Hi all. I could do with a bit of advice. For the past few weeks, most nights, my levels have been around 6-8 at bedtime. Around 1am they start to rise to around 11/12, stay at that until around 5-6am then start to drop. My waking levels are then back within normal range. There is nothing different happening before bed, my carb ratio doesn't seem to need altering. I mentioned it to my DSN and asked about changing the basal rate. She said not to atm as the morning levels are normal. Ok, i thought, i'll just monitor. Then twice this past week i've had an overnight hypo (which i've never had before!!) then last night, my bedtime level was 8.5, i woke at 5.30am to find that it was 15.4!! It had been a really sharp spike. I had a 2u correction then slept. Waking at 8.30am it had still only gone down to 10.5. Any ideas about the higher overnight levels? Its making me feel rubbish and tearful. I do have a few stresses atm but have been managing these. The fluctuating overnight levels just seem like an added stress.
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Any ideas?
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rebrascora
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Which basal insulin are you on and when do you take it?
If the spike is happening towards morning it is likely caused by Dawn Phenomenon. I am lucky that it doesn't kick in for me until I get out of bed and then I bolus 2 units for it as soon as I get up, but some people find kicks in much earlier for them, around dawn unsurprisingly, and that can be trickier to deal with, particularly at this time of year when dawn is so early.
The timing of your basal insulin can sometimes help to counteract this depending upon which one you use or perhaps a change of basal if the one you take can't be adapted to cover it, but I would be inclined to gather more data before taking any radical action.
What time did the hypos occur. Could they have been due to alcohol or increased activity the day before?
If the spike is happening towards morning it is likely caused by Dawn Phenomenon. I am lucky that it doesn't kick in for me until I get out of bed and then I bolus 2 units for it as soon as I get up, but some people find kicks in much earlier for them, around dawn unsurprisingly, and that can be trickier to deal with, particularly at this time of year when dawn is so early.
The timing of your basal insulin can sometimes help to counteract this depending upon which one you use or perhaps a change of basal if the one you take can't be adapted to cover it, but I would be inclined to gather more data before taking any radical action.
What time did the hypos occur. Could they have been due to alcohol or increased activity the day before?
I have 12u Tresiba usually between 10-11pm. I've not had a problem with it before, only the last 5-6 weeks and even then, not every night. The overnight hypos - one was around 3am and lasted until around 5am when i woke up, tested and treated (i did have an extra ((small)) glass of wine to what i would usually have the night before but had a snack and insulin to cover so i put the hypo down to that) but the second overnight hypo, i'd woke and scanned about 5am and it was in the 6s, woke at 6am and it had dropped sharply to 3.5. No idea on the possible cause of that one as i'd had no snack or alcohol the night before. I did wonder whether hormones play a part as i've had lots of night sweats lately...i'm at that age .
rebrascora
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Hormones certainly can play a part but the first hypo I would be inclined to put down to the extra wine. If you had a snack but then covered that snack with insulin, that was probably a mistake. The alcohol stops your liver from trickling out glucose during the night, so you would either reduce your basal insulin, if you were on something like Levemir which is shorter acting and will give you a more immediate effect than Tresiba or have the snack before bed without insulin to keep you high enough so that when the alcohol effect kicks in, you can afford to drop without going too low.
I seem to find that a certain level of alcohol or particular types of alcohol have little effect (like rum) but gin or wine seem to have a much greater affect on me through the night. I am on split dose Levemir so I can just take less Basal if I have had more than a small glass of wine, but I could have 3 rum and cokes and not see any effect, even with my full dose of Levemir.
Tresiba is a much longer acting basal insulin and doesn't allow for any real adjustment like that as it takes 3 days for any changes to make a difference, so can be more difficult to balance if you have a less regimented or more variable lifestyle, diet, drinking or exercise regime. If the problem continues, you might talk to your DSN about a possible change of basal. In the mean time stay safe and probably best to limit the alcohol and log everything food wise and exercise wise to give you a better idea of what might be responsible for significantly unexpected results.
I know a night time hypo can really knock your confidence, but hopefully it won't happen again for a long time and it sounds like you have Libre so you can at least see what is happening whilst you are sleeping and try to find a fix.
I seem to find that a certain level of alcohol or particular types of alcohol have little effect (like rum) but gin or wine seem to have a much greater affect on me through the night. I am on split dose Levemir so I can just take less Basal if I have had more than a small glass of wine, but I could have 3 rum and cokes and not see any effect, even with my full dose of Levemir.
Tresiba is a much longer acting basal insulin and doesn't allow for any real adjustment like that as it takes 3 days for any changes to make a difference, so can be more difficult to balance if you have a less regimented or more variable lifestyle, diet, drinking or exercise regime. If the problem continues, you might talk to your DSN about a possible change of basal. In the mean time stay safe and probably best to limit the alcohol and log everything food wise and exercise wise to give you a better idea of what might be responsible for significantly unexpected results.
I know a night time hypo can really knock your confidence, but hopefully it won't happen again for a long time and it sounds like you have Libre so you can at least see what is happening whilst you are sleeping and try to find a fix.
trophywench
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I'd talk to my DSN soon actually - cos the hormonal thing ain't going away in a hurry, and can last for ages - it's OK firefighting for a bit but if you have to do it for years it will be miserable.
You therefore need to plan a strategy between you.
Myself, I doubt if Tresiba is a really good thing for you at the moment, which is exactly why I want you to talk to your clinic sooner rather than later, bearing in mind it's normally them that have to ask the GP to change your prescription.
You therefore need to plan a strategy between you.
Myself, I doubt if Tresiba is a really good thing for you at the moment, which is exactly why I want you to talk to your clinic sooner rather than later, bearing in mind it's normally them that have to ask the GP to change your prescription.
