Nocturnal Hypo's

[Phil65]

Grainger, I hope you find an answer.....maybe this thread might have added to the confusion, to me though this thread has been fascinating reading......and very passionate......love it!
I have to say though that I do agree with a lot of what Deux has said, I definitely suffer from the somogyi effect, I've had cgm and this supported this, also DP has always been a big problem for me. The pump has really helped me and those problems could not really have been alleviated with MDI (unless lots of work and lots of corrections)

 

[everydayupsanddowns]

What I find most interesting is that the posters who are most convinced that hypo rebounds (let's not use the S word) don't happen in the D they know best - their own or their child's are the ones with most access to CGM data.

I have never had the benefit of CGM, but I have had seemingly random highs after a hypo that bear no relation to food I have consumed, or active insulin levels. When I learned about the possibility of a 'liver dump' post-hypo, it was easy for me to put these two things together and draw a conclusion.

This thread makes me wonder if perhaps Alison (for example) believed in post-hypo-liver-dump-highs before she secured CGM and was able to watch that graph line *not* reacting enough times after a hypo to convince her that any unexpected post-hypo highs must be being caused by something else.

If post hypo-counterregulatory-hormone-highs don't exist I shall really miss them, as they have provided a valuable safe haven for many frustrations over the years.

Still confuses my though why generally basal testing is supposed not to be done after a hypo... From Gary Scheiner's 2008 basal testing sticky in the pumping section...

Your liver should be producing its ?normal? amount of glucose
Do not run the test if you have had a low blood sugar within the previous 4 hours; hypoglycemic episodes tend to result in over-secretion of glucose by the liver.

http://diatribe.us/issues/13/learning-curve

Is it just that this advice is old? Has he changed his postion?

TBH it would make my life much easier if I felt I could basal test even after a 3.7 during the day as when my basals are out it can be very frustrating having to wait for a valid opportunity!

 

[Phil65]

What I find most interesting is that the posters who are most convinced that hypo rebounds (let's not use the S word) don't happen in the D they know best - their own or their child's are the ones with most access to CGM data.

I have never had the benefit of CGM, but I have had seemingly random highs after a hypo that bear no relation to food I have consumed, or active insulin levels. When I learned about the possibility of a 'liver dump' post-hypo, it was easy for me to put these two things together and draw a conclusion.

This thread makes me wonder if perhaps Alison (for example) believed in post-hypo-liver-dump-highs before she secured CGM and was able to watch that graph line *not* reacting enough times after a hypo to convince her that any unexpected post-hypo highs must be being caused by something else.

If post hypo-counterregulatory-hormone-highs don't exist I shall really miss them, as they have provided a valuable safe haven for many frustrations over the years.

Still confuses my though why generally basal testing is supposed not to be done after a hypo... From Gary Scheiner's 2008 basal testing sticky in the pumping section...



http://diatribe.us/issues/13/learning-curve

Is it just that this advice is old? Has he changed his postion?

TBH it would make my life much easier if I felt I could basal test even after a 3.7 during the day as when my basals are out it can be very frustrating having to wait for a valid opportunity!

.....and so irritating that you have to abort your basal testing, especially when the testing period hasn't long to run! I do wonder why my liver does dump during the night and doesn't during the day as a result of a hypo, is it because my nightime hypo goes on for longer without self correction?

 

[HelenM]

This thread makes me wonder if perhaps Alison (for example) believed in post-hypo-liver-dump-highs before she secured CGM and was able to watch that graph line *not* reacting enough times after a hypo to convince her that any unexpected post-hypo highs must be being caused by something else.

If post hypo-counterregulatory-hormone-highs don't exist I shall really miss them, as they have provided a valuable safe haven for many frustrations over the years.

I've never had morning highs that I can relate to overnight lows. If I have a high the next morning I can usually relate it to later meals the night before, particularly high fat meals.

I used to go to bed with a 'normal' level (maybe in the 5s) and woke up at a similar level but I sometimes woke during the night with hypo symptoms When I tested though I wasn't low. I wasn't certain whether it was my age ie menopause related or if I really was going low.
I was able to borrow a CGM . It was very interesting, I was woken by the alarm and my glucose was low according to the monitor but when I tested my glucose was 6 -7. I then watched the monitor show the level rising again . Remember there is a time lag on the monitor.
My glucose levels were falling to hypo levels, presumably my liver intervened and released some glucose but not enough to cause a high next morning. On a couple of nights this happened more than once. My liver was compensating but not over compensating and it was doing it quickly (certainly doesn't work that fast during the day). The rest of the night my glucose levels were almost a flat line.

After discussing this with my doctor I agreed (somewhat reluctantly) to reduce my bolus for my evening meal and go to bed with a slightly higher level rather than trying to adjust the basal overnight. She was concerned that though my liver was doing what it should do that it might not continue to do so. I believe that there is evidence that the glucagon response diminishes both when there are a lot of hypos and also when people have had diabetes for a number of years.
It worked and when I used the CGM again achieved a very gradual slope towards the morning.

