Night hypos advice please

[pippaandben]

Recently I have experienced night hypos about every 2-3 days. Waking up dripping with perspiration but not reaching the chest or finger trembling stage. The latter is usually if I am in the mid to high 2s. The sweating in mid 3s.
Can anyone remind me of the rule I seem to remember being given when first going onto insulin? If bedtime reading below 12 then half a biscuit for each half unit below to ensure against this.
I usually have fruit in the evening after my evening meal - half an orange (shared with OH!) and recently a couple of plums. These I don't inject for on the basis they are spread over 3-4 hours and thought my basal would mop up any carbs from them.

Could it be I need to do more basal testing for the evening basal dose ?Currently I take 12 units both am. and early evening. and have done so for about 18 months. My morning reading this morning was 5.7 - definitely low for me as usually 7-8 and this was after taking 4 glucose tablets at 3.15am

 

[everydayupsanddowns]

Hi Pippaandben

Not sure how this relates to T2 on insulin, but from a T1 perspective:

The rule of thumb I have heard (not sure where now!) is that *any* time you have a low BG overnight without an obvious cause (eg exercise earlier in the day, eating late/meal dose error, alcohol...) you should reduce your basal insulin by 10-20% the following day and monitor more closely.

If you are having low BG overnight that often it sounds to me like your basal is almost certainly over-reaching your current needs - which can change every few weeks/month.

The 5.7 as an early morning reading is fine, but research shows that a waking BG of less than 5.0 can also be a strong indicator of undetected overnight hypoglycaemia.

For us T1s, basal insulin is supposed to have nothing at all to do with carbs/meals. It is only supposed to deal with the trickle of glucose from the liver. So any significant amount of carbs in the evening (10g or more for me) would need extra rapid insulin, unless I thought I had made an error with my meal calculation/dose.

Hope you get some ideas from insulin using T2s and fix those lows. They must be making you feel grim and won't be doing your warning signs any favours.

 

[DaveB]

Hi Pippaandben

Not sure how this relates to T2 on insulin, but from a T1 perspective:

The rule of thumb I have heard (not sure where now!) is that *any* time you have a low BG overnight without an obvious cause (eg exercise earlier in the day, eating late/meal dose error, alcohol...) you should reduce your basal insulin by 10-20% the following day and monitor more closely.

If you are having low BG overnight that often it sounds to me like your basal is almost certainly over-reaching your current needs - which can change every few weeks/month.

The 5.7 as an early morning reading is fine, but research shows that a waking BG of less than 5.0 can also be a strong indicator of undetected overnight hypoglycaemia.

For us T1s, basal insulin is supposed to have nothing at all to do with carbs/meals. It is only supposed to deal with the trickle of glucose from the liver. So any significant amount of carbs in the evening (10g or more for me) would need extra rapid insulin, unless I thought I had made an error with my meal calculation/dose.

Hope you get some ideas from insulin using T2s and fix those lows. They must be making you feel grim and won't be doing your warning signs any favours.

I agree with this. It does sound like the Basal is a bit high but not sure if the poster is also using a Bolus insulin? As a LADA, I wouldn't worry about a bedtime bit of carb with a BS of 12 in fact I might even do a small Bolus shot which again implies the Basal is a bit high.

 

[pippaandben]

Thanks Mike. I reduced my evening basal to 11 instead of 12 - but then forgot to bring my meter to bed so did not do a night reading!! Blame being very tired from several hours of gardening during which I tested a couple of times but didn't need any corrections or glucose surprisingly. Previous years it has been mowing 2 strips across the lawn - empty grass box - have a jelly baby and repeat. However no hypo and 8 this morning!! Why can't the diabetes fairy play fair and let you know why things happen - or don't! Dave - I am also on bolus of 1 unit for 9 gms carbs with a correction dose of 0.5 for each glucose reading unit.

 

[Northerner]

Thanks Mike. I reduced my evening basal to 11 instead of 12 - but then forgot to bring my meter to bed so did not do a night reading!! Blame being very tired from several hours of gardening during which I tested a couple of times but didn't need any corrections or glucose surprisingly. Previous years it has been mowing 2 strips across the lawn - empty grass box - have a jelly baby and repeat. However no hypo and 8 this morning!! Why can't the diabetes fairy play fair and let you know why things happen - or don't! Dave - I am also on bolus of 1 unit for 9 gms carbs with a correction dose of 0.5 for each glucose reading unit.

I hope that the reduction in basal helps things settle. I have two meters, so always keep one by my bed 🙂

 

[Redkite]

If you've been doing a lot of gardening recently, it's quite likely that this is the culprit for your night hypos (exercise earlier in the day can lead to lows hours later, as your muscles are replenishing their glucose stores when you are sleeping/resting). Perhaps have a bedtime milky drink on days when you've had a heavy gardening schedule?