Bedtime glucose level 6

Tracie1212 said:

Once again I find myself with bedtime blood glucose of 6. I've been on daphne course which advises bedtime level of 8+. Novorapid was injected 4 hours before. Decided not to inject lantus last night as fed up of eating when I don't feel like, this morning my level was 9.1. This is a regular occurrence with good control before bedtime. I do suffer with asthma/allergies and find chest is quite tight if I don't inject lantus? Unsure what's going on. Can anyone advise on best way forward. Thanks

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Hi @Tracie1212 - I didn't realise that DAFNE recommends going to bed with glucose levels above 8. That explains a lot about why the UK average glucose levels are so high.

It is perfectly safe to go to bed with a glucose level between 5 and 8 if you have basal tested and know that overnight, your glucose levels don't drop and you know what happens with your bolus insulin.

If I was you, I'd suggest that you undertake some basal testing to confirm what your overnight levels look like, and then make an informed decision as to what you want to do.

It's important to take your lantus as it's your basal (background) insulin @Tracie1212

Have you basal tested, if not then you should do to determine if your basal insulin is set at the right dose, if it isn't it can lead to erratic bg levels where your bg levels can go high or low in the absence of food, here's a link which explains all:

https://mysugr.com/basal-rate-testing/

As for going to bed on 8, if after basal testing and adjusting your lantus you find that your bg levels stay steady overnight then you could go to bed on a level lower then 8.

@Tracie1212 @tim2000s DAFNE does not say go to bed over 8.

The targets in my DAFNE course book are:

• 5.5 - 7.5 before breakfast
• 4.5 - 7.5 before other meals
• 6.5 - 8 before bed

So, DAFNE guidance is to be under 8 before bed, not 8+



If you can't comfortably go to bed at 6 without risk of a hypo during the night then you really need to do some basal testing following the guidance in the link at post number 3 from @noblehead , while you wait for an opportunity to do some overnight basal tests you may also want to consider a small reduction in your basal dose to avoid the risk of overnight hypos. The job of your basal is to keep your blood sugar flat when you aren't eating or bolusing, it shouldn't be doing any big drops overnight.

Tracie1212 said:

Once again I find myself with bedtime blood glucose of 6. I've been on daphne course which advises bedtime level of 8+. Novorapid was injected 4 hours before. Decided not to inject lantus last night as fed up of eating when I don't feel like, this morning my level was 9.1. This is a regular occurrence with good control before bedtime. I do suffer with asthma/allergies and find chest is quite tight if I don't inject lantus? Unsure what's going on. Can anyone advise on best way forward. Thanks

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I learned from the Dafne course that your basal insulin did not require you to eat when taking it.

First of from me is certainly one size does not fit all!!

For example... novarapid probably lasts longer than 4 hours.. its given as a standard that it last 4 hours but for me it works a lot longer at night but in the mirning when its up against strong waking phenomen ut can look like it only lasts 2 hours, but thats only because I have such a strong reaction to getting up each day.
Just check that your bolus for last eating of day isnt causing levels to go lower later. Ie if you ate a snack with a bolus at 7 or 8pm just see if that is working later than the 4 hours dafne tend to tell you that it works for. Other books say 5-6 hours. Mines 6 hours now.

It maybe that if drops continue that you may be more level at night with tresiba.

Could you get your hospital to give you a free libre for a couple of weeks to try to save sleepless nights? Yes you can wake and scan, but it would also give you more of an idea exactly what time changes happen.

I agree that you have to live outside of diabetes and have a life!! I have tonwake each mirning at 4am for an injection, no choice and its horrible doing so. Even my puppy dog wakes me at 5 to 4 each morning now!!

I used tonget big drops at night and my dafne trained educator still swears blind that the tresiba was causing it and not the insulatard that she says only works for 16 hours. (I have to have two background basal insulins!!).... yet having eventually gained agreement to drop the insulatard (I've just reintroduced just 1 unit) not the 8 units they wanted) my night sleeping is not dropping..

Each and every one of us is individual and as I was so rightly told by a member here... hospital persons are specialists, we the individuals are the experts with our bodies.

I suspect there is a linkage in your body with your asthma and not having the lantus. I would onlynadvise that you lower lantus but not stop it. I suspect you know there is a link bwtween the two but not having had asthma I cannot advise if there is a definitive link.

Have you ever discussed having tresiba instead of lantus?

Tracie1212 said:

My blood sugars can drop quickly think that's why I was advised 8+ and to eat a biscuit at bedtime .

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Only you know your own body @Tracie1212 , given what you've said if you feel safer going to bed 8+ then just carry on.

