Night-time hypos - how worried should I be?

[27Chris]

I was diagnosed with LADA about four months ago and am very much feeling my way. I am currently on 4 units of Semglee and 2 x Metformin 500mg a day, and am trying to limit carbohydrates in my diet. Recently I felt everything had stabilised nicely - I was 95-100% in range, with an average of 7 trending down. But recently, without any change in my circumstances, my blood sugar levels are continuing to fall. in particular I am getting hypos in my sleep. I go to bed with a measurement of 6+ but within two hours or so this falls to between 3 and 4. But I feel no symptoms and sometimes do not wake. If I do wake I take glucose, but sometimes it wears off and another hypo occurs. By the time I wake levels have recovered to 6 or so. How much of a cause for concern should this be? As I say, I feel no effects either during my sleep or in the morning.

 

[In Response]

Reading your comments, I find myself asking two questions
- why are you trying to limit your carbs?
- if you get no hypo.symptoms, how do you know you are low? Could they be compression lows from a CGM?

 

[Jaylee]

I was diagnosed with LADA about four months ago and am very much feeling my way. I am currently on 4 units of Semglee and 2 x Metformin 500mg a day, and am trying to limit carbohydrates in my diet. Recently I felt everything had stabilised nicely - I was 95-100% in range, with an average of 7 trending down. But recently, without any change in my circumstances, my blood sugar levels are continuing to fall. in particular I am getting hypos in my sleep. I go to bed with a measurement of 6+ but within two hours or so this falls to between 3 and 4. But I feel no symptoms and sometimes do not wake. If I do wake I take glucose, but sometimes it wears off and another hypo occurs. By the time I wake levels have recovered to 6 or so. How much of a cause for concern should this be? As I say, I feel no effects either during my sleep or in the morning.

Hi,

Are you checking against a fingerprick on these lows.? What time do you take the Semglee? What time are the reported lows?

 

[27Chris]

Thanks for taking an interest! Answering your questions:

Jaylee - the lows register on my Libre sensor, down to about 2.9 in one case. I'm too sleepy to check with fingerpricks, but I calibrated my sensor against a fingerprick when I put it on, and the readings were compatible. The reported lows are roughly between 2,00 and 4.00 am, after which levels recover of their own accord, to about 6 when I take a reading at 8.00. I also take my Semglee at about 8.00 am.

In Response - I limit my carbs (not severely) as a way of reducing the sharp spikes which I was experiencing after meals, in particular breakfast. As I say, I feel no symptoms of a hypo, but they register on my Libre readout (and the alarm goes off, sometimes but not always waking me).

 

[In Response]

@27Chris those lows sound very much like compression lows. These are false lows when pressure is applied to the sensor.
I know it is annoying but, if you are awake enough to eat some glucose, you are awake enough to check the lows with a finger prick.
It is important to know if these lows are real or not. If they are not, you risk over treating and you will not reconsider your sensor placement. If they are real, you need to review your basal dose. Given you are recently diagnosed, your body may temporarily reawaken the insulin producing cells so you need less insulin. Plus you need to manage your worrying lack of hypo awareness.
Please do your self a huge favour and check the lows with a finger prick next time they occur.

 

[Jaylee]

@27Chris ,

Do you use a 3rd party app to calibrate? I’m not aware the librelink app can be calibrated. But other app can.

It could be a “compression low”:by sleeping on the sensor thus putting pressure & burying deeper below the intestinal fluid layer causing wrong readings?

What I do know is a “Glargine” based insulin hypo can recur when just hit by sugar. You may need longer acting carbs as an additional

Personally I would be double checking with the meter. I do appreciate waking form one can be a pain..

 

[27Chris]

Thank you to both of you for this advice. It shows how much I have to learn that I have never heard of a compression low or what gives rise to it. I was set up with the sensor and the basic kit when I was diagnosed a few months ago but my first clinic appointment only comes up next month. Your explanation would account for the fact that I don't feel any of the effects of a real hypo. Also my current sensor is on my left arm and I sleep predominantly on my left side, and it is placed in a position where it is put under pressure when I sleep.
Clearly I have to be more conscientious about doing a finger prick test in the middle of the night. Previously I have tried to stay as near asleep as possible (or lie awake for hours) and not to wake up my wife!

 

[27Chris]

Last night my glucose alarm sounded at 2.45. Sensor reading 3.8. I checked with a fingerprick test - reading of 5.8. So it looks as though your helpful diagnosis of compression lows was absolutely right. Thank you so much for your help!

 

[Daibell]

As a LADA/T1 you probably need the Basal/Bolus regime to add a Bolus. It gives much better control than just the Basal. Is there a particular reason you were prescribed Semglee as it's not commonly used but may be the right choice for you? If there was no special reason for that you might want to discuss changing to Levemir. I find my control very difficult and split my Levemir three ways as well as taking my NovoRapid Bolus. I take my last Basal at bedtime and adjust the dose to avoid a nightime hypo but my Libre still alarms sometimes.