I changed to Tresiba just before Christmas as Lantus wasn't working long enough. Since i stopped work in March i've had to increase it 3 times and change bolus ratio at lunchtime as activity levels changed. I've been back at work 2 days a week for the last two weeks and next week will be back to 5 days so no doubt insulin will need tweaking again. I'll ring my DSN next week and see what she says. I've not seen her since January and had to rely on a couple of phone calls, its hard to explain things over the phone when she hasn't got your levels in front of her. I use Librelink so will see if she can access it.
SB2015
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Most clinics have some way of downloading the Libre data, which makes conversations a lot easier as they can see what you are seeing.
Apologies if you have already answered this, but have you considered a pump. It does take a bit of work at the start but makes it a lot easier for you to match your background insulin to what you need hour by hour, and none of have a flat profile for the basal insulin you need.
Another thought is have you tried Levemir for your basal This can be split am and pm and enables you to adjust night dose without impacting on the daytime dose.
As others have said it is time for a discussion with your DSN. The change is unlikely to go away if it is hormonal, and will go on for a very long time so needs sorting to get a management plan for each month.
Apologies if you have already answered this, but have you considered a pump. It does take a bit of work at the start but makes it a lot easier for you to match your background insulin to what you need hour by hour, and none of have a flat profile for the basal insulin you need.
Another thought is have you tried Levemir for your basal This can be split am and pm and enables you to adjust night dose without impacting on the daytime dose.
As others have said it is time for a discussion with your DSN. The change is unlikely to go away if it is hormonal, and will go on for a very long time so needs sorting to get a management plan for each month.
I've not thought about a pump, no one has ever mentioned it. I really don't know anything about them tbh. I'll ring the DSN on Monday. I seem to get 2 or 3 days in a row when my levels are great and in target but if i have a high overnight it seems to fluctuate more the next day.
rebrascora
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I'm like that.... I can have 4 or 5 days when things are pretty good with most (finger prick) readings in range and then things go wrong and it seems to take me a few days to get back on track. I am certain that my problems stem from not having a set routine and even when I really try to have regular bedtimes or meal times or exercise routine I can't seem to maintain it long term or I get stressed about trying to stick to it. I spent a lot of years working rotating shifts which I think is part of the problem for me.
The LIbre is very new to me but really helping me to make better decisions and very much hoping I will see significant improvement in HbA1c as a result. It is looking very promising so far, but I think HRT is probably also helping, so that may be something to consider. It has certainly made a huge difference to my quality of life.... hard to believe a tiny clear patch changed every few days, can have that much of an impact but the effect is a revelation!
The LIbre is very new to me but really helping me to make better decisions and very much hoping I will see significant improvement in HbA1c as a result. It is looking very promising so far, but I think HRT is probably also helping, so that may be something to consider. It has certainly made a huge difference to my quality of life.... hard to believe a tiny clear patch changed every few days, can have that much of an impact but the effect is a revelation!
Nice to know i'm not alone in this. I've been really tearful all day which is what makes me think this could be hormonal. I've only had the Libre since February and am on a 6 month trial to see if i can have it on prescription. I really hope i can as i can't afford to self fund atm and its making a difference, great for work. I'm a teaching assistant and can't always leave the room to check. I can scan and get an idea of whats going on.
trophywench
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@rebrascora - Barbara dunno if you know this but important - don't 'wear' an HRT patch where bright/hot sunshine will be on it for longer than a few minutes any time because it renders them useless!
SB2015
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When I was teaching I had no qualms about testing in front of the students. It was a secondary school, but it just made them aware. They were better than me at picking up a hypo sometimes!!
Mine is primary, ks1. I sometimes take a class or step in to cover and its awkward to test, thats why its so much easier to scan. Well...bed last night (11 ish) was 7.8 with no wine or snack. By 1am it rose sharply to 13 and stayed there most of the night with a few small dips but then went back up. Started to come down around 7am and by 8am was 10. Not so high as the night before but there does seem to be the overnight pattern. I'm not having breakfast this morning so won't bolus and see what happens.
trophywench
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Brill Libre results overnight @freesia ! Why? - because it shows exactly why Tresiba is NBG for you. Levemir though probably would, cos it builds up to a peak over the first 4-ish hours so you'd do your jab at say 10pm, bed at 11pm, then the peak in the Levemir would match the peak in your BG. OK, you'd need another Levemir jab in the morning to then last you through the day - but one extra jab a day to gain better control isn't going to cause any grief when the 4 you're currently having doesn't work!
I don't mind how many jabs i need as long as i stay in target with reasonable levels. Its confusing though as pre lockdown all was ok, and even now i get up to 3 days where levels daily and overnight are good before everything goes haywire again.
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Ugh! I feel your pain @freesia
Really sorry that you are being given the runaround with your diabetes at the moment.
I have been having the opposite problem recently - where quite often I can be pottering along above range with (allegedly) enough IOB, but levels not descending... until I go to bed, and then after about an hour any remaining IOB sometimes, but not always, becomes supercharged.
So I face a delicate balancing act many evenings of trying to resist adding more insulin late on to tackle unshifting, or rising double-figures late on... because I fear a crash once I’ve nodded off!
Have you ever considered an insulin pump? Would that appeal? the basal flexibilty that a pump allows would certainly help you right now
Hi Mike. I've never given a pump a thought to be honest, i'm only just getting to grips with the big D after 2 years. Its good to know that i'm not the only one who has problems. Its a constant balancing act. After nights with high levels and days trying to bring them down i've today had the opposite..a 9 at breakfast which has steadily got lower through the day. Oh well...
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