(as long as I didn't eat high fat, late meal . Then BG starts to rise in the early hours. That only started when I stopped running so many miles a week. I suspect I no longer had to 'fill up' my glycogen stores. I found out that was happening after a later session with a cgm)

 

[AlisonF]

This thread makes me wonder if perhaps Alison (for example) believed in post-hypo-liver-dump-highs before she secured CGM and was able to watch that graph line *not* reacting enough times after a hypo to convince her that any unexpected post-hypo highs must be being caused by something else.

Spot on Mike, I always believed in it, but after using the CGM I've never seen the evidence that they exist in me.

 

[Abi]

Generally if I'm high after being hypo- or suspected hypo and not tested, been asleep etc- it's either overtreatment of hypo or ignoring symptoms for too long so that Mr Liver decides to intervene, or me and Mr Liver intervening together- so we both raise levels by a few points-need to communicate more with each other!

 

[pgcity]

My theory for what it is worth is that post hypo highs are caused by either over correcting or by the release of adrenalin and that is why you shouldn't basal test after one. I am surprised there is no evidence showing the somogyi exists but I have only read the wiki page.

 

[grainger]

I'm back - sorry for delay in replying

Hi all,

Apologies for silence, manic few days as usual.... very interesting read though! Not convinced I have a clue what's going on with me... so... I'll take some advice... post my bs levels, food, exercise levels etc and you guys can draw some conclusions.

Will say this... I cannot and will not test every hour throughout the night, I start work at 7.30am, am up at 6 and need to be able to concentrate. I'm also rubbish at not letting life get in the way so there are nights this week I've had a drink (or several etc) which I realise will not make working anything out easy...So I apologise in advance. I plan to have a sensible week until Friday when I fly to Thailand so hopefully I'll be able to give better readings then.

Should also mention, my sugar levels through the day are good - generally between 4.5-6 before lunch and maybe slightly higher 5-8 before dinner. Finally, I test in the morning after I've showered etc before drying hair (just incase you were interested!)

OK...
4th Feb
Dinner 19:45 BS 5.4
Home made Lasagne, garlic bread and homemade smoothie (strawberry, raspberry and banana).
CPs = 9. Novorapid = 9
Bed 22:31 BS 5
Ate 1xCP (digestive biscuit 10.1g) and didn't inject for it.
Levemir = 9Units

5th Feb
Waking BS 6:15 = 18.3
Workout before dinner - 30 mins intensive circuit type training
Dinner 18:30 BS = 8
Pasta with homemade mint pea pesto, smoothie (this time blueberry and banana)
CPs = 6.5. Novorapid = 4.5
Bed 22:16 BS = 8.4
Levemir = 9Units

6th Feb
Waking 6:20 BS = 13.2
Hypo at 13:47
Workout before dinner - 30 mins intensive circuit type training
Dinner 19:30 BS = 11.6 (figure I over ate after hypo)
Homemade fish curry with rice and green beans
CPs = 6. Novorapid = 6
Bed 23:05 BS = 10.4
Levemir = REDUCED TO 7.

7th Feb
Waking 6:19 BS = 7.8
Hypo before dinner (one of those things) at 18.57
Out for dinner 19:05 BS = 4.2
Pasta with tomatoes, various other veg type sauce. 1/2 bottle of red wine
Then another large glass of red wine.
Bed 00:05 BS 18.5 (I forgot to inject for dinner all together - no concentration after hypo!)
Levemir = 7


8th Feb
Waking 6.20 BS = 17.4
Workout before dinner - 30 mins intensive circuit type training
Hypo at 20:15 (ops)
Dinner 20:30 BS = 4.5
Thai takeaway (starters, then shared a red thai curry with rice), 1/2 bottle of prosecco.
CPs = 10 Novorapid = 10
Bed 00:36 BS 10.4
Levemir = 7

9th Feb
3.00am - hypo
Waking 9:33 BS = 13.3
Dinner 18:22 BS = 7.4
homemade cottage pie + veg, 1/2 crispy creme doughnut
CPs = 4 Novorapid = 4
Bed 23:50 BS 14.4 (completely underestimated dinner!)
Levemir = 7

10th Feb
Waking 9:10 BS = 8.3
Dinner 19:55 BS = 6.9
Chicken baguette, pork pie.
CPs = 8 Novorapid = 8
Bed 22:22 BS 6.6
Levemir = 7

11th Feb
Waking 6:24 BS = 15.7

So there you have it - to me it still doesn't make any sense. Although the days I wake up really high I wake up very sweaty and tired.

What do you think??? Sorry for the essay!

Hannah

 

[grainger]

Should also add, I massively summarise my conversations with consultants - we do go through a lot!
And he has said if we can't solve it the way I'm trying to now they have no issues with me having CGM for a week to see.

 

[fencesitter]

Glad it was a home made lasagne 😱

 

[fencesitter]

Sorry for flippant remark ... I do feel for you, very hard to see what's going on there. You have had a few better mornings with the reduced Levemir dose, but was it like that on the higher dose too (ie some good and some not so good)? I wouldn't have thought every hour was necessary for night time testing, maybe just once a night to see if you can find out when the rise starts, but easy for me to say that when I don't have to get up at 6am. As you say the wine might have interfered a bit too so perhaps you should do a really squeaky clean week of testing weighing all your food to make sure the carbs are really accurate, avoiding the booze and so on. Something to look forward to after your holiday 🙄