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Close to night time hypo, how to avoid?

S

smidge

Well-Known Member
Messages
1,761
Type of diabetes
LADA
Treatment type
Insulin
Hi all,

My diabetes is inconsistent and is just classified as 'type unknown'.

About a week ago I was put onto 6 units of basal insulin before bed to try to bring down high fasting levels. This has worked pretty well with my fasting levels now between 4.0 and 6.3. However, last night my pre-bed reading was 8.0 and i was a little concerned that the insulin would reduce it down too much overnight (it's generally over 9 before bed ). Anyway, as I was worried I reduced my insulin to 5 units - and then thought it might still be too much so had a piece of toast. I woke at about 2am and decided to take a reading - it was 6.4 so I thought it was probably OK. Anyway, when I woke at 6am (my normal time) it was only 3.2! I felt OK, just a little shakey and I eat straightaway, which brought it back up pretty quickly. I'm very new to this insulin thing, and I have a couple of questions that I'd like your thoughts on:

1. Am I better to reduce the insulin dose if I think it will be too much, or is it better to eat some carb and leave the dose alone? (I know I did both last night, but I wasn't too successful with that and I remember Ken telling me before I went on insulin that eating a snack late at night might actually reduce the fasting BG, so should I avoid that now?)
2. What kind of BG level should I aim for before bed?

Thanks in advance

Smidge
 
Hi Smidge, I would reduce the insulin,,,,as I don't want to gain weight...BUT, I am intesrested by something you said.
You mentionedthe fact that you usually go to bed with a blood sugar around 9? What kind of insulin are you taking? Lantus, Levimir etc all have a profile...ie, they go into your system...start to work, work up to a maximum level, and then tail off a bit. The trick is finding one that works for you. Sounds to me (although I am not a DR, so this is just an opinion) that it may be the time that you take the insulin may not be right? If you are dropping fast over night...this is not good obviously, but at the same time, you are high before bed. I would be tempted to do the injection first thing in the morning and see how thatgoes...if that doesn't work, try splitting the dose.

I say this, though, as someone who has been injection insulin for years...so it is definately worth talking to your Dr about this. I would guess that you may be better with 2, smaller doses of basal insulin...but it is a guess, so get some professional help.

I aim for a BG level between 5 and 6...but I am on an insulin pump now, before the pump, I aimed for 6 to 7. Night time hypos should be avoided at all costs...but so should higher blood glucose levels.....Welcome to the diabetic tight rope!
 
Thanks, Sugar2.

My insulin is called Insuman - I've not seen anyone on the forum say they use this one and I really don't know much about it.

I've got a review with the diabetes nurse next Friday to see how I'm getting on, but maybe I'll reduce the dose for a bit and give her a call on Monday.

I was given insulin because my BG was drifting up overnight, but now it seems to be doing the complete opposite. It all seems so complicated and is making me scared to go to sleep Maybe I'll set the alarm for 4.00am and check what's happening to be on the safe side!

Smidge
 
Sounds like you'd be better on a split basal dose, eg one dose at breakfast time and one at bed time, your basal dose should hold you steady throughout the night so you are waking up with roughly the same reading as you go to bed on, perhaps a little lower depending on when you last ate before you went to bed but not much lower. Not heard of insuman, most people here are on base insulins like lantus or levemir.
If I was you I'd be aiming to go to bed with a reading between 6 and 8, perhaps have a little snack before bedtime.
Good luck
 
Thanks the-anticarb. To be honest, I'm pretty confused why I've been put on basal insulin if it's supposed to hold the nightime figure steady - I was given to believe it was to reduce my fasting BG. I don't really know what's going on because my BG was 9.8 just now, which is too high, but overnight that will come right down, whereas before I went on insulin it woulkd stay high and be between 8 and 9 in the morning but could drop as low as 4 by lunchtime so I don't think I'd want to take any insulin in the morning. I'm pretty scared of how much it can drop overnight now, so I've just reducced the dose down to 4 units as 6 units was bringing it down by between 4 and 5 points. Thanks for your help, I really appreciate it and I'll try to speak to the nurse on Monday to see what it is supposed to be doing.

Smidge.
 
Hi, your insulin is different than the ones mentioned by the other people. Lantus and Levimir do indeed have a flat profile and are indeed meant to keep your levels stable.
Here is it's profile
If you take this insulin at say 10.30pm, then it's maximum effect may be at the time most people are most sensitive to insulin, hence a risk of hypos. Later,, when you need it to counter the dawn phenomena it may be less potent. You need to take enough to counter the dawn phenomena but also have high enough levels to avoid early morning hypos. Ragnar Hans recommends that with this type of insulin you should be at least between 8-10mmol when you take it. From anecdote many people who used to use it took a small bedtime snack... preferably something slow absorbing, not a fast carb by itself.(there is some evidence for this in T1s who were also using a mealtime insulin)

http://www.docguide.com/news/content.ns ... 9E00019C1C

On the day you woke with a hypo, you had both a reduced dose and took a snack. I wonder if you had been a bit more active on that day, something caused you to be lower level at bedtime than normal. If you had been a bit more active, that could reduce your insulin resistance causing the insulin to be more effective.
You really must show your readings to your DSN, I don't have experience using this type of insulin (there are a few on here that do) If it were me though I would be very inclined to reduce the dose by another unit and take a small snack if my levels were below 8mmol at bedtime.
edit: DO CHECK THE LABEL THAT ITS INSUMAN BASAL THERE ARE OTHER INSUMAN INSULINS. They have different profiles and uses.
see http://www.yorkshirediabetes.com/downlo ... Poster.pdf
 

