Advice with night time hypos

[chezpez]

Hi , I'm on lantus which I take in the morning 13 units. My bloods are under 10 through day . I'm quite active late afternoon, so for tea i ratio 1-14 which allows me to go to bed on level l2-13, but I drop about 6-7 mmol through night . 1 unit would drop me 5 . I hate I'm in the teens just so I can have a decent sleep without a hypo. I'm trying to lose a little weight and don't wanna eat before bed.
Do you think a change of insulin or shall I split lantus?
Many thanks

 

[Inka]

What time you do you eat your tea @chezpez ? Have you tried reducing your Lantus to see if that helps? Have you done a basal test during the day? It could be you’re just taking too much Lantus. If reducing it doesn’t work, you might need a shorter acting twice daily insulin like Levemir or one of the isophanes.

 

[chezpez]

What time you do you eat your tea @chezpez ? Have you tried reducing your Lantus to see if that helps? Have you done a basal test during the day? It could be you’re just taking too much Lantus. If reducing it doesn’t work, you might need a shorter acting twice daily insulin like Levemir or one of the isophanes.

Hiya, I eat about 5.30pm.
I've not done basal test in day. Because I'm always active in the afternoon so would that not give a false test result?
Also I'm 49 yrs old at at that special age, so I'm insulin resistance too. So didn't want to reduce lantus too much

 

[Inka]

No, a basal test wouldn’t give a false result if that’s your normal routine. I asked about a basal test because I’m wondering whether your Lantus is just too much. You say you’re always under 10 during the day but maybe that’s too much basal. It would be good to rule that out (if it was too much, you might need to then look at your meal ratios).

It could just be the exercise causing your nighttime drop. In which case, a twice daily basal would be better. You might also like to know that Levemir was associated with less weight gain than Levemir. Being able to take as little basal at night as you need would make things a lot easier.

 

[Inka]

Just seen your ‘special age’ comment. It doesn’t sound like you’re particularly insulin resistant. You’re not on large doses of insulin. Perhaps you just need the flexibility of a twice daily basal? You could then take as much or as little as you needed for the day and then the night.

 

[chezpez]

No, a basal test wouldn’t give a false result if that’s your normal routine. I asked about a basal test because I’m wondering whether your Lantus is just too much. You say you’re always under 10 during the day but maybe that’s too much basal. It would be good to rule that out (if it was too much, you might need to then look at your meal ratios).

It could just be the exercise causing your nighttime drop. In which case, a twice daily basal would be better. You might also like to know that Levemir was associated with less weight gain than Levemir. Being able to take as little basal at night as you need would make things a lot easier.

Ok thanks for your help, I will do a basal test to see first.

 

[chezpez]

Just seen your ‘special age’ comment. It doesn’t sound like you’re particularly insulin resistant. You’re not on large doses of insulin. Perhaps you just need the flexibility of a twice daily basal? You could then take as much or as little as you needed for the day and then the night

Just seen your ‘special age’ comment. It doesn’t sound like you’re particularly insulin resistant. You’re not on large doses of insulin. Perhaps you just need the flexibility of a twice daily basal? You could then take as much or as little as you needed for the day and then the night.

I do have to pre bolus 10 to 25 mins as the fiasp doesn't kick in . Especially second half of cycle

 

[Inka]

I do have to pre bolus 10 to 25 mins as the fiasp doesn't kick in . Especially second half of cycle

Ah, you’re on Fiasp. A number of people have found that that doesn’t work for them or works initially but then seems to stop working. Just bear that in mind if your basal tests/changes don’t give a result.

If you Google “Fiasp like water”, you’ll see some info. There are also threads here, eg:

https://forum.diabetes.org.uk/boards/threads/post-fiasp-resistance.106217/

But, start with a daytime basal test just so you can check that first. There are a number of things to try so I’m sure you can improve things.

