How did type 1 diabetics used to manage sugars whilst sleeping, before the glucose monitors came out? Advice needed

[cbooth5]

Hi there, I am a newly diagnosed type 1 diabetic, diagnosed early. Had hypos during the first few nights of starting on insulin on starting doses, then my sugar levels stabilised and were perfectly stable at night for 3-4 nights. From what I've read so far, this means the basal dose is perfect at the moment (on tresiba 4 units morning, novorapid 1 unit TDS With meals). I tried carbohydrate counting Friday with novorapid to experiment with the diabetic nurses advice, but this was a mistake as I am still early diagnosed in hooneymoon period and caused 5 x hypos in 24 hours so I went back to the starting doses as above. Since I have been better, but only get one or two hypos in the night which isn't too bad to say its only my second week of insulin. I think maybe the high dose novorapid day shook my sugar balance and I'm only just stabilizing back maybe? My sugar control is usually pretty good during the day.

My questions are;

1) Is there anything I'm doing which may be causing nighttime hypos that I don't know about? I have tried to exercise early in the day, always have a big evening meal, avoid alcohol (not drunk for 6+ months), I do check BM levels at 10-11pm before bed and not been sleeping great due to anxiety around it dropping. Sometimes I'll try to have a long-acting carbohydrate before bed (crackers, corn flakes, toast etc.) so that I don't have to worry until morning. I can try to eat a bigger evening meal but my sugars will go above 12+ and I cannot increase my novorapid dose yet due to the big hypo risk and I'm extremely sensitive to insulin right now.

2) I honestly can't imagine how type 1 diabetics used to manage without Libre 2 and CGM's (finger pricking only!?), in terms of safety whilst sleeping. What used to happen if say, you had not eaten enough, or misjudged the insulin requirements for the day and had a severe hypo? I'm talking about someone who lives alone, would this have been extremely unsafe? At the moment I live alone and do not have the glucagon injection, which I am a bit concerned about. I've thought about telling my partner (lives 5 mins away) to make an agreement, such as if I ring 2-3x in the night then I need them to come over. I keep loads of snacks in my bedside drawer which is a really good idea, just in case there is an issue with the monitor sensor (have a sensor alarm), or somehow it has failed and I wake up with a BM of <4, unable to get to the fridge.

Any info/advice would be really appreciated, as couldn't find any info from searching forums. Thanks in advance

 

[Zhnyaka]

my diabetes is 19 years old, and I was able to earn enough to afford cgm only this year (where I am, the state does not issue cgm for free). I have been living alone for about 5 years and there have been no problems with hypo, this is a condition from which you wake up regardless of whether you have cgm or not, you just feel so bad that your brain wakes you up. Just don't let BG be low around the clock, so as not to lose sensitivity to hypo. Before finger pricks, people generally only did urine tests.

 

[EllieM]

Hypos have only been an issue for me when I lost hypo awareness, which tends to happen if I have too many hypos. Pre cgm it happened when my a1c got below 48 (my two pregnancies were not fun, particularly for my husband). Now with a cgm can maintain hypo awareness much more easily....
And diabetics used insulin for 60 years before glucometers came on the scene
..

 

[Ushthetaff]

As a diabetic of 40+ years, iused to deal with them by treating them when they happened , bearing in mind when I first had diabetes there were no personal blood meters, I suppose practically , sugars were running higher in them days, but always having hypo treatment available was a must , these days with the Libre system and the like I set my. Low alarm at 4.2 as the Libre reads low it gives me plenty or warning , so as soon my alarm goes off I treat a hypo even thought I am not feeling it must admit doing this has definitely reduced hypos

 

[Fairygodmother]

Diagnosed Type One in 1969, I had to learn from experience. I did have a few nasty night time hypos which were scary when I was on my own. There weren’t mobiles back then and my hampered brain and limbs wouldn’t have been able to use one even if there were.
Hypo treatments by the bed, eaten when finally awake and then, a warm bath and hot drink when sufficient control’s regained, plus a towel over the damp sheets, made things better again.
A doc told me that the liver eventually releases glucose to counter low blood sugars so even though it’s unpleasant and the washed out feeling lasts throughout the next day, mortality is eye-wateringly rare.

