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Frequent hypos at night

Discussion in 'Type 1 Diabetes' started by nicki92, Jan 31, 2022.

  1. nicki92

    nicki92 Type 1 · Active Member

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    Hi all,

    I was diagnosed in September 2021, taking Tresiba (basal) and humalog (bolus)

    My basal was just reduced from 6 down to 4 units every night, because of frequent hypos

    However my alarm is still going off every second night. I can quickly eat something - I've found one or two jelly babies and half a granola bar works well for the rest of the night - but this doesn't feel sustainable for me. If it was once a week then that wouldn't be so bad, but every second night is a lot.

    Does anyone have any idea what's happening or how to improve it?

    This has happened when I've gone to bed with my BG at 11 and 7, and anywhere in between (I don't go to sleep under 7 as a result & will have a snack before bed)

    Thank you for any advice
     
  2. In Response

    In Response Type 1 · Well-Known Member

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    @nick192 I assume you are wearing a Libre 2 and this is the alarm that is waking you.
    Do you always check your readings with a finger prick before treating?
    The reason I ask is because the alarm may not be reporting a true low - it may be a compression low where pressure on the sensor (such as lying on your arm) can cause the Libre to report a fake low.

    If you are testing and the lows are genuine,. I would look at the pattern of the lows on your graph.
    - Are they heading downhill for the whole night? If that is the case, it is likely your basal is still too high.
    - Are they remaining level and then falling after a certain time? This may be due to your basal insulin not having a flat profile. For example, Lantus has a "kick" after about 5 hours. If you are taking Lantus you. could ask for an alternative basal with a flatter profile or move the timing of your Lantus.
    - Are they heading downhill and then stabilising? This could be because your bolus insulin is still working when you go to bed. What time do you take your last bolus dose? When reviewing your bedtime level, do you consider bolus insulin "on board"? I assume you are not taking insulin with your bedtime snack?
    - Does this happen every night or is there another pattern such as when you do exercise or drink alcohol? Both of these can lower your levels. Depending up on your basal insulin, you could lower your insulin doses on the days you exercise and/or drink or have a bigger snack.
     
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  3. EllieM

    EllieM Type 1 · Moderator
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    @nicki92 there is also the possibility t hat you are in a honeymoon period, where your supported pancreas produces more insulin for a while.

    Honeymoon Phase - Honeymoon Period Causes and Duration (diabetes.co.uk)

    I would strongly urge you to contact your team to talk about adjusting your insulin again (assuming the lows are genuine, @In Response makes a good point about compression lows leading to fake hypos.)

    No, there is no reason to have a hypo so often. (Or at least, there may be a reason but you need to adjust your insulin so that it doesn't happen.)
     
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  4. nicki92

    nicki92 Type 1 · Active Member

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    No I don't check with a finger prick, I know this is something I should do, I just really struggle at night.
    But I think the lows are genuine - on the Libre graph I can see the dip and then it goes back up and slowly reduces again towards the morning

    Yes I've made sure that there shouldn't be any bolus on board before bed (and definitely no insulin with the bedtime snack)

    I do exercise and drink alcohol but honestly haven't noticed the pattern with those, I thought they might be affecting it but don't seem to be linked
     
  5. KK123

    KK123 Type 1 · Well-Known Member

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    Hi there, the libre is good at showing the graph dipping, rising and everything else but I find it is just not accurate when it is hovering around the low 4s, the graph will show the pattern but not necessarily the correct figure. I have had several 'hypos' during the night according to my libre and I ALWAYS check the libre reading with a finger prick. I would say at least 90% of the time when the libre is telling me it's at 2, 3 or even a low 4 the finger test tells me it is at least 1.5 points higher. I account for the 10/15 minute time lag and factor that in with extra testing 15 mins after and so on, so I know that the libre struggles to give the actual reading when it gets around 4. Your lows are probably genuine, especially if you are feeling them but maybe you could try following a few of them up with a finger prick test? If the libre is regularly reading low when it's not then they may well replace it for you. Also, it could be the way you sleep if you are sleeping on the arm with the libre on. If it is happening regularly it may be best to at least test it with the finger pricks. As others have said you are probably in the honeymoon period that adds a whole new level of chaos! We cannot tell you what to do of course and I'm sure your medical team will assist, but I would not have a snack if I was at 7 as when I did that (in my honeymoon period...which I think I'm still in), I suspect my own insulin production kicked in, then met up with that previous basal and wham...a low! In the end I dropped to 4 units and then 2 units of basal (hardly any I know) but this did the trick.
     