 

[chezpez]

Ah, you’re on Fiasp. A number of people have found that that doesn’t work for them or works initially but then seems to stop working. Just bear that in mind if your basal tests/changes don’t give a result.

If you Google “Fiasp like water”, you’ll see some info. There are also threads here, eg:

https://forum.diabetes.org.uk/boards/threads/post-fiasp-resistance.106217/

But, start with a daytime basal test just so you can check that first. There are a number of things to try so I’m sure you can improve things.

Thanks so much, I will try the basal test first.

 

[rebrascora]

I have to prebolus 45 mins in advance of breakfast most of the time with Fiasp and 10-20 mins for other meals, but if my levels are above 8 it can take considerably longer and above 10 I can be waiting well over an hour for it to work before I eat.. (I try to eat when my levels are mostly mid 5s).

I am not sure I could manage with Lantus, but it might be worth trying to split it and see how you get on as it will no doubt take time to get changed over to Levemir (which I personally love) and it will get you started on a routine of morning and evening basal injections. Some people find splitting Lantus works for them so definitely worth a shot.
Like you my night time levels are very susceptible to exercise the previous day and I have to adjust my evening doses of Levemir on an almost daily basis depending upon what I have done during the day. My daytime dose is pretty stable at 22 units but my evening dose can be anywhere from 0-5 in half units adjustments and it is quite tricky balancing it but I get it right most of the time now and you get better the more you practice! I would really struggle with a single dose basal.

 

[TheClockworkDodo]

I wouldn't split the Lantus because it's known for not being very stable in small doses (that was certainly my experience!), and you're not on a huge amount, so two small doses would be likely to make things worse rather than better. I think the people who find it helps to split it tend to be people who are on much larger amounts. As you are quite active late afternoons it sounds as though a split insulin might be a good idea for you though, and Levemir would allow you to adjust doses more easily as it doesn't last as long in your body, so I think if I were you I'd be asking to try Levemir. Then you could have a much smaller dose overnight, as others have suggested.

 

[helli]

I wouldn't split the Lantus because it's known for not being very stable in small doses (that was certainly my experience!), and you're not on a huge amount, so two small doses would be likely to make things worse rather than better.

Before pumping, I was on a similar dose to the OP and was advised to split my Lantus. I never knew (or experienced problems with small doses which were as low as 5 units when I first started basal bolus.
However, my reason for split the dose was in order to manage the problem that it did not last 24 hours.
I understand, as Lantus last 20 to 24 hours, splitting it does not really accommodate the problem of different needs morning and night. Something shorter acting like Levemir is more likely to help.

Just to add, I found Lantus very flexible with regard to changing my dose from day to day depending upon my level of exercise or hormonal changes.

 

[TheClockworkDodo]

It really seems to vary from person to person @helli - it was an absolute nightmare for me, and possibly still is as the random plummeting hypos I have now may be to do with Lantus being stored in my body for years.

 

[trophywench]

Got fed up with Lantus since I couldn't be sure about whether any change (up or down) until after Day 3 since the alteration. Plus from Day 1 it was always literally a pain in wherever I jabbed it, not usually the A*** back then though!

Levemir twice a day worked far better for me.

 

[chezpez]

Thanks for all the advice. So I did a basal test in the afternoon and I was stable in the 5's for 4 hours. So I presume that's ok.
I was starving for my tea!. I'm now thinking about pre bolusing a couple of units in my stomach wait half an hour or so, (just incase my meal isn't ready ). Then bolus the rest for meal and eat it immediately . Would that help with spikes? - thanks

 

[chezpez]

I do have to pre bolus 10 to 25 mins as the fiasp doesn't kick in . Especially second half of cycle

The pre bolusing seems to be helping

 

[rebrascora]

I think prebolusing 30 mins in advance of your evening meal with Fiasp might be too much even if it is just half the dose unless your levels are at the higher end of the range or above range. If you are in the 5s then 2 units 30 mins before you eat may well hypo you, especially if you are eating something slow release. For me, taking into consideration my BG levels before the meal and what I am going to eat are both quite important considerations with Fiasp.

