Bedtime snack (a study)

[alphabeta]

http://care.diabetesjournals.org/content/26/1/9

I stumbled across this article because I have a problem with my basal profile. I take 13 units Lantus at bedtime but there is a problem; 13 is the lowest I can go, but it drops me by 8 or 9 points throughout the night. My dinner is basically carbs (1 loaf of pita bread with some non carb stuff on it). For this reason I have to sleep at 14.0 say to wake up at 5 or 6.. this is dangerous and impractical (please don't mention my diabetes team they aren't much of help). I was considering adjusting my Lantus dose according to basal testing, NOT my fasting BG. During the night I seem to need less basal and much much more in the day. In fact, I noticed a 2 unit increase in my bolus to support my basal needs. I was previously on 19 units Lantus and used to sleep at 9.5-11.0 and wake up in range. I have an idea what should my levels look like regarding bolus and stuff.
My point is, I am considering full fat powder milk as a snack since it lasts some time to breakdown. Or should I consider the 15g carb biscuits? Just looking for thoughts not a medical advice. Afterall, I have a meter and it is all about trial and error. I'm excited to hear your say about milk.

 

[EllieM]

13 is the lowest I can go, but it drops me by 8 or 9 points throughout the night.

What happens when you go lower than 13? Not enough basal during the day?

Have you tried taking the lantus in the morning instead of at night?

 

[Antje77]

Lantus often doesn't last for the full 24 hours, so if you take it before bed the peak action will be during the night and it might not do much anymore the last few hours before bed. Which probably is when you need it the most after your dinner. Agree with EllieM, why not take it in the morning or take a split dose?

 

[kitedoc]

Hi @alphabeta, I think you have been down a similar path some time back.
From past experience as a type 1 diabetic and not as professional advice or opinion:
The very sensible suggestion back then was to consider use of a different long-acting insulin.
The current situation you describe about your evening Lantus sounds untenable.
Something to discuss with your doctor and health team.
But ...they cannot help you unless you are more flexible.

 

[alphabeta]

Hi @alphabeta, I think you have been down a similar path some time back.
From past experience as a type 1 diabetic and not as professional advice or opinion:
The very sensible suggestion back then was to consider use of a different long-acting insulin.
The current situation you describe about your evening Lantus sounds untenable.
Something to discuss with your doctor and health team.
But ...they cannot help you unless you are more flexible.

Some time back I was actually on spoiled Lantus and before that 19 units which was perfect. My healthcare team did agree with me to stay on Lantus in the mean time and then switch to Tresiba later around spring (February March around this time). However, if my basal profile is that I need little in the evening and more during the day, this seems like bad idea to use Tresiba because of its flat profile. I was actually thinking of adding milk or high fat stuff to my evening so that the digestion is slower thus helping my Lantus. Once, my endo told me that I have a slower digestion in the evening but did no tests to confirm this. I don't know where he brought this up from but I still doubt it. In fact, Levemir seems to me the best option since I can control day basal and night basal separately. Does this make any sense?

 

[alphabeta]

What happens when you go lower than 13? Not enough basal during the day?

Have you tried taking the lantus in the morning instead of at night?

Below 13 (at 12) there is a very slight reduction between before bed sugar and fasting but my doses during the day are much higher than usual and probably won't be enough which can be confirmed by basal testing; the sugar will rise while fasting with no Humalog on board.

 

[alphabeta]

Lantus often doesn't last for the full 24 hours, so if you take it before bed the peak action will be during the night and it might not do much anymore the last few hours before bed. Which probably is when you need it the most after your dinner. Agree with EllieM, why not take it in the morning or take a split dose?

I am quite aware of this problem of Lantus not lasting full 24 hours which used to be a slight problem that can be solved by taking a unit of Lispro if I want to delay my dinner and it works perfectly well. The peak is the problem so i am investigating adding some fat and proteins to my evening. I considered taking Lantus in the morning which can solve this problem probably but I will face another problem; I will rise significantly by 5 AM till I wake up between 6:30-9:30 since as you said Lantus won't cover full 24 hours.

 

[kitedoc]

Some time back I was actually on spoiled Lantus and before that 19 units which was perfect. My healthcare team did agree with me to stay on Lantus in the mean time and then switch to Tresiba later around spring (February March around this time). However, if my basal profile is that I need little in the evening and more during the day, this seems like bad idea to use Tresiba because of its flat profile. I was actually thinking of adding milk or high fat stuff to my evening so that the digestion is slower thus helping my Lantus. Once, my endo told me that I have a slower digestion in the evening but did no tests to confirm this. I don't know where he brought this up from but I still doubt it. In fact, Levemir seems to me the best option since I can control day basal and night basal separately. Does this make any sense?

