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Hypos during the night

It’s some time since I contributed to the T1 forum
My wife’s blood sugar readings range from 2.7 to 18 sometimes higher.
We are supposed to be between 6 and 10, there is is no rhyme or reason why this happens.
We have come to the conclusion that it is impossible to control the levels.
The forum keeps advertising low carb diets but we are told to have at least 120 carbs a day. Everything is so frustrating!
Everything seems to be guesswork.
My wife is putting on lots of weight but we don’t know why.
On the basis that we are now 80 years old and with luck have another 20 years,does any of it really matter?
If you are reading this then you will realise that frustration reigns!
At the annual check by the doctor indicated that he was happy with the way my wife was coping, we just don’t get it.
Instead of controlling the condition it is the other way round.eg she won’t eat something since it will affect the sugar levels
Proper exercise is a thing of the past
Gardening is her passion however she can do some gardening and the levels come down to say 4 and she has to stop have the normal jellybaby or coke and sit down for half an hour. Alternatively the level goes up why does this happen? No one knows
There are far more hypers than hypos so we are worried about effects on eyes.
The libre2 alarm goes off every time she goes into the room where the alarm is located, I would guess at least 5 or 6 times a day.

That is the end of my rant!
 
Dear All
Since my last post my wife’s levels are still uncontrollable in fact over the last week she has had a lot of high readings several of them being hi, which is in the high 20’s and is very worrying.
The problem is that we don’t know why.
Any ideas?
 
Been having alot of libre readings of me being in the red for 2-3 hours at night and it seems to have gone up to 6-8mmol/l by itself, idk if glucagon is still a thing or the compression low phenomenon is what's happening.
 
Might be helpful if you could give some indication of what she eats and when and what she's dosing.

Looking back at the posts from 2 years ago I see overnight lows. Treating lows requires added carbs, which are effectively unplanned (and fast acting), so these add energy that has to go somewhere (hence the potential for weight gain). Cutting these lows and therefore the requirement to treat them is probably the most important thing to do.

Seemingly random overnight lows can be associated with activity in the previous day, this is different for everyone and depends on general level of activity. Something to consider. As mentioned above if the lows are reported on a CGM they may be false/compression lows, always check with a finger prick unless the signs are obvious.

Highs may be related to overcorrection of previous hypos, or illness - I'm strangely running high overnight at the moment despite riding to work by bike. This is unusual (the highs) so I assume I may be fighting some underlying injection even though I otherwise feel fine.
 
grahamrb said:
Can you believe it, the Doctor said that readings of HI , which is off the scale is OK!!
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They may be thinking that complications from high blood sugars are likely to take a couple of decades to manifest, so not as important for someone in their eighties??? But you are still going to feel pretty ill with levels that high, plus I'd be concerned about possible DKA.... I do find the comment surprising, though I can understand that they would be a lot more concerned about hypos than hypers.

My advice would be not to give up though, as a T1 I ask for advice from my team, but I manage my levels myself.

Good luck.
 
How old is your wife? Hormones can really affect blood sugar levels.
 
Dear All
Controlling my wife’s hypos at night is still a problem.
What we tend to do now is make sure that before we retire at night is to make sure that the readings are between 14 and 18 so that hypos are less likely to happen during the early hours
If the readings, before retiring,are below that she will not go to bed since we are worried about hypos. Even then she will get a hypo at about 4 am.
Once again instead of controlling the T1 it’s controlling us.
The nurse advised us to up the long lasting insulin from 18 to 20 which we are now doing, doesn’t make any difference though,

Thanks for listening
Graham
 
Good morning @grahamb I have to say I am more than a little confused by your nurses advice. For night time hypos the opposite of increasing the basal should be the answer surely. I sympathise with the problem. Being constantly woken in the night is dreadful. Plus it’s an awful drop from
+ to a hypo which will be having a bad effect on her.
 
It does sound like there's much too much insulin on board which results in getting such drastic drops overnight.

What would help us, and perhaps you if you don't already do it, is to note down when and what (and the carb content) of meals during the day along with the times and doses of insulin that are being taken. She has a libre I remember from above, so could you post the data from that alongside the above information and we can see what we think might be going on?

Is there anyone who uses Librelink who knows whether a CSV file (raw data) can be exported rather than faffing around with screenshots? I'd be happy to create a graph integrating the all of the above to post it here which. Being able to see all the data in the same place makes the libre a much much more valuable tool in my opinion, especially if you can see estimates of how much insulin and carbohydrate are active across the day (which I realise are estimates, but still much easier to absorb visual information than go from numbers on a page)
 
I guess that both you and your wife are exhausted from those night-time hypos.
Your poor wife would be feeling rather unwell with readings that high before bed-time.

I am of similar age to you and your wife, and I wish to recommend something that has helped me previously.
Try to time your evening meal so that it is at least four hours before bed-time. That way the fast-acting insulin (bolus) you injected for the meal would have been used up. If the amount of your wife's long-acting insulin is correct, then her readings would stay steady. If the hypos continue, then the long-acting insulin (basal) is too high. You could adjust it down, one unit at a time (in liaison with the hospital diabetes nurses).

