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Safe Bedtime Reading

Paulaah

Paulaah

Well-Known Member
Messages
92
Hi all,

Apologies if I only ever seem to post when I need help, but being new to all this, I'm not confident enough to pitch in with my experience yet, as ......well, haven't really got that much!! :?

I've been doing ok until the last two weeks and now I'm really struggling. My DSN suggested changing my Lantus timing to 8.30am, as when I was taking it in the evening, it was running out and coinciding with my evening meal - making a double whammy spike.

Her theory is that if it runs out in the morning there will be less of a spike because it's on the back of a fasting period. I was also going too low in night (coinciding with the full strength Lantus profile at the 6 hr after injecting mark), and was therefore keen to try a change. I realise splitting Lantus might be an option further down the line, but wanted to try this first in order to keep to one injection rather than two if poss.

However, it's totally thrown me all about. Hypoing right left and centre morning noon and night.

At this stage, I've now sorted mornings, afternoons and into early evenings. And indeed, the running out effect in the morning is minimal, so from that point of view its helped.

But evening meals are causing me a problem.....

My ratio is 1:10g carb in evening. I've had a couple of low carb, low gi meals and totally crashed on a couple of occasions. I'm guessing because the Apidra is peaking before the carbs have been delivered into the bloodstream. This has really spooked me. I'm thinking the Lantus previously running out at this time might have been masking the true Apidra effect so I had a safety cushion.

Last night at the 2 hr after meal mark I was 5.9 and panicked, thinking I daren't go to bed with a 5 in the title. So I had an oatcake and at 2a.m. I was 9.3!!!! :? So frustrating after all my hard work in the day.

Other nights, I have taken a 2 hr reading and it was say 7.4 but done nothing and tested again before bed, it was 8.5 so risen.

On nights where I've gone to bed on a 7 or 8 where i feel "safe" and had no pre bed snack, my Lantus has held me at exactly the same level overnight.

I read Pneu's fascinating piece last night about Apidra absorption and that was very helpful. Especially because I though Apidra peaked at 2 hrs and Pneu says it's before, which is really relevant to my question......

I think what I'm asking is, after the say 2 hr to 3 hr mark, if I am about 5.8, am I safe to go to bed without the fear of a hypo overnight? Should it sort of stabilise at that stage if I'm going to sleep?

My aim is to go to bed on a better reading, in order to wake up on a lower reading, but without the risk of a hypo.

Hope someone can help. I would really appreciate a fresh pair of eyes. My husband and I are totally stumped.

Thanks

Paula
 
Morning Paula,

It's a little difficult to say because insulin works differently in us all... but from the manufactures guidelines Apridra is meant to be mainly active between 1 and 4 hours post injection, more info here: http://www.lantus.se/Global/Docs/DIABET ... gelska.pdf

Personally I have found that post 2 - hours it has very little effect but I also find that other insulins I take have a shorter duration than expected... you will need to do some testing on yourself to find out how the insulin effects you...

Reference going to bed at night! Well if I were unsure I would set my alarm and then do a test in the night just to make sure...

What I would suggest you do first however is ensure that your Lantus is working correctly... you do this by having fasting periods... so for instance you might skip breakfast one morning (don't inject any apidra) and then see if your reading every hour are stable.. next day you might then skip lunch and then check during the afternoon etc... and then finally skip dinner and check during the evening.. if all your readings are +/- 1 mmol/l from the average then your Lantus dose is correct... if you find your readings are increasing or decreasing at certain points of the day then you may want to adjust or split your dose...

Once you have got your Lantus right you then need to get your Apidra ratio's correct.. It's difficult to get correct ratio's if your background insulin is wrong as you will get skewed results.. again this can be done with counting the carbs in the meal injecting your normal amount of insulin and then checking results at + 1, 2, 3, 4 hours etc... if you go low adjust your dose down, if you go high adjust it up.. remember that eating a meal heavy in fats will delay the carb release so thats why you check over four hours.. Finally you will probably find that your ratio's are different with you needing more insulin in the morning compared to the afternoon / evening this is normal but its useful to know!
 
Paulaah said:
I think what I'm asking is, after the say 2 hr to 3 hr mark, if I am about 5.8, am I safe to go to bed without the fear of a hypo overnight? Should it sort of stabilise at that stage if I'm going to sleep?

My aim is to go to bed on a better reading, in order to wake up on a lower reading, but without the risk of a hypo.
Click to expand...

Pneu's advice is all excellent of course. The only other thing I'd add is: if I was in your situation and going to bed on 5.8, I would probably risk it BUT I would also be asking myself a couple of other questions: what kind of exercise had I done that day, and had I had a drink (alcoholic) that evening. I would also be taking into account how I felt - I am quite attune to the way I feel when my bg is on its way down, and I don't trust a blood test result by itself because it's just a snapshot. Blood test plus my knowledge of what I'd done that day plus how my body felt = decision about whether to eat an oatcake!
 
Another thing I may do if I am not sure is do two further tests at 15 mins and then 30 mins later... if your 5.8 mmol/l reading is stable then that's probably ok... if your still going down then you might want to wait a little bit and say test at +1 hour or set your alarm or eat your oat cake :)

Bedtime sugars are a bit of a hot topic and lots of people have opinions on what levels you should be at..
 
