What are people's BG levels before bed?

[Age_wills]

Hi there,
I've posted on here before about going low during the night - I was just wondering how people set themselves up for the night? More specifically people on lantus or levemir? Am I right in thinking that lantus/levemir will bring down the BG level by approx 1 unit every hour?
I currently use 18 units of levemir at 6pm but am finding that I'm waking up with high BG levels which suggest I've been crashing during the night and my body has been bringing the levels back up but too much.
E.g. - Level before bed - 8.8
Level first thing in the morning - 16

I've checked my overnight levels before - they seem to be ok - the mid-night levels are around 6 so it seems like it is going too low overnight and I'm not waking up.

What sort of levels do people usually go to bed on?

Thanks,
Adrian

 

[phoenix]

Am I right in thinking that lantus/levemir will bring down the BG level by approx 1 unit every hour?

no, its purpose is not to lower bloodglucose levels but to keep them stable ie to prevent glucose released between meals causing your levels to rise. A perfectly matched basal to needs results in no rise or fall overnight.
When I was on lantus (I now pump) I was very lucky and able to have a fairly low target at bedtime of around 5 and wake up between 4.5 and 5 .5, unless I'd had a fatty meal the night before when I might see a rise later, or if I had done a large amount of exercise when I might have a hypo during the night (so had to eat before sleeping)

Other people have far more variable blood glucose levels overnight.... some fall dramatically during the early hours,(which may result in a rebound high) but others rise towards Dawn, some have a slight fall followed by a slight rise To find your pattern, test during the night at different times and different days to find out whats happening .

 

[NickW]

Hi Adrian,

What do you mean about Lantus / Levemir bringing BG down by 1 unit an hour?

The idea of these background insulins is to keep your BG stable - the ideal is that, if you don't eat any food, your blood sugar stays perfectly flat throughout the day. Your quick acting insulin should then cover your food.

If you're waking with high BG's, it could mean you're going hypo in the night; or it could just be that your blood glucose is rising! It's dangerous to assume night-time hypos are the cause without any other evidence.

On the nights where you've checked your overnight bloods and they've been OK (i.e. the 6's you talk about), have your morning bloods still been high? If so, this implies that you're not going hypo and your BG is simply rising in the early morning, either because of dawn phenomenon or because your background insulin is insufficient. You might need to look at both the timing and the size of your background dose to cater for this (many people split their lantus / levemir doses into two injections to give better control).

To answer your question, I personally aim for a blood around 5 to 6.5 before bed and the same when I wake, but also aim for the blood to be "stable" (i.e. not rising or falling quickly) for the couple of hours before bed by trying not to eat within about 3 hours of bed time. That's what works for me, I'm sure others use different targets.

 

[howie]

these guys have said what to do really, personally getting ya basal right is the most integral part of good T1 control. you could try putting of a meal for a while and check if your bg rises or falls to give you an indication but i think checking during the night a few times is da best way.

i'm pretty confident with my basal dose so on a normal night i go to sleep between 4.5 - 5.5 and wake up pretty much the same. if i've been exercising intensely in recent hours then 5-6 and when drunk i aim for about 6 and usually take my levimer down by a unit or two.

all best,
howie

 

[Age_wills]

Hi all,

Thanks for responses, I think like you all say, I'll do some more overnight checks to see if it's actually dropping too low or whether its rising. Also, the delaying a meal idea to see whats happening with regards to my basal is a good idea, will try that to get an idea of how to set my basal amount.
It's frsutrating waking up with a very high bg, as it tends to mess up the rest of my morning levels as I'm having to use extra novo rapid to bring it down. When I wake up at 4 or 5 I tend to find the rest of the day is much easier to control.
Thanks again for the advice.

 

[lilibet]

I think personal goals/experiences are v different despite general observations on insulin types

On premix I could go to bed at 5.5 any time after 11pm and be ok, waking up the same ish

Just started b/b and go to bed and wake up within one mmol. Last night to this morning I was a bit lower, by 2mmol (but still ok) . My novorapid doesnt bring it down too much and seems to be quite flat in profile to the four hour point and although meant to be out my system, will work another tiny bit after the four hour point

So quite good for working out if im ok to go to bed, and so far so good (ie safe(

Interestingly though, because on premix your fbg and injectin/brekkie are all at the same time, I didnt apprehend any Dawn Phenomenon but now I have seem myself jump from 6.3 to 7.8 in 20 mins so I need to eat to get some insulin in before the Levemir kicks in, or take some novo without eating but im such small doses its prob not safe to do that yet

 

[moonstone]

I'm on DAFNE right now, and that's a classic scenario to manage. Do a test at 3am, because that is when the hypo traditionally hits (you said it was 6 at midnight, I think). You can then confirm the dawn phenomenon. You should exclude other reasons first, eg a correction dose or meal close to bedtime, and then as long as you're sure it's your basal night dose you need to bring it down the very next night. You bring basal down by 10-20% at a time - 10% if you're taking less, 20% if you're taking more, therefore you should take yours down by 20%. Repeat your 3am tests until you've got it right. Exactly as you say, a high BG in the morning leads to poorer control throughout the day.