I am now using an insulin pump that stops insulin if my reading are going low, so I hardly ever get night-time hypos, unless I have had an unusually active walk or been raking leaves in the garden. In my case having this pump gives me better sleep. Perhaps a pump is something you may wish to discuss with your wife's diabetes team? But pumps are hard work, cannulas can be uncomfortable and tubing can (and does) get blocked.

All the best.
 
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I agree with @ElenaP 's suggestion, however depending on what and how much you're eating, 4 hours may not be enough time for the food to be digested (and therefore the effect on blood glucose to finish), so there may be a rise once the evening bolus has warn off.

I had a quick look above but couldn't see what type of basal and bolus insulin she's taking - did I miss it, if not could you let us know please?

If she's taking a long acting basal (lantus or similar rather than an intermediate-long acting insulin such as isophane) I'd expect her to be running low during the day too (given that her BG appears to drop quite considerably overnight) or to require additional snacks/a very low insulin to carb ratio. It is possible though that she has very low basal needs overnight (it's certainly not unheard of) in which case looking at what time of day the basal insulin is given and what type it is might be worth doing.
 
SimonP78 said:
....... there may be a rise once the evening bolus has warn off.
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@SimonP78 considering that the problem has been unwanted hypos during the night, does it really matter if any food remaining in the small intestine causes a small rise in blood glucose?
 
ElenaP said:
@SimonP78 considering that the problem has been unwanted hypos during the night, does it really matter if any food remaining in the small intestine causes a small rise in blood glucose?
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Not immediately, no, but assuming the basal rate is sorted out, it would imho be worth knowing that even eating early doesn't necessarily result in a flat profile when going to bed when doing a single supper bolus - certainly before I started splitting dose I was upping my basal rate thinking it was a background effect (not having done an evening fast) when it was in fact the effect of supper dragging on into the evening.
 
May I ask what level the alarm is set at?

I have my low alarm set at 5.0, which then gives me the chance to finger prick to confirm, and if lower than 5.0 gives me a chance to head off a hypo. Please also be aware than medication, especially if it is a recent addition to your wife's regime can have an affect on BG levels.

My diabetes team insisted that my BG levels of 16 were too high. That's where my levels were when I started chemotherapy, although on chemotherapy days my BG would rise into the mid to high 30's. I'm now down to around 10.
 
Dear All
Many thanks for your responses and advice
We have tried most of what has been suggested but the problem still exists.
In fact tonight’s reading is very high.(over 20).
By morning it will be about 4.
This is a fact of life, drank some water and dosed with insulin
We used to keep a record of what my wife ate this added about 30 minutes to the meal time after calculating carbs and all the formulas etc to work out the insulin dosage. This is very demoralising and puts you off eating anything.
We tried creating a meal plan for the week; on day one we didn’t fancy the food on the plan so we cooked something else.
We lead busy lives and lunchtime is very short in between activities this completely negates any planning
The last nurse said to put in 6 units of insulin before each meal irrespective of what is being eaten I think that she is wrong but we tried it anyway
So carb counting has stopped
Frankly we are fed up with it all, insulin is a requirement in order to stay alive. So we clearly continue to try and follow the rules.
Every time my wife takes a reading her first question is Why especially when the reading is 3,4 or 20+
Very rarely the reading is between 5 and 10 which is the target
As they say “plough on Macduff” which we will continue to do
 
How about trying a week of set meals: if you’re in the U.K. there should be carb quantities for pre-cut bread and cereals, and you could weigh and calculate the rice, potatoes, etc then have the same carb amount each time.
It might be a boring food week but by the end of it your wife might have a better idea of how food and doses affect blood sugars.
It can also be difficult to break habits such as grabbing a biscuit in passing. This type one thing can feel like a ball and chain!
Good luck.
 
grahamrb said:
We used to keep a record of what my wife ate this added about 30 minutes to the meal time after calculating carbs and all the formulas etc to work out the insulin dosage. This is very demoralising and puts you off eating anything.
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Even if you don't dose for it at that point, note down what was eaten (you can do this after the fact) so you get some idea of what the effect of a given meal type/carb quantity vs dose had (it's worth noting down what the meal was as well as carb content as meals with high fat content slow digestion). You can then review this later and get a feeling for what does and doesn't work.

Assuming you sometimes eat similar things, it should then be reasonably straight-forward to get some idea of the carb quantities from a similar meal on a previous day and adjust dose based on what happened last time around.

It does take some time to note down the quantities, but I do think it's worth it (and eventually you can estimate very accurately what's in a serving even without looking anything up) - I tot up the carb quantities while I cook (write all the totals down on a bit of paper as things go in the pan/oven/etc), then I look at how much of the finished item I think I'll eat when it's ready to be served and calculate insulin then

I tend to run low before my supper so I don't need to bolus too far in advance, but if I happen to be running high and need to correct and pre-bolus, I take a guestimate pre-bolus dose (which I know will get some insulin in the system and which I will definitely be able to use when I eat), then take another dose as I start eating once I've worked out how many carbs I'm actually going to consume.
 
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