Blood sugar drop every night

[idkatten]

Hi - I have diabetes T1 for 36 years now. I can manage quite well, but almost every night the blood sugar drop to between 35 and 50 (1.9 - 2.9). I have lowered the basal Insulin now to 6 units per 24 hours, but it does not change anything. I have made basal insulin test 2 times, but blood sugar dropped too low, and I had to eat something. I do not produce insulin. I have been tested for many things, to find the reason for low blood sugar in the night. I take 6 units of Tresiba (long acting - over 43 hours) and 1,5 to 2,5 units Novo Rapid by every meal. I eat little carbohydrates. One thing I have noticed over the years is that if I do not eat enough fat, my situation get worse. It is opposite all experiences from other people with diabetes. Are there anyone out there, who has similar experiences??

 

[Jollymon]

When I relax and go to sleep, my blood sugar can fall. Inversely if I stay up and fight sleep to finish a task, it can rise.

I have to adjust the basal rate on my pump to deal with both.

 

[EllieM]

Hi - I have diabetes T1 for 36 years now. I can manage quite well, but almost every night the blood sugar drop to between 35 and 50 (1.9 - 2.9). I have lowered the basal Insulin now to 6 units per 24 hours, but it does not change anything. I have made basal insulin test 2 times, but blood sugar dropped too low, and I had to eat something. I do not produce insulin. I have been tested for many things, to find the reason for low blood sugar in the night. I take 6 units of Tresiba (long acting - over 43 hours) and 1,5 to 2,5 units Novo Rapid by every meal. I eat little carbohydrates. One thing I have noticed over the years is that if I do not eat enough fat, my situation get worse. It is opposite all experiences from other people with diabetes. Are there anyone out there, who has similar experiences??

Try lowering the basal some more? Some people just don't need much insulin....

 

[kitedoc]

Hi @idkatten,
From my experience as a diabetic, not as professional advice or opinion.
For how long has your BSL been dropping at night time? Can it be linked to a change in insulin, diet or health status?
Looking at Tresiba, it tends to last 30 hours plus. So could there be an overlap in long acting insulin effect from one day to the next ? Is the Tresiba relatively new on the scene?
Other thoughts: an under active thyroid condition can slow the breakdown of insulin and make hypos more likely
and a worsening of kidney function will also affect breakdown of insulin.
How much fat and carbs are you eating? Has that changed recently?
Any increase in regular exercise?
Best Wishes.

 

[Alison54321]

I don't take Tresiba, so I don't have direct experience of this, but what time of day are you taking it? Because although it's a very long acting insulin people using it have said that it peaks a few hours after taking it, and that makes their blood sugar fall.

If you are taking tresiba at night it might be worth switching to morning, and see if that makes a difference, as a drop like that during the night is not good.

 

[Deleted Account]

Is the low reading from Libre or a Cgm?
I ask because lying on these can cause false low readings due to the pressure.
Any nighttime lows should be checked with a finger prick before making any dosage changes

 

[idkatten]

Dear all, Thank you so much for your answers and questions, which gave some new ideas. I will try to answer:
1. Tresiba is new on the market yes. I got it 1 year ago and at that time it was completely new. My diabetes doctor says it react in 43 hours, but if it react over shorter time, I will try to calculate again, if the overlapping could be the cause.
2. I take Tresiba every morning, so that is not the reason for low in the night, but maybe overlapping is.
3. The dropping blood suger in the night - this time I have had it 4 to 5 month. Not every night but almost. When it goes too low, I start having alarm clock on in the night and drink something sweet, but it is tiring. Even on other kinds of insulin and insulin regime, I have had the same problem years back. When I change to a new kind of Insulin, I am ok for some time 1 to 1,5 year but then it starts again. For that reason my diagnose is: Brittle Diabetes (unpredictable). Honestly - no doctor has been able to find out why. So I just wanted to ask in the diabetes community if any other has the same problem.
4. According to latest blood tests my kidneys should be ok (Creatinine normal), Thyroid check also ok, but some time since I checked it last.- I will try it again.
5. I always try with finger prick test - have no FreeStyle Libre, but I'm trying to get one.
6. I have not changed my food or exercise, it is more or less the same every day.
Once again, thank you all for your questions and time, I am touched by the willingness to help on this website.

 

[Alison54321]

Hello @idkatten, what time is the fall. I consistently go lower between 10pm and midnight, unless I'm running too high, and then it refuses to drop, even though I want it too.

I think part of that is me, and so my aim, at the moment, is to try and reduce the other factors, so I'm looking at reducing the insulin I have with my evening meal, by eating less carbs, as that feeds into the problem. I also think that's the time my evening levemir starts to peak, and so the three things converge, me being a bit more insulin sensitive, the novorapid tail, and the levemir peak.

