are taking this less than 4 hours before your bed time reading, you may have some "insulin on board" (IOB) which will continue to drop your BG for a few hours. Depending on what you eat, eat you may be able to overcome this by taking your bolus a little earlier before your meal.

Thanks for your response!! so sorry I didn’t reply I got caught up with exams and travelling etc! Unfortunately I’m still having this issue, but maybe my answers can help. Yes I’m currently using the libre with the miaomiao sensor to use it as a CGM, but I don’t think the drop is a pressure low because I’ve confirmed it with a blood test and can feel my lows very well so know I’m going low. The drops are very big too, from 18 all the way down to 6mmol ! This is why I eat til my bloods are high, as I worry about going to bed on 10, and waking up at 2 or 3 in the middle of the night. I am on lantus and you’re suggestion sounds like a good idea so I’m deff going to give that a try! Splitting the dose is another option too. I did this many years ago but at that time I had terrible control so didn’t think it made much of a difference :/ I eat fairly early around 6:30/7:30 and use Humalog as my short acting, and don’t go to bed until around 12am. Thanks to my Miaomiao I can see that by 11 I have no more IOB so think that isn’t the problem. Your suggestions have been amazingly helpful and I think my plan of action is to start by bringing forward the glargine to around 9pm (instead of doing it at 11pm like I currently am) and see how that goes. If that doesn’t work, I may ask my diabetic nurse or consultant for advice about splitting the dose and try that. Thanks again for all the advice and sorry for the late reply!