4am dip

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Colm

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Type 1
Hi all, I just started using CGM for the first time about 5 weeks ago, Dexcom G7, its fantastic for showing me, or highlighting where I have been going wrong all these years... I used to take 20 units of Lantus at about 10.30pm each night, and typically I would take 6, 6, and 12 units of nova rapid for meals. the CGM is highlighting me going low every night / sleep for the first week I had it.
I have reduced my Lantus down to 16 now, but found I need to take more Nova Rapid as a result, but to be honest, I don't think I was ever taking enough to begin with.
So, now I am "fine tuning" things, on my 16 Lantus I seem to be holding steady enough, but I am finding a dip down to 4mmol about 4am,
It stats slowly dipping from 1am, then it comes back up on its own to 5.5 or 6 by the time I get up at 7.30am.
I am 72 Kgs, according to the Lantus website I should be on 14 units for my weight
what should I do about the dip? reduce Lantus another one unit maybe?

Thanks for any advice
Colm.
 
Night time dips can be from lack of fluid on the sensor either because you’ve not drunk enough fluids or because you’re lying in such a way that it means less fluid gets to it (sometimes lying on the sensor, sometimes lying with that arm in the air can cause it). If you can confirm with a finger prick you’ll have more of an idea if it’s a true dip or fluid issues which will help you decide on what to do from there. And yes if you drop your basal you tend to need to put your bolus up.

Sensors are great in helping spot trends. I’m glad you’re getting on well with it.
 
What levels do you have when you go to bed?
If you check with finger pricks as @Thebearcametoo mentioned you may find it better to have a small snack before going to bed rather than relying on basal.
The limitation of injected basal is that it assumes the same level 24 (or 12) hours whereas our body's requirement is not that stable.
 
I certainly recognise the night time dip, and discovered it when I first started using a Libre. My overnight graph looks like a slack washing line. Increasing basal makes me plummet faster in the first part of the night, then tail off in a flat line. Decreasing basal keeps me steady in the first part of the night, and then I have a huge rise from 4am. This has nothing to do with dehydration and compression of the sensor, I've double checked with fingerprick tests often enough, and the fact that the graph shifts one way or another depending on how much basal I take is more evidence.
During the night, the body shuts down, with less cortisol and adrenaline being produced, so the liver pumps out less glucose, and then it ramps up from 4am to gear you up for the day, (a relic of when we had to go out hunting wooly mammoths for breakfast).

I couldn’t get Lantus to work for me. The first thing I did was swap to Levemir as a basal, and take it twice a day, That way I can take a larger dose in the morning, to keep me steady during the day, and a smaller dose at night, to stop the plummet into the red. The other thing I did was to take a couple of units of Novorapid first thing in the morning, on top of whatever I need for breakfast, which copes with the dawn rise.
The only time I don’t get the dawn rise is if I've had alcohol the night before.
My clinic accepts that it works for me, so I carry on. The other solution would be a pump, where you can vary the amount of basal going in.
 
My situation is almost identical to @Robin's above and I follow the same strategies. The main difference for me is that I have a huge difference between waking and sleeping needs and I normally need about 20units of Levemir in the morning but just about 5 at night.
At the moment I am not needing any evening Levemir and still hypoing during the night because I am doing a lot of daily exercise, although I cracked that last night by pushing my levels up to 12 before bed with unbolused carbs and caught it at 4.2 this morning at 6am just as it was attempting to drop into the red. a JB soon fixed that.
The great thing about Levemir is that you can adjust it on a day by day or night by night basis and you get real time results so you can match it more closely to what your body needs. Even adjusting the time you take it, so that you get a bit of overlap of doses when you need it most and a gap where you need it less. So I take my morning dose at 7am but my evening dose at bedtime which is usually about 11pm or midnight. That way the small evening dose has an overlap with the morning dose to counteract Foot on the Floor syndrome which causes my levels to otherwise skyrocket when I get out of bed. I have also used a couple of extra units of bolus insulin to tackle it as @Robin describes.

I would highly recommend a switch to Levemir. I absolutely love it for how flexible it is and how I can match it to my needs.....most of the time 🙄 anyway.
 
Another vote for Levemir over Lantus. I had a 3AM dip with Lantus and struggled to find a safe level before bed that wouldn't lead to a hypo.
Split dose Levemir is a big improvement for me.
 
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The human body's natural lowest BG has always occurred at approx 2 to 4 am - it was long referred to by medical students on rotation in teaching hospitals as 'the suicide hour' in A&E for that very reason. My second husband in his younger days worked as a night shift foreman (10pm to 6am) on the line at the Jag for several years and confirms that the whole line got the munchies at around that time - and if you speak to anyone on nights anywhere to this day they all say the same.

It's primeval.

We're stuck with it!
 
Thanks a million guys for all your help...Levemir sounds like its worth a go...only thing putting me off is, its another injection...another jab to remember. Is it similar doses to begin with, like 20 of lantus = 10 + 10 of Levemir? then i presume fine tuning after that.

Thanks again.
C.
 
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