So what time is the drop happening?

 

[Tabzmcfc]

Hi I’ve recently upped my exercise and slowly needed to reduce my Lantus by half. I split my doses to morning and evening as per doctor’s advice which worked for me when I didn’t expect it to due to the overlap. Additionally I’ve found that if I go low at night it’s the morning dose that I need to reduce. ‍

 

[idkatten]

Hello @idkatten, what time is the fall. I consistently go lower between 10pm and midnight, unless I'm running too high, and then it refuses to drop, even though I want it too.

I think part of that is me, and so my aim, at the moment, is to try and reduce the other factors, so I'm looking at reducing the insulin I have with my evening meal, by eating less carbs, as that feeds into the problem. I also think that's the time my evening levemir starts to peak, and so the three things converge, me being a bit more insulin sensitive, the novorapid tail, and the levemir peak.

So what time is the drop happening?

The drop start sometime after midnight, and if it is under 80 (4,4) around 3:00 - I drink some sweet. but it drops most in the early morning 4:00 to 5:00. At the moment I try following: I eat 1/2 piece of low carb bread with butter and cheese before bedtime. I can avoid the low in the morning if I go high before sleep. Last night I measured 177(9,8) before bed and woke up with 77 - so a fall of 100. But I do not want to take it so high as a routine.

 

[Alison54321]

The drop start sometime after midnight, and if it is under 80 (4,4) around 3:00 - I drink some sweet. but it drops most in the early morning 4:00 to 5:00. At the moment I try following: I eat 1/2 piece of low carb bread with butter and cheese before bedtime. I can avoid the low in the morning if I go high before sleep. Last night I measured 177(9,8) before bed and woke up with 77 - so a fall of 100. But I do not want to take it so high as a routine.

So it just falls all night. 6 units of tresiba is quite low, how are you day time sugars?

How much fat are you eating? there is a recommended daily amount, are you eating enough?

If 9.8 before sleep gets you down to 7.7, would going to sleep at about 7.8 stop you going hypo in the night? that wouldn't be too bad.

I think, maybe, it would be worth seeing what blood sugar you can go to sleep on that doesn't result in a hypo, and go for lowest safe level. I agree 9.8, and waking on 7.7, is far from ideal, but can you go to sleep on 7.8 and wake on 5.7? that would be ok. Or doesn't it work out that easily.

Maybe exploring that might help.

 

[idkatten]

So it just falls all night. 6 units of tresiba is quite low, how are you day time sugars?

How much fat are you eating? there is a recommended daily amount, are you eating enough?

If 9.8 before sleep gets you down to 7.7, would going to sleep at about 7.8 stop you going hypo in the night? that wouldn't be too bad.

I think, maybe, it would be worth seeing what blood sugar you can go to sleep on that doesn't result in a hypo, and go for lowest safe level. I agree 9.8, and waking on 7.7, is far from ideal, but can you go to sleep on 7.8 and wake on 5.7? that would be ok. Or doesn't it work out that easily.

Maybe exploring that might help.

Hi Alison, - Thank you for your persistent interest and advises. I think I wrote a bit unclear in my answer to you. The Blood sugar went from 177 (9,8) to 77 (4,2) - not 7,7. - It was a big drop, and it is not always like that. I try though to do what you are suggesting. See how high I need to go and still wake up (if it is too low I do not wake up) (But my family know what to do - no problem).
I do not know how much fat I eat in gr., but eat something for every meal. A little bread with cheese and butter or salat with oily dressing. Do you have experienced the same: that the blood suger drop if not eating any or too little fat?
I can keep the blood sugar quite nice during the day, but it goes very high if I forget to take insulin for 1 meal - up in 275(15,2) to 300(16,6). The smallest changes get me out of range, that is why I try to get a FreeStyle Libre.

 

[kev-w]

I don't take Tresiba, so I don't have direct experience of this, but what time of day are you taking it? Because although it's a very long acting insulin people using it have said that it peaks a few hours after taking it, and that makes their blood sugar fall.

If you are taking tresiba at night it might be worth switching to morning, and see if that makes a difference, as a drop like that during the night is not good.

I've just done exactly this, having moved to Tresiba from Lantus a couple of months back I found a regular drop happening around 6 hours after injecting it and was frequently waking hypo. I missed Thursday nights injection and took it Friday morning, I was spiking upwards but woke this morning to a pretty flat line so I'm hopeful.

Good luck with it!

Edit, and you take it on a morning now, ah, I missed that post.