Constantly waking up around 6-7am with low blood sugar

[Hazza1989]

Hey all,

I'm a Type 1 diabetic who for the past 4-5 years have been fighting a constant battle with the before bed BG and the waking up BG. I'm currently on Lantus and take 18 units which has been reduced since i was first diagnosed 12 years ago. The issue i have if i go to bed with a BG of say 6 when i wake up my blood will be low...the same applies for if my blood is 6-9 it will almost definitely be low come 6-7am.

I do use Freestyle libre and can definitely see the trend that it seems to dip whilst i'm a sleep, i have tried reducing the Lantus dose further but i seem to find that my mid morning blood sugar shoots up..

Wonder if anyone else has been fighting a similar battle?

 

[catapillar]

How low is low? Are you waking hypo? If you are waking hypo you should really reduce your dose to stop that as a first step.

Check whether your basal is working right for you by basal testing.

You might also need to consider timing of your basal doses - maybe splitting it two to a morning and evening dose. Maybe trying an alternative basal insulin like levemir.

 

[SWUSA_]

I am type 2 and currently on 40 units of Lantus. My diabetes educator told me when I started taking insulin that if my evening reading (at least 2 hours after dinner and right before I go to bed) is 117 or less I should have a 15-20 grams of carbohydrate snack with some protein before I go to bed. This is like 2 whole wheat crackers and a Tablespoon of peanut butter or so.

 

[Hazza1989]

How low is low? Are you waking hypo? If you are waking hypo you should really reduce your dose to stop that as a first step.

Check whether your basal is working right for you by basal testing.

You might also need to consider timing of your basal doses - maybe splitting it two to a morning and evening dose. Maybe trying an alternative basal insulin like levemir.

Low can be anywhere between 3.8 and the reader displaying low.
I don't always wake which is the biggest problem i have, and when i'm most at risk as there have been times where i have slept in and then had a hypo and needed help to get up and come round.
I did try Levermir a few years back when i was working on a night shift, i think the problem i have is that with the night time insulin i like the fact its one hit rather than 2 as i worry i'd forget to inject at the same specific time if i split it.

 

[himtoo]

Hey @Hazza1989
your description does sound like a delayed DP ( dawn phenomenon) ( sudden rise after waking at a low level )
potentially reducing your night time basal and taking a correction immediately upon waking could assist in this-- do discuss it with your DSN

 

[rockape37]

That might be the answer, splitting your basal. Might be worth having a chat with your diabetes team.

I was told to take my Basal at 0700 and before i went to bed at 2300 hrs. I did this with good results whether on day shifts or night shifts till a few months ago when the Dawn Phenomenon kicked in which resulted in my using a pump now.

Regards

Martin

 

[catapillar]

If your doing twice daily basal you don't really need to get too hung up on injecting at a specific time, one on waking and one going to bed is, broadly, fine.

You really need to make adjustments to your basal if you are waking LO and not waking to hypos. Night time hypos should be avoided as priority - if reducing the lantus dose causes morning highs you can deal with that as step two, by thinking about splitting basal or increased breakfast ratio or an am correction dose.

Have you sought advice from your DSN? It does seem like a pump could be considered to help with getting your basal dose right for you.

 

[Hazza1989]

Thanks for all your suggestions guys, in terms of my diabetes team that would be just be my GP i stopped going to see my Mr Diabetes at my local hospital as he rubbed me up the wrong way...

Pain in the backside really as that wasn't the first time i walked away from going to hospital to see a regular diabetes expert!

Don't know what i'd do if my GP retired!

 

[himtoo]

try your DSN at hospital too -- possibly a good intermediary

 

[Jaylee]

Hi,

Do you take your Lantus around the 23.00 hour mark perchance..?

 

[Sarebear86]

I had an absolutely terrible time on lantus and levermir, thank god for tresiba! Anyway I'd try having a snack before bed to see if that stabilises it, if you've already tried different doses with no luck then maybe it's just not right for you.

 

[Hazza1989]

Hi,

Do you take your Lantus around the 23.00 hour mark perchance..?

Not religiously, probably between 22:00 to 23:30

 

[Jaylee]

Not religiously, probably between 22:00 to 23:30

Religiously? Nor I. But I do inject myself somewhere about the same time... Your "Libre trend" would the "dip" be about 3am??

 

[StewartH]

I had a similar series of morning lows start recently. my BG control was good for a year and then all of a sudden regular morning lows started while food intake and insulin were as before the! strange how things can change.

As a result I split my lantus dose taking half at the usual time of 2300 or so and half at midday. My phone alarm sounds off at 1200 to remind me which is great. This new routine has been easy to get used too and is giving me normal BG levels. I also take 2 units of novorapid immediately I wake to deal with dawn phenomenon. That way BG levels stay flat until I breakfast and I take a separate dose to suit food eaten. If I dont get time to breakfast, no worries, I still have flat BG. More spikes but well worth it.

 

[tim2000s]

Hi @Hazza1989 - whilst you might have a great GP, they aren't a Diabetes Specialist. I'd strongly suggest that you get a referral to a diabetes clinic so that they can help you with this. The suggestions that everyone on here has made stem from plenty of good experience, but ultimately, you won't get the treatment you really need, whether that's a different basal (Tresiba maybe) or a pump, without being at a clinic.

Just to add to your choices with Lantus, the alternative is to take it when you get out of bed in the morning, such that you are then awake as the drop kicks in and can deal with it.