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Night time hypos

C

crumpy

Well-Known Member
Messages
83
Type of diabetes
Family member
Treatment type
Insulin
Hello all

Does anybody have any ideas on how to conquer night time hypos?

Current regime is 16 levemir every morning. Used to do a split dose but have slowly brought the night time dose down to the point of nil. Still hypo-ing between 1am and 3am every night despite eating dinner early with humalog (6pm) and having a low gi snack (10g) before sleep.

All ideas welcome.
 
How does your blood glucose level look throughout the day? By all rights, with 16u of Levemir, there shouldn't be a lot of Levemir in your system at the time of your hypos. It sounds as though you should probably do some form of basal testing to determine what is happening, and potentially gather evidence to suggest a requirement for a pump.
 
The 16u works fine for the day so we're hesitant to change that. We've got a CGM at the moment.

My OH doesn't like the idea of a pump. I don't think a pump would help in this circumstance would it as like you said there should be very little basal in the background?
 
There should be, but I don't know your weight and therefore the amount of insulin/kg of body weight you are taking, which would give some idea of how long it would be having a noticeable absorption rate.

That could affect the life. Likewise, a pump would mean that you could guarantee no insulin at all over the period when you hypo, whereas with a basal insulin, you can't.

Secondly, how long have you been diabetic?
 
She's been diabetic over 20 years. 63kg. What's the formula to use?
 
I've never used Levemir so can't comment on that, but a pump solved my nighttime hypos. No changes I made to my long acting insulin could help as it couldn't match my insulin needs overnight, but a pump perfectly matches what my body needs. My blood sugar stays stable overnight now.

I was nervous about getting a pump and thought it would be like having a piece of medical equipment attached to me and that it'd be in my mind all the time and affect my personality almost. Actually, I forget I'm wearing it, and the only affect it's had on me is to give me back my freedom. It may not be suitable for,you, but don't rule it out. It's completely different from what I imagined before I had it.

Could you set an alarm to test and eat before the hypo strikes? Would that work for you?
 
Thanks.

It would most likely work but just trying to find a solution that results in an uninterrupted sleep.

I'm thinking maybe bringing the day dose forward an hour to 730 and try a few other different low gi snacks before bed.
 
Ok I guess it'll take a bit of experimentation to get things right. Could you also try a slightly larger snack or has that been tried and resulted in highs at other times of the night?
 
Think we'll have to experiment with a higher snack yes. Just gone up to the 10-15g level so far. Shame we can't get s good nights sleep going to bed on a 5-6 blood level figure without having to eat but we will preserve.
 
Adding some fat to the snack might help it be absorbed more slowly too if you find it's not lasting long enough.
 
I was thinking along those lines too. Maybe some cheese spread on oatcakes or something like that.
 
Surprised the basal dose is still having an effect in the early hours of the morning @crumpy, for most people levemir lasts no longer than 16 hours and that is why it's often given as a split-dose.

Perhaps a change in basal might be a better solution if your OH isn't keen on the idea of a pump, get her to speak with her diabetes team and see if she can change to the new basal called Tresiba, its said to have a flatter profile and is also said to reduce the frequency of hypo's caused by some basal insulin's.
 
Thanks.

I was also thinking along the tresiba avenue myself. We'll experiment a little further and go from there.
 
When I was on Levimir my blood sugar levels would drop by around 10mmol/L overnight. I was regularly hypo in the night. My (excellent) diabetic clinic put me on Tresiba long acting insulin and there was a dramatic improvement after a few weeks trial getting the dosage right. Now I manage my blood sugars at bedtime to be around 10mmol/L and it now is around 8 or 9 when I get up. I keep these levels as occasionally it does drop to around 4 or 5 mmol/L.

One of the reasons for this type of erratic behaviour is due to my injection sites becoming tough and hardened. As a result the insulin doesn't get absorbed in to the body very well. Having been Type 1 for some 60 years I don't have any injection sites that are normal. Always check where you are injecting as it can make quite a difference.

BlueBoat55
 
I naturally have a low need for insulin from midnight to about 3am in the night. All my life being diabetic, unless I eat a carb snack before bed, I would go fairly hypo. It's just the way things go for some people. Two things that will prevent low bg......make bg levels a bit higher before the snack so that not quite so much needs to be eaten. Try 8mmol. If 8mmol is not a bg level you want, then eat more snack instead.. I can feel a nice chocolate digestive with 1 or 2 tsp peanut butter coming on.......heaven in disguise....
 
Thanks. OH Tried cheese spread on granary bread last night (15g) Still the same thing. Steady decline from 1am onwards until hypo at 3ish. Trying to tighten control at the moment so don't want to go bed more than 6.5.
 
Hi Crumpy. Have to agree with Tim. I had very bad night time hypos on basal bolus regime but I wanted to improve control as I had developed background retinopathy, tightening control on basal bolus just tended to increase regularity of overnight hypos. 5 years ago I started using a pump and night time hypos are a thing of the past also meaning much better sleep. Also eating lots of extra carbs and fats could mean weight increase also the need to eat when perhaps not hungry. So easy to adjust basal rates with pump. Also effectively only one injection every 3 days rather than 5 or 6 a day. Also very little bleeding with pump cannula as opposed to pens. I could go on and on, certainly worth considering pump route. Oh and retinopathy has now regressed as well!
 
As a diabetic of over 30 years about 4 years ago my husband was put on a split insulin dose including Levemir.
Since then he too has suffered from night lows resulting in long sleepless night sessions for both of us and we are tearing our hair out. He has shifted his night Levemir dose to tea time and reduced it, reduced his short term insulin, all to no avail. He requested a pump but was ignored. I ensure he eats about 30g of carbs last thing at night and I don't let him go to sleep until his blood glucose is up to about 18 mmol/l all this just to get us through the night. We have also noticed between 04:00 and 06:00 his blood glucose can drop to below 4 mmol/l before recovering to about 10mmol/l by 08:00 hrs. this didn't occur before levemir. He says he will be requesting his endocrinologist to prescribe a different base insulin. If you find an answer shout it from the roof tops.
 
Hi every one.
I some times have hypos at night around 4 o-clock, before I go to bed I put a bottle of Lucozade and some Jelly Babes on my bedside table if I wake with the sweets they are handy also if I have to go to the toilet I have a swig of Lucozade and 2or3 JBs and it helps.
 
Hi shrimpsusan
Your request for a pump should not have been ignored, I have copied this directly from the NICE website as the first criteria for considering pump therapy
  • attempts to achieve target haemoglobin A1c (HbA1c) levels with multiple daily injections (MDIs) result in the person experiencing disabling hypoglycaemia. For the purpose of this guidance, disabling hypoglycaemia is defined as the repeated and unpredictable occurrence of hypoglycaemia that results in persistent anxiety about recurrence and is associated with a significant adverse effect on quality of life
Sounds as though your husband fits that criteria. Well worth taking that up with whichever clinic your husband attends.
Persistence may result in a positive outcome here, I would be very surprised if a pump wouldn't help in your case. Having to engineer
a blood glucose of 18 mmol/L may produce long term diabetes issues with also the potential risk of ketoacidosis with high blood glucoses like that. Also has your husband been on a DAFNE or other similar course? I found that helped a great deal with many type one issues. Good luck.
 
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