A few years back I was talking to a lady with brittle diabetes, she too would go to bed on a higher level due to the unpredictability of her bg levels.

donnellysdogs said:

For example... novarapid probably lasts longer than 4 hours.. its given as a standard that it last 4 hours but for me it works a lot longer at night but in the mirning when its up against strong waking phenomen ut can look like it only lasts 2 hours, but thats only because I have such a strong reaction to getting up each day.
Just check that your bolus for last eating of day isnt causing levels to go lower later. Ie if you ate a snack with a bolus at 7 or 8pm just see if that is working later than the 4 hours dafne tend to tell you that it works for. Other books say 5-6 hours. Mines 6 hours now.

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You're absolutely right @donnellysdogs ... The guidance that insulin lasts 4 hours is absolute tripe. The reality is that in the clamp studies, it clearly shows that at 5 hours, using the mean values, there is still insulin on board, and if you follow the maths of the mean, and the average half life of the insulin, there is no way, even if you reduce mean half life by 20%, that the insulin is out of your system after five hours. The issue is that when you test, you test using small amounts, so the effects aren't obvious after about 3-4 hours. I wrote about it recently here, and it's something that everyone using insulin really should be aware of.

Even John Walsh, who wrote "Pumping Insulin", questions why people think that insulin lasts for less than five hours, and has written papers on this.

tim2000s said:

You're absolutely right @donnellysdogs ... The guidance that insulin lasts 4 hours is absolute tripe. The reality is that in the clamp studies, it clearly shows that at 5 hours, using the mean values, there is still insulin on board, and if you follow the maths of the mean, and the average half life of the insulin, there is no way, even if you reduce mean half life by 20%, that the insulin is out of your system after five hours. The issue is that when you test, you test using small amounts, so the effects aren't obvious after about 3-4 hours. I wrote about it recently here, and it's something that everyone using insulin really should be aware of.

Even John Walsh, who wrote "Pumping Insulin", questions why people think that insulin lasts for less than five hours, and has written papers on this.

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Thank you for all that easily understood information. Do you mind if I keep that for when I talk to my consultant?

I think you could only try tresiba as no one could categorically say what would happen to your body. However, if you think you would get a reaction that is probably enough to avoid it. You could even get a reaction because you are thinking you will... our brains are ultra sensitive to reacting to things when we are expecting things.. thats why I no longer read side effects until after taking tablets....

Abbott were giving hospitals libres to give patients to trial. It was just 1 to each patient. No feedback as an official trial. It was just for patients to try them. The hospitals werent having to buy them. Its worth asking for a freebie to try, glad you got it on your list of questions.

Thanks again for your info help to me, that very good. I had quoted John Walsh, just like last time I quoted NICE guidelines when nurse was ignorant of them. Still doesnt make any difference. My consultant actually quoted from info he was told whilst training (prob 30 years ago) so it is quite annoying when 25 years later he hasnt actually realised changes...

donnellysdogs said:

Thank you for all that easily understood information. Do you mind if I keep that for when I talk to my consultant?

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Feel free to print it out and hand it over. It was written for both HCPs and insulin users alike.

Tracie1212 said:

Thanks for your great response! I'm going to ask consultant if eligible for freestyle libre this week but don't hold out much hope as I'm told not available on NHS yet. Another member has suggested tresiba I've looked at reviews for but am a little worried it could make asthma worse. I've got a long list of questions for my annual visit to hospital this week.

How many injections do you have per day? I'm on 5 but looking to reduce due to skin hypersensitivity.

Thanks again for your reply .

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I have COPD and Tresiba did not affect my condition at all

tim2000s said:

Even John Walsh, who wrote "Pumping Insulin", questions why people think that insulin lasts for less than five hours, and has written papers on this.

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Anything on-line where you can see the papers? Does he also mention this in Pumping Insulin.

noblehead said:

Anything on-line where you can see the papers? Does he also mention this in Pumping Insulin.

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Yup - here: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4454113/

Worth noting that he states that there is a mistaken belief that small insulin doses in children last for a shorter period of time than in adults, however the proper studies that have been undertaken show otherwise, and that pretty much all insulin in all people lasts for at least 5 hours.

noblehead said:

Anything on-line where you can see the papers? Does he also mention this in Pumping Insulin.

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Its definitely in his book...

my consultant still reverted back to his training days and said it only last four hours!! Ggggrrr. I found this so frustrating when he told me this and the educators too believe its four hours..
I worked it out by my body and constant testing through out the years and I'm still not believed... ggggrrr.