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Nighttime Hypos

T

TOMJC

Well-Known Member
Messages
69
Type of diabetes
Type 1
Treatment type
Insulin
Hi all,

I have recently been struggling with nighttime hypos which my consultant or nurse have been unable to explain and was wondering if anyone here might be able to help.

I am a trainee accountant currently in the middle of a few big projects which means for the past 4/5 months I have been working late (leaving office usually between 10-12pm). I have been finding that when I have been working these hours I regularly go low at night between 1.30 and 2.30am. I have my levemir (which I have recently reduced with no apparent effect) between 7-9pm and my last meal in the office about 8pm. I am sedentary for most of the day and as a result my blood sugars have been generally higher than during my normal routine so daytime hypos are rare. I generally get home and go to bed around midnight with blood sugars usually above 9mmol.

Does anyone have idea what might be causing these lows? I would have no short acting insulin in me, and I can't see my levemir pushing my levels down so quickly. As an example I dropped from 9.6mmol last night at 12 to 1.6mmol at about 2am. This happens almost nightly when working these hours, but come the weekend when I'm not working I don't hypo in the night.

It's pretty frustrating to wake up in the middle of the night and have to go eat when already tired so really hoping someone might have had some experience with this and has a solution.

Hope this makes sense, thanks in advance for any help.

Tom
 
How strange! If you had taken no fast-acting within the preceding 4 hours and have tried lowering your Levemir without success perhaps you should ask to try a different basal insulin? Have you used Lantus before? A lot of people have also had good experiences with Tresiba. In your position I would be wanting to try a different basal as the next step. I guess the other alternative would be to try taking your Levemir in the morning instead of the evening?
 
I also wonder whether there is an additional hormonal thing going on. When you finally get to bed, you are likely to be reducing cortisol levels if you are currently under stress, and the sudden removal of cortisol may lead to a reduction in liver produced glucose.

Why is this relevant? Cortisol causes the release of glucose and a reduction in cortisol will reduce glucose production. With the drop off in circulating glucose when you go to bed (11pm ish), the bolus insulin tail in your system (if you are eating at 8pm ish, it may be there to 1am) may be acting (even in small amounts) to finish off what was already being reduced.
 
What happens to yr bg during the night when you are not working?

The pancreas and the liver do strange things during the night and no 2 people are going to be the same.
Not sure what the reason is or yr bg to drop like it does but maybe eating 2 jellybabies before getting into bed will do the trick.
Has a pump been mentioned to deal with the bg drop?
 
Hi all,

Thank you very much for the quick replies - much quicker and more helpful than I expected!

RE: pinewood
I haven't tried Lantus yet, but it has been mentioned a few times by my consultant although no action taken. Although slim and fairly active, I am concerned by the potential weight gain that I have heard can be a side effect. Maybe I should give it another look though. I have pushed for Tresiba as the clinical trials look very good especially with regards to nighttime hypos but was told that it is currently too expensive and my clinic couldn't justify the cost. I don't think Levemir in the morning is an option as I experience the Dawn Phenomenon and Levemir as far as I understand is only effective for 20hrs or so.

RE: Jack412
I think you are probably right. I was on twice a day about a year ago but stopped after attending Daphne course when my total levemir intake was cut in half and nurse and I felt it wasn't worth doing it twice a day. I wasn't working such long hours then so unfortunately can't compare to now.

RE: tim2000s
I have had cortisol test before and nothing unusual was noted. Your theory sounds very plausible though as I don't tend to hypo at the weekends when not working so I think it's worth broaching the subject with my consultant.

RE: iHs
No hypos, all perfectly under control!
I do tend to have a snack before bed, but don't like doing it when sugars are above 8mmol, mainly out of habit I guess. Pump has been mentioned. At present, although I completely understand all the merits of a pump it's just not something I want as I'm not keen on the idea of being attached to something all the time and feel like it turns my diabetes from an invisible disease to a visible one. May be a bit short sighted of me, but that's how I feel at the moment.

Thank you once again for all your help. Greatly appreciated!

Tom
 
I've only been diagnosed since December so take my comment with that in mind, but I've had no issues with Lantus. I'm also active and slim and haven't noticed any weight gain yet (although I realise this is commonly reported). If they won't let you try Tresiba maybe it's worth a shot.
 
Hi Tom and welcome to the forum

You could reduce your basal dose further or take it earlier in the day to see if this helps, but depending on how long you are going to continue with these long hours you could just take on board some extra carbs before bed to compensate for the drop in bg levels, so if you were only going to be working these long hours for another week or two then an extra snack might be the solution, but that said insulin requirements do change and you may find even when you go back to working regular hours you might still hypo in the early hours.

Do try lantus if levemir is causing problems, but I would keep pushing for the Tresiba or ask about a pump as night-time hypo's is one of the reasons why people move over to pump therapy. Good luck and hope your studies go well.
 
RE: Pinewood
Think you are probably right, thanks for your help. Hope everything is going ok for you, first few months of being diabetic for me were a blur!!

Re: noblehead
Given the fact I am pretty sedentary when working these hours I'm not too keen on reducing levemir further as I'm finding during the day I'm generally higher than I would like. Eating is probably a good idea I think in the short term so that's what I will look to do initially. Thanks very much for your help. Will update the post if I find a solution that works or if I switch from levemir as I imagine I'm not the only one considering it.

Thank you all once again.
 
@TOMJC, when I briefly changed to levemir a few yeas ago I had nothing but trouble and ended up switching back to lantus, overall lantus gives a better 24 hour coverage than levemir although some people do still have to split-dose, discuss the posibilties of a pump when you next see your diabetes consultant.
 
@ TOMJC

I have found thst Jellybabies only seem to have effect on bg levels for about 1.5hrs so could be a quick short fix for you until yr honeymoon phase is over.
 
Hi Tom,

I have recently switched basal to Tresiba. I am still having the odd early morning hypo at the moment, but I'm still trying to get my dose right, although it is getting there. I was on Levemir for a couple of years, switching from Insuman Basal due to mid morning hypos, but I had lots of problems with it. I found that for me it only lasted about 10 hours, so even with a split dose I was waking with high fasting levels and was going high by late afternoon. I also found that I was hypo'ing about 1.5 - 2 hours after my evening Levemir dose which I took at 6.30pm - everyone kept telling me that this couldn't possibly be caused by the Levemir, but as I hadn't taken any rapid acting since lunch at 12.30pm I can't see what else could have caused it. My standard deviation also increased badly while on Levemir, with more and higher highs as well as more and lower lows and I experienced more unpredictability generally. Overall, Levemir just didn't work very well for me - some people do very well on Levemir, but for me it was just a bit rubbish!

Smidge
 
Hi, Tom, I may be saying something similar to Tim, I am unsure. Years ago i was doing a course requiring late studying and long exams, and having bad night hypos, and ending up exhausted, and had no idea what to do. Years later it was explained to me by my consultant - any stress, and pushing yourself to work long late hours is a stress, produces adrenalin, and this has an anti insulin effect - essentially, if i understood correctly. when the adrenalin level drops, then the insulin can work ok again - even some of the short acting may have had its action delayed by the adrenalin - In these situations, it may be wise not to correct what seems a high and try and have a snack before bed, even if you are 9.0, at least as an experiment for a few days....Ann
 
Similar @ann34+. Both are stress hormones, and adrenalin acts over a shorter period. Dependent on the amount of time spent under duress, the two act together in a positive feedback loop, with adrenaline causing shorter term variation.
 
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