Night time micro managing

[megan]

I'm on a pump and cgm and started ozempic this summer so the game has been changed to the positive but with quite a journey along the way. Currently I'm baffled and wondered if anyone can shed some light. Evening I need a lot less insulin so adjust accordingly. But later eve the last 3 days I've had to unplug the pump for over two hours to avoid hypos and the first night it happened even that didn't stop them. I unplugged before getting to a hypo. With the carbs I've had on board this shouldn't have happened as I've greatly lowered the bolus ratio. So rather than just lower, tonight I've not taken a bolus for 40g carb. My sugars are still good. That was two hours ago. As I've come to a blood of 5 now it's quite possible I may need to unplug again.
But then by 8 am I'm at 14!
I know ozempic delays stomach emptying, and I'm insulin resistant, but this is a complete turn around and as it's 3 nights in a row I'm a tad tired and not sure how else I could handle it other than the usual micro managing and test through the night. But it doesn't stop it from happening

 

[Antje77]

Have you adjusted your basal as well?

 

[megan]

Have you adjusted your basal as well?

Yes. The basal afternoon and over night is lower than the morning. So it changes at 8 am to the higher basal doses and lowered later in the afternoon over night
It's 2 1/2 hours since having the 40 g and no bolus now

 

[Antje77]

Yes. The basal afternoon and over night is lower than the morning.

But have you changed it based on your low numbers as well, or are you still getting the same basal rates from before starting the ozempic?

If you need less insulin, it makes sense you not only need less insulin for food but less basal insulin as well.

 

[Deleted member 527103]

The wonderful thing about having a pump is that we can adjust our basal pattern for different times of the day. If your body needs less basal at night, adjusting your basal at that time (or maybe an hour prior) should stop the hypos.
I think of my basal as my foundation. If I haven't got my foundation stable and try to build on a wobbly foundation with a compensating bolus will lead to the house falling down.

 

[megan]

Thank you for your responses. I've had 5 basal programs in my pump that I work around over time. Since starting ozempic I am down to my lowest set category ( one I've rarely used before). I also have needed to set over night to TBR to 90% or 80%, 70% of that lower category.

This is to a further extreme. Unplugging for over two hours and carbs not needing boluses, hypos.... I don't know what happens between 1am and 8am that's made the last few nights go higher. It's a new curve hall
Going onto t slim in sept
But for now I need sleep. Here's hoping for a better night

 

[Marie 2]

I need less insulin at night, so I have less carb ratios and less basal settings for the evening and the night. If you are still dropping continually every night you need to lower it even more.The figuring it out of the amounts is the trick, because you usually make small adjustments until you find out what works. I have always needed less insulin at night, but about 6 months ago when I first started adding using an inhaled insulin for some reason my needs at night really dropped to about half of the already lowered amounts I had set. I did use a separate program for it because I wasn't sure how long it would last and it was significant adjustments.That did end up changing back closer to my more normal lower amounts after a few months.

But the other thing that happened is a huge DP increase. DP is Dawn Phenomenon. It's a liver dump of glucose usually around 5 am to get your body ready for the morning when you wake. "Normal" people make insulin to use it. I had mild DP before I started the inhaled insulin, but along with the drop in needs of insulin, my DP shot through the roof for a bit. Then it dropped back to mild after maybe a few weeks and after a few months has now gone away. But I program in an extra dose of insulin around 5 am. It's just the only way you find out you don't need it anymore is by being woken up by dropping too much. My getting DP is an off and on thing so I am used to making adjustments for it.

I was sure sleepless too the first couple of weeks trying to figure out what was needed and going on with me!

 

[megan]

Well morning came and it turned out I didn't need any insulin for the 40g! ? And still fine

 

[megan]

As expected once I've found what works it changes... it's a regular thing for me. So last night I needed more insulin and tonight it just starts rising quickly with no food or change of routine. Just being it's usual predictably unpredictable self
Ozempic has certainly helped but my basals are not the same for very long. Hence basal testing is not very useful for me. I can't explain why it's like that but it is. It fluctuates and has for years. Hopefully going into the t slim control IQ will help. The idea being it takes over my micro managing. I'm a vintage diabetic so I'm used to figuring it out for myself but with this new pump when I get it I've been told I'll need to sit on my hands for a time whilst the pump works out the algorithms