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How to stop/limit a night time hypo?

J

John Marsden

Newbie
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1
Type of diabetes
Friend
Treatment type
Insulin
Hi all

My girlfriend and I are at a bit of a loss trying to figure this one out so I thought I would seek some advice. She has type 1 diabetes and has had for around three years now so we know about, although we are not always 100% accurate with, carb counting etc. She also had a stroke about 3 months ago which may possibly have an effect on the diabetes which has seemed to be reacting a little differently ever since.

Her insulin before the stroke was

novorapid (day)
Lantus 28 units (night)

Our problem now is she measures her BSL just before bed (@ 23:00) and it ranges between 7 and 12. She then injects the Lantus and over the past week she has been up must nights @ 01:30 with low BSL (2.1-3.5). We have tried lowering the dose of Lantus and last night she injected 21 but still woke up at 01:30????

Any ideas?? I am thinking we could try injecting the Lantus earlier say @ 21:00 that way come bed time any spikes should have occured and can be dealt with.

I am fairly new to this whole thing, but do know the basics, so any help would be much appreciated.

Cheers
John
 
Hi, sorry to hear that your girlfriend had a stroke! Hope she is covering well :) I would suggest contacting her DSN first to inform them of what's happening as they might have more of an insight into whether strokes effect sugar levels. I would also do as you suggested of having her back ground insulin earlier or your girlfriend could split her dosage into two. I have half my back ground insulin in the morning and the other half 12 hours later (I generally inject 10am and 10pm as guaranteed to be up at both them times). I was having quite a lot of night time hypos so it was suggested to me by my consultant to split the dose to two injections and I'm so grateful I did! I did lower the dose by four-five units too. Apparently the back ground insulin is unlikely to last the whole 24 hours so it's more effective to have it in 12 hour intervals :) hope this helps, good luck!


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What time is she having her last Novorapid? I always leave at least 4 hrs between the last Novo and bed to, hopefully, make sure there's no active bolus on board. A night time basal test would give you a good insight as to what's happening. My Lantus lasts the 24 hours but I know it doesn't for everyone. Definitely let her DSN know though.
 
I echo what Kelsie says about contacting her DSN.

You could try moving the lantus back to earlier in the evenin., I use to have a few hypo's in the night when I injected before bed and my DSN suggested moving it to around tea-time to see if that helped, I wasn't optimistic that it would work but went ahead and never really had any problems since, with lantus you can inject it any-time you want as long as your leave it 24 hours apart before you next inject it, some people on a once daily dose take theirs in the morning.
 
Hello Mr Marsden,

I don't know if this will apply to your situation, but it might be useful for you or others. It comes directly from personal experience.

I have used Lantus for around 10 years. Over the last 1 year I experienced a lot of overnight low blood-sugars. I did not realise the source of the problem for a long while (although with hindsight it seems clear).

Eventually I traced it to the fact that a large amount of my Lantus dose before bed (18 Units, split into 2 injections) was acting immediately, rather than evenly over 24 hours.

Lantus Insulin is slightly acidic; when the acidic solution hits healthy fatty tissue it forms tiny crystals. These crystals then dissolve at a uniform rate, giving a steady release of the Insulin over approximately 20 - 24 hours. The injection site is really important for Lantus. If you hit a non-fatty area (blood vessel, or muscle, or possibly an area damaged by previous injections) then these crystals do not form correctly. This can mean large amounts of the Insulin active immediately and acting more like a Rapid Insulin.

I started to take more care with my Lantus injections, and for me the overnight lows stopped immediately. I now scrupulously avoid 1 area of belly tissue that had been damaged by Lantus injections with larger disposable needles over many previous years. And I now make sure to rotate my Lantus injection sites, ensuring to take a good pinch of healthy tissue. Basic stuff that I should have been doing anyway, I guess.

After this small change, the overnight lows stopped immediately and I was able to reduce my Lantus dose from 18 to 14, without changing anything else in my routine.

http://www.lantus.com/starting/how-to-use/choosing-site.aspx

The information available for Lantus does give all the right advice about how to inject. But it does not give any information regarding WHY it is important to get it right. How the Insulin is designed to work is not explained, and I think this is very unhelpful. Obviously there are serious effects if it acts more like a Rapid Insulin.

Regards,
Antony
 
Hi. Many good comments so far from other posters. Has your girlfriend lost any weight recently as this can have an effect on the insulin needed; just a thought? I'm on the other popular '24hr' insulin called Levemir which I gather isn't so acidic and doesn't sting at all. It doesn't last as long as Lantus and is nearer 18hrs max so a split dose is quite common. If you can't get the Lantus right it might be worth asking to change to Levemir; it may or may not help.
 
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