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    #5 KK123, Jan 31, 2022 at 9:35 AM
    Last edited: Jan 31, 2022
  6. ert

    ert Type 1 · Well-Known Member

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    The Libre readings outside the normal range need confirming with a finger prick. This needs to be your first check. If you are actually hypoing then test your basal isn't still too high by skipping (or eating a very low/no-carb) dinner.
    False hypos overnight happened so frequently using the Libre, I switched to the Dexcom G6.
     
  7. Daibell

    Daibell LADA · Master

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    Hi. It may be worth suggesting to your GP/Endo that you swap the Tresiba to Levemir. Tresiba isn't normally split as it lasts more than a day. Levemir has to be split as it lasts a lot less than 24 hours. By taking different amounts day and night as I do it gives you much better control. I vary my night-time dose at bedtime based on my Libre reading when I go to bed.
     
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  8. Hertfordshiremum

    Hertfordshiremum · Well-Known Member

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    Hi Your problem is very common in the first year, I remember having to change my insulin dose up and down every couple of months, my nurse told me happens to almost everyone. I still, 3.5 years in, have to alter my insulin. All the points raised are really good valid points that you need to rule out one by one to find out which is causing the problem. However I also think Levemir would be a lot easier to adjust than Tresiba as your basal insulin. I would be emailing / phoning my nurse as well.
     
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  9. ert

    ert Type 1 · Well-Known Member

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    It's very common to anyone not producing their own insulin. I change my basal insulin dose every day sometimes.
     
  10. nicki92

    nicki92 Type 1 · Active Member

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    Thank you for all the replies, I really appreciate every piece of advice and experience.
    I'm really struggling with this because even if they're not genuine lows I don't want to be woken up every night by the alarms, but of course because this is all new to me I'm scared to turn off the alarms.

    Every night after going to bed and injecting Tresiba my levels will decrease to around 5/5.5 (from whatever the starting value is), and then seem to stay between 4 and 5 all night. On the graphs I see slight fluctuations, including occasional dips below 3.8, which is where my alarm goes off. Last night it went off for the first time, I set an alarm for 15 minutes and checked again and I was at 4.5, so I left it. Then an hour later I was apparently too low again, so ate something.

    About a week ago after seeing my doctor I decreased the Tresiba from 6 to 4 units; I haven't seen any difference in my graphs/average BG since then. I'm wondering if I should decrease even further down to 2 (it's only in 2-unit increments). That seems crazy, especially given that when I was first told how much to inject in hospital I started on 10 units!

    The doctor also suggested injecting Tresiba earlier in the evening - e.g. with dinner - but that feels more difficult routine-wise. Also the night-time lows are at different times every night, sometimes an hour after going to bed and sometimes 6 hours later so I'm not sure this would help the issue!
     
  11. Hertfordshiremum

    Hertfordshiremum · Well-Known Member

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    Hi It’s very common for insulin to suddenly kick start a positive reaction by your own body shortly after diagnosis. I had to halve the insulin I started on after 6 months. I remember having to frequently change my doses in the first couple of years. We can’t advise on doses you need to talk to your team but don’t carry on like this. FYI I take my evening Levemir just before dinner and suits me much better than before bed. I would give this a go, could you not take it when you inject your humalog for your dinner?
     
  12. nicki92

    nicki92 Type 1 · Active Member

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    Thank you <3
    Yes I will try taking it at dinner, I've got into a good bedtime routine with the Tresiba and think that it'll make it harder e.g. if I'm out at dinnertime, but that's not so much an issue at the moment so I'll try that.

    Thank you again for the advice
     
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