Type 1 Nocturnal hypos caused by Tresiba....

[Alex_B]

I am on Tresiba, have been for at least a year and a half now, when I first got it and used it there were no problems, then I started getting bad hypos, some going below 2.0, some I was waking up for and some I weren't.

Recently, I have been having them again, I wake up with terrible headaches, confusion, dizziness and tiredness, but I don't wake up for them when I am having them which I heard can be dangerous.

Should I ask to change my background insulin to another one? But I don't know if a new one will do the same because of the change. I don't know what to do. The DSN's and doctors tell me to keep lowering it, but its still happening even when I take 10 or 9 units...

 

[Knikki]

Well you could try taking the Tresiba in the morning time, then if you do drop low you would at least be awake and able to catch it.

It was happening to me so I changed from last thing at night to first thing in the morning, I still go low at night but nowhere hear as low as did before I changed.

Just a suggestion not medically trained.

 

[searley]

May be worse on a new insulin as most other insulin’s act faster for the first few hours then start to tail off.. you have to allow changes in does of tresiba to take effect can take up to 4 days as it is a very long acting insulin

 

[Robinredbreast]

I am on Tresiba, have been for at least a year and a half now, when I first got it and used it there were no problems, then I started getting bad hypos, some going below 2.0, some I was waking up for and some I weren't.

Recently, I have been having them again, I wake up with terrible headaches, confusion, dizziness and tiredness, but I don't wake up for them when I am having them which I heard can be dangerous.

Should I ask to change my background insulin to another one? But I don't know if a new one will do the same because of the change. I don't know what to do. The DSN's and doctors tell me to keep lowering it, but its still happening even when I take 10 or 9 units...

I have been on Trsiba since July ( 10 units, same amount as I when I was on Levemir) then It went down to 9 because of morning lows, and my consultant said I could take in the morning, which I do. Still have up and down's, you could try 8 units, even 7 if necessary, or changing the time when you take it ?
Have another word with your DSN if it continue's to happen.

 

[SimonCrox]

Not helpful, but Tresiba is the basal insulin with lowest risk of hypos (on average).
9-10 units of background insulin is a slightly low dose; how much do you weigh? How much bolus insulin do you take?
Have you always had this problem of nocturnal hypos or is it newish?
Not taking anything else to make you hypo like tramadol?
Might be worth getting a blood test on 9.00 am cortisol, renal function and thyroid function
Tresiba lasts a long time, so moving the dose is unlikely to make much difference, although it does help with others such as Lantus.
Best wishes

 

[Deleted Account]

They are a number of reasons why you may have night time hypos - not just your basal insulin.

For example, if you have been drinking, your liver will withhold glucose; if you have been exercising, your glucose reserves may be reduced; if you have lost weight, you may need less insulin.

 

[Alex_B]

@SimonCrox My weight fluctuates between 7st 5 and 8 st. My bolus insulin differs to whatever I have eaten, but mainly 18-20 units only at tea time though as I barely eat throughout the day due to sickness. I've only had nocturnal hypos since starting the Tresiba, they thought it was because it was a high does, which was at first 22 units, then they changed it to 20 units, then 18 units and the doctor I saw at the diabetes clinic last week told me to lower it to single digit units. I am not on any medication like Tramadol. I had a test for Addison's Disease early this year (March) and nothing turned up in the results.

 

[SimonCrox]

@SimonCrox My weight fluctuates between 7st 5 and 8 st. My bolus insulin differs to whatever I have eaten, but mainly 18-20 units only at tea time though as I barely eat throughout the day due to sickness. I've only had nocturnal hypos since starting the Tresiba, they thought it was because it was a high does, which was at first 22 units, then they changed it to 20 units, then 18 units and the doctor I saw at the diabetes clinic last week told me to lower it to single digit units. I am not on any medication like Tramadol. I had a test for Addison's Disease early this year (March) and nothing turned up in the results.

Thanks for info. As a type 1 person at about 48 kg, you probably do not need much insulin, as you have found out. It looks like you have already had some helpful advice eg looking for Addison's.
Your blood glucose profile would be helpful
What is your bolus insulin, and is it covering your evening meal OK? The rapid analogues eg novorapid, humalog, apidra are better at avoiding night time hypos than traditional insulins, but perhaps FIAsp might be better still - have not had any experience of it (perhaps other folk here have) and the benefits seem marginal in the papers, but might be worth a try.

I always thought that one did not need a bedtime snack with Tresiba, but perhaps I am wrong.

If feeling sick a lot of the time, do you feel full up when eating quite quickly? Abdominal bloating or acid reflux / heartburn (although Camilleri's review on gastroparesis says these are not helpful symptoms)? Have folk considered gastroparesis as cause of nausea?

May I ask your height?

Best wishes

 

[Alex_B]

@SimonCrox I don't test anymore as fingers are bruised and have a lot of pain which the diabetes clinic are sorting it so I can have a cgm sooner than April.

My bolus insulin is 18-20 units normally but if I have a high carb meal it's usually 30 units.

My sickness is due to IBS so when I get these episodes (which are constantly every day now) I tend to feel sick and refuse to eat.

I never feel full up after a meal which leads to snacking or having another meal after that. So if I don't have an episode of IBS I tend to have 4-5 meals a day.

My height is 5ft 3in

 

[SimonCrox]

@SimonCrox I don't test anymore as fingers are bruised and have a lot of pain which the diabetes clinic are sorting it so I can have a cgm sooner than April.

My bolus insulin is 18-20 units normally but if I have a high carb meal it's usually 30 units.

My sickness is due to IBS so when I get these episodes (which are constantly every day now) I tend to feel sick and refuse to eat.

I never feel full up after a meal which leads to snacking or having another meal after that. So if I don't have an episode of IBS I tend to have 4-5 meals a day.

My height is 5ft 3in

Sorry that you are having a very rough time. Sounds like CGMS or Freestyle Libre would be really helpful. Have you considered alternate site testing - some meters come with a shorter stabber to use on forearm - from what you have written above, I suspect that you and your team have already considered these, and that you have worked out that your BMI is about 20.

Sorry that you also have to cope with the IBS on top of the T1DM.

best wishes