 

[27Chris]

Thanks, but I think I'll wait for my clinic appointment and raise your ideas then. I'm pretty sure the "hypos" were compression lows and things seem to have stabilised (94% in range, average 6.6, estimated A1c 44). Let's see what happens too when I put my next sensor on my other arm (the non-sleeping side).

 

[diabetic.pt]

I was diagnosed with LADA about four months ago and am very much feeling my way. I am currently on 4 units of Semglee and 2 x Metformin 500mg a day, and am trying to limit carbohydrates in my diet. Recently I felt everything had stabilised nicely - I was 95-100% in range, with an average of 7 trending down. But recently, without any change in my circumstances, my blood sugar levels are continuing to fall. in particular I am getting hypos in my sleep. I go to bed with a measurement of 6+ but within two hours or so this falls to between 3 and 4. But I feel no symptoms and sometimes do not wake. If I do wake I take glucose, but sometimes it wears off and another hypo occurs. By the time I wake levels have recovered to 6 or so. How much of a cause for concern should this be? As I say, I feel no effects either during my sleep or in the morning.

As far as I'm aware, based on reading endless studies and discussions with my Endo, insulin is the only necessary requirement for LADA, T1D, not pills. Its worth empowering yourself by researching.

 

[Billy H]

I was diagnosed with LADA about four months ago and am very much feeling my way. I am currently on 4 units of Semglee and 2 x Metformin 500mg a day, and am trying to limit carbohydrates in my diet. Recently I felt everything had stabilised nicely - I was 95-100% in range, with an average of 7 trending down. But recently, without any change in my circumstances, my blood sugar levels are continuing to fall. in particular I am getting hypos in my sleep. I go to bed with a measurement of 6+ but within two hours or so this falls to between 3 and 4. But I feel no symptoms and sometimes do not wake. If I do wake I take glucose, but sometimes it wears off and another hypo occurs. By the time I wake levels have recovered to 6 or so. How much of a cause for concern should this be? As I say, I feel no effects either during my sleep or in the morning.

When I attended the diabetic clinic for the first time following a LADA diagnoses 2 months ago, the first thing the doctor did was take me off all diabetes medications I was prescribed for type 2 because it was ineffectual. Now all treatment is basal/bolus with Freestyle monitoring.
Research shows too many doctors use treatments for type 2 even after it stops working. And if you have a LADA diagnosis it probably came about because your medication wasn't working.
Get referred to a specialist nurse or endocrinology clinic and ask about insulin and monitoring - GP's are good but LADA needs specialist input

 

[Billy H]

As far as I'm aware, based on reading endless studies and discussions with my Endo, insulin is the only necessary requirement for LADA, T1D, not pills. Its worth empowering yourself by researching.

For anyone with diabetes particularly the less known types, research is essential. And be ready to educate the professionals who often take a 'one size fits all' approach while demonstrating thier love affair with drugs like Metformin.
If you struggle with research or challenging so-called professionals get referred to an advocacy service who will support you.
LADA needs 1-2-1 tailored treatment with ongoing reviews and your GP is not equipped to deal with it.

 

[Billy H]

Thanks for taking an interest! Answering your questions:

Jaylee - the lows register on my Libre sensor, down to about 2.9 in one case. I'm too sleepy to check with fingerpricks, but I calibrated my sensor against a fingerprick when I put it on, and the readings were compatible. The reported lows are roughly between 2,00 and 4.00 am, after which levels recover of their own accord, to about 6 when I take a reading at 8.00. I also take my Semglee at about 8.00 am.

In Response - I limit my carbs (not severely) as a way of reducing the sharp spikes which I was experiencing after meals, in particular breakfast. As I say, I feel no symptoms of a hypo, but they register on my Libre readout (and the alarm goes off, sometimes but not always waking me).

I have found the best way to slow down highs and lows is to ensure I have fats and proteins everytime I eat carbs - luck for me my favourite meal/snack is cheese sandwiches (I cut the cheese thick ).
I use the Libre sensor to monitor my levels and go to fingerpricks if under 4.5 or over 15. And I'll stay up as late as necessary to get my levels in range again - don't mess around with hypos and hypers. Even if it means watching endless episodes of The Chase (Challenge channel from midnight).

 

[diabetic.pt]

When I attended the diabetic clinic for the first time following a LADA diagnoses 2 months ago, the first thing the doctor did was take me off all diabetes medications I was prescribed for type 2 because it was ineffectual. Now all treatment is basal/bolus with Freestyle monitoring.
Research shows too many doctors use treatments for type 2 even after it stops working. And if you have a LADA diagnosis it probably came about because your medication wasn't working.
Get referred to a specialist nurse or endocrinology clinic and ask about insulin and monitoring - GP's are good but LADA needs specialist input

100% agree with this. I had to seek an Endo privately, who diagnosed LADA, who wrote to my GP, telling him to put me on insulin. Initially I used lifting, Keto & carnivore to control my NHS misdiagnosed T2, & refused all pills. However, it got to a point where this was not enough. NHS GP was desperate to get me on glyclizide but the private endo put him in his place.