And levemir was one of the suggestions made back then in the previous post but you choose to stay with the lantus.
Please exercise common sense, why wait until springtime?

 

[alphabeta]

And levemir was one of the suggestions made back then in the previous post but you choose to stay with the lantus.
Please exercise common sense, why wait until springtime?

Because I can't make changes on my own!!!

 

[JAT1]

http://care.diabetesjournals.org/content/26/1/9

I stumbled across this article because I have a problem with my basal profile. I take 13 units Lantus at bedtime but there is a problem; 13 is the lowest I can go, but it drops me by 8 or 9 points throughout the night. My dinner is basically carbs (1 loaf of pita bread with some non carb stuff on it). For this reason I have to sleep at 14.0 say to wake up at 5 or 6.. this is dangerous and impractical (please don't mention my diabetes team they aren't much of help). I was considering adjusting my Lantus dose according to basal testing, NOT my fasting BG. During the night I seem to need less basal and much much more in the day. In fact, I noticed a 2 unit increase in my bolus to support my basal needs. I was previously on 19 units Lantus and used to sleep at 9.5-11.0 and wake up in range. I have an idea what should my levels look like regarding bolus and stuff.
My point is, I am considering full fat powder milk as a snack since it lasts some time to breakdown. Or should I consider the 15g carb biscuits? Just looking for thoughts not a medical advice. Afterall, I have a meter and it is all about trial and error. I'm excited to hear your say about milk.

Do you take any fast-acting insulin to cover the evening snack? I have an evening snack of cheese and fruit before sleeping. I wake up naturally during the night around 1:00 to 3:00 and have fruit before falling back to sleep, if I don't then I can't sleep because I keep worrying about a hypo. My endo told me to reduce my basal which I take once a day at 9:00 pm in order to lessen the risk of hypos. Works for me. I hope you find a solution that works for you.

 

[alphabeta]

Do you take any fast-acting insulin to cover the evening snack? I have an evening snack of cheese and fruit before sleeping. I wake up naturally during the night around 1:00 to 3:00 and have fruit before falling back to sleep, if I don't then I can't sleep because I keep worrying about a hypo. My endo told me to reduce my basal which I take once a day at 9:00 pm in order to lessen the risk of hypos. Works for me. I hope you find a solution that works for you.

I take Humalog to cover my dinner. Today I added a cup of milk to the dinner and an extra 20g of carbs, still had the usual drop. I think my mistake is not having the milk before Lantus (2h after my Humalog) but still this is just day 1

 

[kitedoc]

Because I can't make changes on my own!!!

So speak with your health team about it.

 

[alphabeta]

So speak with your health team about it.

My next appointment is scheduled around late February or early March as I stated earlier which is supposed to revolve about a switch to Tresiba but will discuss this.

 

[kitedoc]

My next appointment is scheduled around late February or early March as I stated earlier which is supposed to revolve about a switch to Tresiba but will discuss this.

Why not just ring them, state what the Lantus does, saying perhaps that it is too dangerous to continue with this and you would like to change now etc, etc.?? Where there is a wall find a way around it.

 

[alphabeta]

Why not just ring them, state what the Lantus does, saying perhaps that it is too dangerous to continue with this and you would like to change now etc, etc.?? Where there is a wall find a way around it.

I can catch my diabetes nurse probably but last time we argued about heat-spoiled Lantus. She suggested also that I use 35 units but I ended up at 19! So I do not really trust her much

 

[JAT1]

I take Humalog to cover my dinner. Today I added a cup of milk to the dinner and an extra 20g of carbs, still had the usual drop. I think my mistake is not having the milk before Lantus (2h after my Humalog) but still this is just day 1

Remedy your "mistakes" as you think best. Sounds like you are taking too much insulin of the fast-acting or the long-term or both. It's insulin that drives glucose levels too low in type ones. If you are not confident to make changes on your own then it is imperative you speak to your health providers ASAP. Waiting two months is far too long !

 

[alphabeta]

Remedy your "mistakes" as you think best. Sounds like you are taking too much insulin of the fast-acting or the long-term or both. It's insulin that drives glucose levels too low in type ones. If you are not confident to make changes on your own then it is imperative you speak to your health providers ASAP. Waiting two months is far too long !

In fact, my basal needs for night seem to be low while the opposite for day. I will see what i can do about this