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Hi Phoenix,

Thanks so much for your reply and all the useful information. I did indeed reduce my dose down to 4 units last night and my BG was 9.8 when I went to bed at about 10.30pm. This morning at 6.00am my BG was 4.8 - for the year that I was misdiagnosed as Type 2, I would have killed for a fasting BG of 4.8, but now the drop is just scaring me - and I'm too frightened to sleep beyond 6.00am at the weekend! So taking only two-thirds of the dose prescribed and with a nightime reading higher than it should be, I still dropped by 5! I think I'll down the dose to 3 units tonight to be on the safe side and call the nurse tomorrow. I think I can safely assume I'm not insulin-resistant :lol:

Do you know if the body adjusts to the use of insulin in some way, because the first couple of days I took it, the drop overnight was much less marked (about 3.5) and that was on a higher dose? I don't think my activity level has been any more or less on different days, but I have been off work for a few days, so my stress levels have probably been lower! The night I hypo'd, I think I'd eaten tea an hour earlier than usual, hence the lower bed-time BG and I think I'd injected the insulin an hour later.

Smidge
 
Hi everyone,

Just thought I'd update you on what's been happening. On Sunday night my BGs were 6.4 at bed time (absolutely bizarre for me!), so I didn't take my insulin. I rang the nurse on Monday and she said to only take my insulin if my BG was over 9 at bed time and then to only take 2 units - she also said it might be a honeymoon period with the insulin and we won't know what dose I really need til we get through this period. Well, Monday night BG was 7.6 at bed time and last night 8.7, so on the rise, but lower than normal for me and I didn't take my insulin. Morning fasting figures were OK - slightly lower than the bed time figures, but on the rise over the three days from 6.4 on Monday morning to 7.8 this morning. Tonight, 10.5! I had the same tea (and portions) as last night and even did 30 minutes on the cross-trainer tonight which I didn't last night. The lack of consistency is driving me mad and I'm losing hope of ever getting to the bottom of what's going on! Anyway, I've taken 2 units of insulin and will see what my BGs are in the morning. I'm booked in to see the nurse at the hospital again on Friday and will take my charts, food diary etc and see what she makes of it. I'd like to move my bed time insulin to tea time instead because I feel that if I get that figure lower, the night time and fasting ones will be automatically lower, but I'll wait and see what the nurse thinks. I'll report back on progress, but if anyone has any idea what's going on I'd be very grateful. Sorry to go on a bit!

Smidge
 
Smidge,

Thanks for the update. Sounds like you are working well with the nurse. Honeymoon period is a bit unpredictable! Please don't read too much into the rise in your bedtime numbers just immediately...sometimes other stuff can affect them this way....slight cold, time of the months..that kind of stuff. See how it goes, you sound like you are doing really well!

PS the variation on the blood test meter is quite high as well.....so give it a bit longer before you are sure that there is a trend.....I only say this as it is a mistake I have made myself!
 
Thanks for the encouragement and interest Sugar2 - it really helps.

I'm pretty lucky with the nurse I see now at the hospital, she works with me and listens to what I have to say - it makes such a big difference from the care I was getting from the specialist nurse at my GPs where I spent a year mis-diagnosed as Type 2 trying to control things with diet and exercise and without any monitoring until I was pretty ill. I'd advise anyone who isn't happy with their care to complain and insist on a referral - the consultant and the nurse at the hospital have helped me achieve more in a few weeks than I've managed in the entire year before and I'm feeling far more in control even though I'm new to insulin, having to learn quickly and am frustrated with the inconsistency of my BGs at times! Even the dietician at the hospital has given me nutrition advice on how to keep my weight up and get all the nutrients I need without inceasing my carb intake. She assessed my diet and said that although she would prefer me to follow a more carb-rich diet, my diet is good and she understands that many diabetics choose to reduce carb. I can't thank people on this forum enough for their support and advice though, because it gave me the strength to go back to my GP and insist the care I was getting there was inadequate!

I saw the nurse on Friday and we're going to try moving my basal insulin to around tea time for a few weeks. Just 2 units at tea time to see how it goes. If that doesn't get my BG under control before bed time, I'll be swapped to fast acting insulin at tea time instead. For the last few days, my BGs have been good so no insulin needed, but 12.0 tonight after tea even thought there was very little carb in my tea. Anyway, I took 2 units and fingers crossed it brings my BG down but not too low!

Smidge.
 
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