Hi Snodger and Pneu,

Thanks for your advice and your speedy replies....

I have done the fasting test in the morning and the afternoon, but not in the evening. Thinking about it, that's what I definitely need to do, because that's where the problem is! I will schedule that in over the next couple of days for sure.

Last night, I was 6.8 at 2 hrs, 6.2 at 2.5 hrs and 5.8 at 3 hrs. Sorry, I should have said that earlier as it makes such a difference. Do you think that's a steady drop and not a "runaway train" drop - That's what I call it when I can't stuff jelly babies in faster than I'm dropping.

Snodger - I definitely know what you mean about how I feel because i felt ok last night whereas other times I get blurred vision and dizziness because it's dropping too fast. It's just that I haven't got the confidence yet to not worry.

I had had a glass of wine too with my evening meal, but no more than that. But it was at the back of my mind which I think was the other reason why I opted for the evil oatcake!!!!

Will do some more testing - it's the only way. Even though I think my doctor might be alarmed about how many strips I'm getting through - but that's another topic!!!

Paula
 
Paula,

With those readings and my body I would have given myself a correction and then gone to bed!

However seeing as you appear to be more insulin sensitive and with perhaps a question mark over what your Lantus would be doing I would have probably done another test at +30 mins and then gone to bed if the reading had not been less than 5.4 mmol/l, less than that make a tiny bit of carb and then bed.

Its a really difficult thing to advise on when you don't know the individual?!
 
Thanks Pneu.

New plan for this evening if it happens again - I will sit it out if I don't feel weird and it's not dropping too much, and test a bit later to see if I'm ok to avoid the carbs. I don't like feeding the insulin in any event so I could have done without the oatcake.

I'm amazed you would have taken a correction, but you are obviously under such tight control and an expert at this.

Thanks again

Paula
 
Paulaah said:
Thanks Pneu.

New plan for this evening if it happens again - I will sit it out if I don't feel weird and it's not dropping too much, and test a bit later to see if I'm ok to avoid the carbs. I don't like feeding the insulin in any event so I could have done without the oatcake.

I'm amazed you would have taken a correction, but you are obviously under such tight control and an expert at this.

Thanks again

Paula
Click to expand...

I like to be under 5.5 mmol/l before bed 1 unit would have dropped me from 5.8mmol/l to around 4.6 mmol/l and I know that my background insulin is correct... other people would be shocked and horrified at correcting like that before bed...

Also working in my favour I have a 7 month old daughter who is normally up at least once or twice in the night and I always take the opportunity to test so I know my sugars are stable through the night..

It comes down to personal choice and I certainly do run very tight control.. but then I had 5 - 7 years of no control post diagnoses.. as in I didn't test, rarely injected, etc... I was generally young, stupid and in denial! I then suffered the consequences including a stay in hospital and a brush with the beyond... I had damage to my sight and nerves... I am happy to say that after now 5 years of tight control I had an eye test only five weeks ago where the Dr gave me the all clear... still some minor damage that can't be undone but a lot of the damage has been reversed and I now show no sign's of being 'diabetic' sight wise.. I also no longer suffer from aches / pains and only get the occasional bout of pins and needles.. for me the tight control is worth it and required to some extent due to my previous stupidity..
 
Hi paulaah,

If i had a 5.4 before bed i would have eated 1 biscuit because i am insulin sensitive and would have had a hypo at 5.4.

One of the ways you could track what you lantus is doing is by testing at about 3am for a couple of nights then you may have a better idea what to do. Logically your bs may be the same as when you went to bed or a couple of points up or down - eg 5.4 bed - 3am 6 or 5. Then you could judge if you would need a small bedtime snack.

Obviously it is a quesion of experiments to see what happens. :D :D :D

Hope it is helpful. Keep giving updates :) :)

J

Ps when my kids were little i tested when they had night feeds as well pneu x
 
The thing with Lantus / Levemir is that they don't always have a totally flat profile.. so as Josie suggests if you are very sensitive to insulin then at points when they are 'working harder' if your fasting level is to low you may find that it drops you into a hypo..

I found that with Levemir I could mitigate this somewhat by splitting my dose.. I went to two doses a day and then eventually to three! which really helped to flatten the profile.. at three doses a day however I thought I may as well go back to Insulatard which was always flat for me at two doses, and I needed a load less to get the same results..

Its really all about experimenting... and as with all experimenting information is key... test, test, test and test again for good measure! And remember best to err on the side of caution than have a hypo..

If you are really finding it difficult then you may want to discuss a pump with your HCP... you would have much more control over your basal insulin then... I would love a pump! but alas unless I am paying for it I can't see my HCP dishing one out!
 
Great advice - thanks. Am going on holiday tomorrow to Rhodes and I'm a bit nervous about it because it's all still up in the air and seems a bit more unpredictable than it was only a few weeks ago. (Honeymoon maybe playing a little bit of a part in that?)

We went on hol in May and my DSN warned me to be very careful with doses as she said the heat and the way they prepare food etc may cause lows. To my amazement it went the other way and I was battling to keep myself under 10 the whole time. It was the best I could do!!

I know it varies from person to person in the heat from reading the forum. So I'll have to wait and see what new challenges I will face for the next two weeks!

Paula
 
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