 

[RoughcutAU]

My first year diagnosed I did not have access to CGM which I have actually found quite valuable to learn and test doing it the manual way and not relying on technology. That said now coming up to a year soon having a Libre it really has been a game changer and really allowed some insight as to how my body works.

Like alot of people I have a healthy scepticism about CGMs and still fingerprick a couple times a day especially to confirm hypo/hypers.

 

[Bash_]

Hi there, I am a newly diagnosed type 1 diabetic, diagnosed early. Had hypos during the first few nights of starting on insulin on starting doses, then my sugar levels stabilised and were perfectly stable at night for 3-4 nights. From what I've read so far, this means the basal dose is perfect at the moment (on tresiba 4 units morning, novorapid 1 unit TDS With meals). I tried carbohydrate counting Friday with novorapid to experiment with the diabetic nurses advice, but this was a mistake as I am still early diagnosed in hooneymoon period and caused 5 x hypos in 24 hours so I went back to the starting doses as above. Since I have been better, but only get one or two hypos in the night which isn't too bad to say its only my second week of insulin. I think maybe the high dose novorapid day shook my sugar balance and I'm only just stabilizing back maybe? My sugar control is usually pretty good during the day.

My questions are;

1) Is there anything I'm doing which may be causing nighttime hypos that I don't know about? I have tried to exercise early in the day, always have a big evening meal, avoid alcohol (not drunk for 6+ months), I do check BM levels at 10-11pm before bed and not been sleeping great due to anxiety around it dropping. Sometimes I'll try to have a long-acting carbohydrate before bed (crackers, corn flakes, toast etc.) so that I don't have to worry until morning. I can try to eat a bigger evening meal but my sugars will go above 12+ and I cannot increase my novorapid dose yet due to the big hypo risk and I'm extremely sensitive to insulin right now.

2) I honestly can't imagine how type 1 diabetics used to manage without Libre 2 and CGM's (finger pricking only!?), in terms of safety whilst sleeping. What used to happen if say, you had not eaten enough, or misjudged the insulin requirements for the day and had a severe hypo? I'm talking about someone who lives alone, would this have been extremely unsafe? At the moment I live alone and do not have the glucagon injection, which I am a bit concerned about. I've thought about telling my partner (lives 5 mins away) to make an agreement, such as if I ring 2-3x in the night then I need them to come over. I keep loads of snacks in my bedside drawer which is a really good idea, just in case there is an issue with the monitor sensor (have a sensor alarm), or somehow it has failed and I wake up with a BM of
Any info/advice would be really appreciated, as couldn't find any info from searching forums. Thanks in advance

Libre 2 will enable you to sleep comfortably in the knowledge it will wake you if you Bs drops or rises to your personal settings.
Lucazade orange is my preference is very fast acting, but I only require a small mouthful to bring my sugar up, and then slow acting carbs to follow as and if required. Always remember to take fast acting carbs before slow as bread for example will slow the fast acting solution.
Ideally seek advice if you can take a Dafne course via your diabetes specialist, it's invaluable for carb / insulin balancing.

 

[becca59]

I always woke up. I would be low but aware enough to stick a couple of Jelly Babies in and turn over.

 

[SimonP78]

I always woke up too and normally I'd just pop awake, realise I was low and eat something then go back to sleep, however sometimes I would be really quite low, especially when younger - I vividly recall one time at school waking up and only one side of my body obeying instructions to move. I crawled out of bed using one arm and one leg and managed to find something sweet to eat on the desk next to my bed at which point all was well again. On another occasion while living alone while studying at uni, I recall having to crawl across my flat to the kitchen, then drag myself up the work surface to get to a pot of sugar (usually for coffee) as my legs weren't wanting to support me. After sitting on the floor for a while after having spooned in a fair quantity of sugar I was feeling generally much better so did a blood test and got a result of 1.2 mmol/l. I ate some more food at that point. I've no idea why I didn't have food on the bedside table.