You should do each drop of basal insulin for 48hrs each, so do 2 days at 20% less, test at 3am for 2 days, drop it 20% again for 2 days if necessary, etc. So that you can see a definite pattern. Remember if you're hypoing in the night due to your quick acting insulin still working whilst asleep, then that's something to focus on too. This is because you'd still have a liver dump and it would be due to that rather than the dawn phenomenon. To confirm that, make sure you have your last shot 4hrs or more before bed, then test at 3am, so that you can reasonably exclude it and make sure it's the basal at work.

Good luck. Can you get on a DAFNE course anywhere near you?

 

[Age_wills]

Hi again,

This is all great advice. I'd been told that novorapid lasts for around 3 hours, so I've always had this firgure in my head when thinking ''my novorapid should be out of my system by now''.
I will try eating earlier in the evening and leaving it 4 hours to see if my levels stabilise - if they do then I know I can go to sleep knowing that I'm not going to drop too low in the night, and that my lantus will keep my ticking over nicely till morning (and do any doseage adjustments if necessary.
I guess I'll just have to be tired for a few more days and do some more 3am testing! At least then I'll know whether i'm having a liver dump (never even heard of this term before coming on this forum!) during the night or not.
I'm trying to get on DAFNE - but according to the website you can only go on it if the place where you have your diabetes review is signed up to the scheme? Can anyone confirm this? I was diagnosed whilst at University in Nottingham, so would have been eligable to get on a course at Notts hospital, but now living in London, and none of the London DAFNE centres listed on their website are anywhere near me really - closest is probably Chelsea & Westminister - which I'm guessing only accept people who live there - I wish!
Am seeing a diabetic nurse next Friday, so I'll talk to them about it.
Thanks again for all the help

 

[fergus]

Great advice from everyone so far.
Good luck with the fine-tuning and keep us posted.

fergus

 

[LittleSue]

From what I was told, indeed you can only do DAFNE if you're under the care of the hospital running the course. Two reasons: 1) they probably have a queue of their own patients waiting for DAFNE so potentially unfair to take people from other hospitals/GPs. 2) if your care team don't understand your regime, they'll get huffy if you start having snacks only some days, delaying/skipping meals, eating what you like, correcting highs immediately rather than observing for 3 days first. More dangerous, they may label you a liar or 'non-compliant with treatment' and dismiss any problems as due to this (i.e. your own fault). In comparison, DAFNE-trained staff will respect that you know what you're doing and if you're struggling you've already tried the obvious fixes.

Under the new NHS Patient Choice system you are entitled to choose your hospital and should not be refused an appointment simply because of your address. I work in a Manchester hospital and we have patients coming from as far as Somerset to see experts in their specific condition. So Chelsea should be fine if you're willing & able to get there.

I generally aim to go to bed with bs between 5 and 6. Despite routinely being at this or lower during the day (so my body's used to this level), I find if I go to bed 5 or less, I wake every half hour or so even if bs hardly moves all night. Yet I can sleep through hypos. Maybe I'm just weird :lol:

 

[jopar]

I'm not 100% sure how they work there area in London at all so I might be a bit of the mark on this..

I know that in my PCT area, that DAFNE is offered by my hospital, but the some of the people who attend DAFNE actualy come from other hospital clinics from within our PCT... What I would do is phone one or even a couple of the DAFNE providing clinics, and ask if you would be able to attend...I would also ask your own clinic to see if they do there own carb counting course similar to DAFNE!

There are a couple of other symptons that might suggest that you've had a night-time hypo, if your BG are raised in the morning and you feel like you have an hang-over but haven't been drinking is one of them. In the days when I used to suffer from night-time hypos that I slept through, I would wake up in the morning and wouldn't be able to see probably, it would be like trying to look through very dark, thick netting is the only way I could describe it...

If you are suffering DP, then you don't get this effect, just raising of the BG's and it tends to build into the same pattern of raise ona daily bases... As in doesn't matter what your starting BG is, but if you monitored over the morning (not eating) you would get a reasonable constant raise of xxx amount of mmol/ls give or take a couple...