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Blood Sugar drops during night - Levemir issues?

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oompaloompa

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Hi lovely people, I'm seeking some advise regarding why my blood sugar might be dropping so much during the night. Even if I go to bed with a high blood sugar of 10, 12 etc it stills drops to low whilst I'm asleep. Luckily I wake up. This has been happening on and off over the last couple of weeks.

I've been told in the past that this might be caused by my use of levemir - the long acting insulin which I take once a day. I've read and been told that it doesn't always have the best 24hr properties and because of this, is sometimes taken twice a day instead. Does anyone have any advice around this or experience around the use of levemir causing a drop in blood sugar a few hours after taking it? My diabetes team have recommend me the use of another new long acting insulin in the past although they're hard to reach at the moment and I'm hesitant to start something too new in the current climate.

Any advise will be really appreciated! Thanks in advance
 
Hi there,

Your right in regards to some basals not lasting the full 24 hours, however if this was the case then you'd be going high not low as you are currently doing so through the night. If you're going low by 3am then this would indicate your basal dose is too high. What time are you waking ? Otherwise you could be taking too much quick acting in the evening, unless your correcting the high ?

Tresiba is the best insulin for it's got a flat profile and lasts around 36 hours, so incredibly stable, but depends on when normal service will resume, so getting your current basal dose right is important to avoid these night time lows.
 
Hello. Levemir doesn't have a smooth 24 hour profile and you may be getting your dose front loaded during the night. Does this also mean you are getting higher towards the end of the 24 hour period? e.g. you have to do correction doses by suppertime.
\Things to chat through with a nurse
The other possibility is that you are getting the dosing wrong for the evening meal e.g. eating high fat/high carb meal in which your carbs are delayed in their absorption?
Are you stopping eating 4 hours before bed to give your short acting insulin the chance to work through yur body.
Or you are taking too much levemir and could try dropping the dose by 2 units though it sounds as if you are dropping too much (from 10-12 to hypo?)
Now on the pump but I always split my dose 12 hours apart. This also mitigates the impact of the larger dose going in all at once which an create lumps and an unpredictatblae response.
Hope that give you a few things to think about. I do not know if you have someone you can chat to clinically about this but more importantly a good supply of testing kit.
Glad you have good hypo awareness however the longer term effect of regular hypos is to lose that awareness so its worth getting on top of.
 
Now I'm on the libre I can check my levels more and Iv seen my overnight drops me low all the time but Iv found the dose of levemir I'm on is correct as when I wake I'm at a good bg level

I can have tea at 7 so when I'm off to bed I'm still high but Iv had my basal dose at 8 aswell as my qa with tea. I find I might be around 10-12 before bed but am starting to come down. I wake through the night for the toilet and I often find I'm between 3.5 and 5 then when I wake in the morning I am back up to 5-6

I never wake for hypos but always seem to come out of them easily enough. Iv only woke once and that was when I was down to 2.2 but that was before I was put on the 2 pens a day

I would do a test to see where you are through the night and then the morning to test if you are giving too much basal.
 
I’m using Levemir too. I split the dose, taking it 12 hours apart, the morning dose at 09.00 and the evening dose at 21.00. I do find that I need a little more in the daytime than the nighttime, but we’re all different. I used basal tests to work out what doses I needed, it took a bit of time but it was worth it. Maybe you could get a telephone consultation with your DSN to talk it through and get advice.
 
Most of the long-acting insulins don't last up to 24 hours.
But that shouldn't be the problem, probably you take too much Levemir. Did you notice when in the night the lows occur? Are they happening around the same time?
 
Hi all, to echo what others have said, its difficult to make changes without discussing them with your diabetic team. Is there an email for the DSN? Perhaps phone or skype? My clinic is trying to set up skype for prearranged clinics so might be worth asking?

From what I've been told, big drop overnight could be due to your evening meal bolus insulin having an effect which is overlapping with your basal dose. It is easier said than done as life gets in the way, but I try to inject and eat at least 4hrs before bed as that seems to be the max action time for novorapid.

It could also be that your levemir dose is too high. From what I've read (will try and post links tomorrow!) Levemir can start acting within an hour of injection and doesn't smoothly release over the action period unfortunately. It seems to peak and have a skewed effect within the first 6-12 hrs but this also depends on the quantities injected. Eg The higher the dose in relation to body mass the more skewed the action. This skew can be advantageous acting against the 'dawn phenomenon' but could cause hypos if dose is too high.

I started noticing my blood glucose values creeping up mid afternoon- evening following almost 13yrs of only injecting levemir around 10pm. My consultant suggested slowly trying to split the dose, as many studies say levemir can last 18-26hrs (not sure what this depends on) so the fact my glucose levels were creeping up early eve suggested my once daily levemir was running out earlier than it had previously done. I started on the Libre and this completely reinforced this too! With their help I started shifting one unit at a time to the morning, giving myself 3-4 days between ever change to see the effects on early eve glucose values.
I'm now almost evenly split with my doses morning and evening but that's only been since lockdown! I've also noticed a few false hypos register on my libre where eg it says 3.9 and finger prick capillary test says 4.3. I've rescanned 5-15mins later to account for diffusion time lag of libre and it's still off. I've read lots about the libre losing accuracy at low or very high readings, which is why Abbott advises finger prick capillary test at these times. Still annoying when the libre log says hypo and you can't change it!
Sorry for the late long post, hypos are horrible esp at night so hope you get them becoming less frequent!
 
@UK T1 I would say a difference of 3.9-4.3 is negligible. I get a difference bigger than that on two blood glucose monitors, both with solution tested strips.
 
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