In the days pre-CGM I do recall that I was significantly more relaxed going to bed with a gf there knowing that there was someone else (beside myself) to hopefully notice if I went low. After getting married and being used to someone else being around all the time, I found the concern about going low at night was significant if I was away for work, etc. (not helped by travel, unusual eating and normally drinks)

CGM with alarms (so XDrip+ from libre1 days onwards) removed almost all of this concern (which I should add wasn't a really massive thing, but it was enough that I do recall thinking that I was much more relaxed with someone around).

 

[In Response]

@cbooth5 from your message i guess you have a CGM like Libre. Are you checking those night time hypos against finger pricks? It seems that it is rare for new Libre users to be warned about compression lows. Since the advent of Libre, threads about night time lows have become common and often they are false lows due to pressure being applied to the sensor when you lie on them.

But to your questions, I lived alone for the first 5 or 6 years after diagnosis and have only had CGM recently. I did experience night time lows but always woke. In some ways, sleeping alone was easier because I didn’t have to worry about disturbing anyone when I turned the light on and treated the low.
Hypos can be serious but, for me the nasty ones are very rare.
I think, when I was injecting (I now have a pump), I was more conservative with my insulin doses and careful to stay above 8 before going to sleep.

Given technology can fail, it worries me that newly diagnosed people with type 1 are not able to cope without their Libre. I would recommend taking an ocassional Libre break to ensure you can confidently cope without.

 

[cbooth5]

I always woke up too and normally I'd just pop awake, realise I was low and eat something then go back to sleep, however sometimes I would be really quite low, especially when younger - I vividly recall one time at school waking up and only one side of my body obeying instructions to move. I crawled out of bed using one arm and one leg and managed to find something sweet to eat on the desk next to my bed at which point all was well again. On another occasion while living alone while studying at uni, I recall having to crawl across my flat to the kitchen, then drag myself up the work surface to get to a pot of sugar (usually for coffee) as my legs weren't wanting to support me. After sitting on the floor for a while after having spooned in a fair quantity of sugar I was feeling generally much better so did a blood test and got a result of 1.2 mmol/l. I ate some more food at that point. I've no idea why I didn't have food on the bedside table.

In the days pre-CGM I do recall that I was significantly more relaxed going to bed with a gf there knowing that there was someone else (beside myself) to hopefully notice if I went low. After getting married and being used to someone else being around all the time, I found the concern about going low at night was significant if I was away for work, etc. (not helped by travel, unusual eating and normally drinks)

CGM with alarms (so XDrip+ from libre1 days onwards) removed almost all of this concern (which I should add wasn't a really massive thing, but it was enough that I do recall thinking that I was much more relaxed with someone around).

Wow those stories are scary, you did well to manage it on your own for so long!

 

[cbooth5]

@cbooth5 from your message i guess you have a CGM like Libre. Are you checking those night time hypos against finger pricks? It seems that it is rare for new Libre users to be warned about compression lows. Since the advent of Libre, threads about night time lows have become common and often they are false lows due to pressure being applied to the sensor when you lie on them.

But to your questions, I lived alone for the first 5 or 6 years after diagnosis and have only had CGM recently. I did experience night time lows but always woke. In some ways, sleeping alone was easier because I didn’t have to worry about disturbing anyone when I turned the light on and treated the low.
Hypos can be serious but, for me the nasty ones are very rare.
I think, when I was injecting (I now have a pump), I was more conservative with my insulin doses and careful to stay above 8 before going to sleep.

Given technology can fail, it worries me that newly diagnosed people with type 1 are not able to cope without their Libre. I would recommend taking an ocassional Libre break to ensure you can confidently cope without.

Thank you, really good point. I am overly reliant on my libre as before this I finger pricked for a few weeks before my diagnosis, will go back to this as a back up and to confirm hypos! Really useful thanks