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Nighttime Hypos

Diabolus X

Diabolus X

Member
Messages
11
Type of diabetes
Type 1
Treatment type
Insulin
I've been diagnosed T1 6 months now and I've been experiencing perpetual and persistent hypos overnight. Despite taking dextro and a pre bed snack my BG plummets in the early hours and is difficult to stabilise thereafter. Does anyone have suggestions?

Thanks,

Diabolus X


Sent from the Diabetes Forum App
 
Assuming you are on a Basal/Bolus insulin regime, it sounds very much as though your basal (e.g. Lantus or Levemir) dosage is too high.
Getting the basal dose right is really important. It can be difficult especially as you are probably still in the "Honeymoon Period" when your pancreas still produces some insulin.

Talk to your Diabetes Nurse or consultant.
 
I'm on 4 units of NovoRapid per meal and 8 units of Lantus a day. I think you're right about the basal dose. I will definitely speak to my doctor.

Thank you for your help, it's much appreciated :)




Sent from the Diabetes Forum App
 
Hello Diabolus X,

(This is a copy-and-paste of a reply I have made on several other threads. Hopefully it's helpful for you).

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 had problems with overnight lows. After discovering the above information, 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
 
diamondnostril said:
Hello Diabolus X,

(This is a copy-and-paste of a reply I have made on several other threads. Hopefully it's helpful for you).

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 had problems with overnight lows. After discovering the above information, 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
Click to expand...

Dear Antony,

Thank you. I simply had no idea. How the insulin is designed to work is not explained and this is unhelpful to say the least.

I believe now that the Lantus is the site of my problems, as it the one consistent feature of every evening. I will get my dose sorted and hopefully some sleep!

Thanks for informing me :)

Diabolus X
 
If your blood sugar is ok during the day then your Lantus might be fine for the day but too much for the night. In which case you might want to go on to a twice daily split basal regime with less overnight basal but the same daytime basal. Eg maybe 4u Lantus in the morning but 2u at bed time.

Sent from the Diabetes Forum App
 
Spiker said:
If your blood sugar is ok during the day then your Lantus might be fine for the day but too much for the night. In which case you might want to go on to a twice daily split basal regime with less overnight basal but the same daytime basal. Eg maybe 4u Lantus in the morning but 2u at bed time.

Sent from the Diabetes Forum App
Click to expand...
It's certainly worth trying tomorrow. Splitting the dose may help with sleep as my nights are insulin heavy. It's now clear (thanks to the forum) that it's either a matter of volume or timing with the Lantus. I'll divide the dose in the morning, and see how it goes :)


All best and thanks for the advice.

Diabolus X
 
Diabolus X said:
It's certainly worth trying tomorrow. Splitting the dose may help with sleep as my nights are insulin heavy. It's now clear (thanks to the forum) that it's either a matter of volume or timing with the Lantus. I'll divide the dose in the morning, and see how it goes :)


All best and thanks for the advice.

Diabolus X
Click to expand...
No worries, good luck in the morning Diabolus. :-)
 
Just for the sake of "informed consent", I should make it clear that the use of Lantus for twice daily split basal is unconventional, and it is more normal to use Levemir for this technique. The very renowned Type 1 diabetic doctor, Dr Richard Bernstein, recommends twice daily Lantus but you will not find it recommended by the NHS (though I don't believe they oppose it or would have any reason to oppose it). But if you want to stick to what you would probably be advised by the NHS, wait until they prescribe you Levemir if you want twice daily split basal. Even if you do the Lantus split dose yourself (as I did), your team may advise you to switch to Levemir. In my case my hospital team were totally fine about the split Lantus and didn't even suggest I went to Levemir.

FYI Bernstein prefers twice daily Lantus to either once daily Lantus or twice daily Levemir. His argument is that the duration of action of a single injection of either insulin is not really sufficient for 24 hour coverage, and Levemir is not really adequate even for 12 hour coverage.
 
One of my dsn's got me to split my Lantus, it works well for me as it was only lasting sonewhere between 18-20 hours. X
 
My consultant advised splitting Lantus for me as I was having severe night hypos, and it works for me at a very reduced dose at night time. This was after years of debilitating night hypos that caused rebound the next day too_Overall control has been much better since, and it looks like the medics in the UK are finally ( No pun intended:D ) waking up to the fact that Lantus can be successfully split .

Signy
(Edited for typo )
 
Not sure If anyone has mentioned this lol because I am too lazy to read but sounds like you need to do a basal rate test! Basically do not eat after 10pm and then test your blood's say every 2 hours throughout the night and if and when you hypo take note of that and then go back to your diabetes nurse who will more than likely change your basal rate! Defo sounds like you are on too much though!
 
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