Type 1 Random highs at 3am!

[iliveinessex]

Hi!

I can’t find this problem on here anywhere else but I may have missed it so apologies if this is discussed somewhere else but it’s something that’s really bugging me.

I’m type 1, have been for 12 ish years. Been changed from Tresiba to Lantus due to the shortage of Tresiba last year and it’s awful.
I take it in the evening, 12 units, my blood sugar drops within an hour, to usually a level which means I have to eat quite a lot of sweets to bring it back. I then go to bed a few hours later, it’s all fine until about 3am usually then it goes high in a very short space of time. This morning I woke up on 19.8, went to bed at 5.7. Obviously not secretly eating during the night, I don’t know what’s happening. Thought about taking my Lantus a bit later as maybe it’s running out but then I’d go dangerously low during the night. Not sure what’s happening, can’t get an appt with diabetes clinic at the moment so any help would be appreciated!


Thanks

 

[jaywak]

I also had this and it was probably happening for years , I have only now noticed it in the last 9 months because of the Libre cgm , I used to wake in the morning with an elevated bg and give myself a bigger bolus to get it down and then spending the morning fighting off hypos , I then saw it was rising at like you say at about 3 am and guessed it was probably the start of the dawn phenomenon or my Basel was running out as I give my Basel when I wake , I then tried giving my Basel before bed and give myself more to no avail if anything it made it worse , I then went back to my morning basel , I had a word with my consultant himself a type 1 and he said why not do what he did and set my Libre alarm to a high of 8 and if it goes off during the night give myself 1 unit of bolus and see if it works , well it has it was a pain in the beginning waking me sometimes 3 times a night , it's been a few weeks now and I have now set the Libre alarm to 9 and very rarely get woken and the dawn phenomenon has all but gone , it's almost like I've taught my body that I don't need this liver dump first thing in the morning , maybe something to think about it worked for me .

 

[EllieM]

OK, I'm not a lantus fan, have had a couple of lantus lows.... (if you inject into a blood vessel it acts fast instead of low)

But I unilaterally converted to splitting the dose so I inject twice a day and it works much better (for me) now.

Having said that my consultant has just offered me a pump so maybe it isn't that good...

 

[iliveinessex]

Yeah I had suspicions that it’s to do with the Lantus as it’s only happened to me recently since being on that (fingers crossed Tresiba comes back soon) so may try splitting the dose. Hadn’t heard of dawn phenomenon so will give me something to google

Will also set an alarm, I’m starting to get PTSD from those libre alarms going off at crazy hours .

Thankyou both for the advice

 

[Antje77]

(fingers crossed Tresiba comes back soon)

As far as I know, it's only the prefilled U100 pens there is a shortage of.
There is no shortage of U200 prefilled pens or cartridges to use with a Novopen.

If you did much better on Tresiba, you might want to ask to be switched back to it and use a reusable pen.

 

[Jasmin2000]

@iliveinessex - you're not alone by a long shot.
There are several things in play here but these are my observations and you will need to work out what works for you.

1. going to bed reduces stress and your BG can drop by 1-2 mmol/L in the first 30 min, so be ready for that and have an appropriate snack before bed.
2. depending on when you take your Lantus, your BG will fall, so I take it as I go to bed knowing it won't be active in the first 30 min.
3. my nighttime Lantus (10 units) kicks in 60=90 minutes later, so I make sure my BG is about 5.5-6.0 before going to sleep.
4. As @jaywak noted, the dawn phenomenon kicks in about 3-4 am and there are ways to control this
(i) insulin pump
(ii) getting up and taking a couple of units of fast-acting insulin
(iii) my preference, getting on my exercise bike and burning 500kcal in 30 min
(iv) let it happen and do (ii)/(iii) when you get up (which is where most of us were before CGMs!)

Something I've observed is that the dawn phenomenon produces insulin resistance, and I needed more fast-acting than normal. I used 6-8 units before with no effect (!) and a risk of hypo later, and now I prefer the exercise bike. Increasing Lantus won't drive down the dawn phenomenon without causing a hypo risk at some point.

 

[becca59]

Get the doctor to prescribe a pen that you can put the cartridges into. There is no shortage of these and the person changing it to Lantus should have known this. Not acceptable in my opinion and an absolute pain to have ended up causing you so many issues.
The advantage is the pen is reusable, has half units, and if you can get the up to date one it will scan into your Libre app. A win win!

 

[agwagw]

Definitely protest and get back onto Tresiba if at all possible. I used to be on Lantus and had various unexplained hypos now and again (I hadn't heard of the dangers of injecting into small blood vessels at the time). Finally, the whole daily dose must have gone into blood (or lymph) and the resulting hypo almost saw me hospitalised. Fortunately went onto Tresiba and it has been great (not chemically possible for the Lantus blood vessel phenomenon to occur).