So if I was on 7 or above, half an hour before the meal, then I would probably prebolus the full amount up front, plus whatever correction I needed because for me the Fiasp will take longer to bring me down from higher levels. If I was in the 5s and about to eat pizza or pasta in a creamy sauce, then I might inject just 5 mins before I ate and split the dose so half before the meal and half after although I don't eat pizza or pasta anymore personally. If I was on 5 and about to eat something like bangers and potato mash (mash is very fast release for me) I would probably inject 15 mins before I eat and inject it all at that time. If my meal was after an exercise session or a lot of physical activity, I would maybe just inject 5 mins before I eat.
You really have to weigh up all the potential factors and then make a best guess and see how that works out. This is probably why having a routine with diabetes helps because there is less guessing with a routine once you find a formula that works. I fail miserably when it comes to having a routine so I have to wing it a lot. In the early days though it is very much a case of trial and improvement. Don't worry about getting it wrong. There are plenty of times when I have injected too far in advance and had to eat a jelly baby just as I was sitting down to a meal to slow the drop, or even needed to eat one half way through a meal. Give it a good chew so that it is absorbs quickly through your mouth cells rather than swallowing it down and then it sitting on top of the food you have already eaten which will slow it's action down, and then resume your meal. We are so lucky now to have Libre and other CGM which warns us so that we can take action before we drop too low, in these situations and also guide us on our timing, so that we can better work out when to prebolus. Prior to Libre we just had to inject and hope we got it right and most often everyone's levels spiked high after pretty much every meal and whilst not ideal, people have lived decades like that without suffering obvious complications, so whilst we can now fine tune our diabetes management much better, the body is surprisingly tolerant of us getting it wrong occasionally, so don't sweat any errors you make, just experiment, learn from them and find what you can improve on but otherwise, move on and forget it.

 

[chezpez]

I think prebolusing 30 mins in advance of your evening meal with Fiasp might be too much even if it is just half the dose unless your levels are at the higher end of the range or above range. If you are in the 5s then 2 units 30 mins before you eat may well hypo you, especially if you are eating something slow release. For me, taking into consideration my BG levels before the meal and what I am going to eat are both quite important considerations with Fiasp.

So if I was on 7 or above, half an hour before the meal, then I would probably prebolus the full amount up front, plus whatever correction I needed because for me the Fiasp will take longer to bring me down from higher levels. If I was in the 5s and about to eat pizza or pasta in a creamy sauce, then I might inject just 5 mins before I ate and split the dose so half before the meal and half after although I don't eat pizza or pasta anymore personally. If I was on 5 and about to eat something like bangers and potato mash (mash is very fast release for me) I would probably inject 15 mins before I eat and inject it all at that time. If my meal was after an exercise session or a lot of physical activity, I would maybe just inject 5 mins before I eat.
You really have to weigh up all the potential factors and then make a best guess and see how that works out. This is probably why having a routine with diabetes helps because there is less guessing with a routine once you find a formula that works. I fail miserably when it comes to having a routine so I have to wing it a lot. In the early days though it is very much a case of trial and improvement. Don't worry about getting it wrong. There are plenty of times when I have injected too far in advance and had to eat a jelly baby just as I was sitting down to a meal to slow the drop, or even needed to eat one half way through a meal. Give it a good chew so that it is absorbs quickly through your mouth cells rather than swallowing it down and then it sitting on top of the food you have already eaten which will slow it's action down, and then resume your meal. We are so lucky now to have Libre and other CGM which warns us so that we can take action before we drop too low, in these situations and also guide us on our timing, so that we can better work out when to prebolus. Prior to Libre we just had to inject and hope we got it right and most often everyone's levels spiked high after pretty much every meal and whilst not ideal, people have lived decades like that without suffering obvious complications, so whilst we can now fine tune our diabetes management much better, the body is surprisingly tolerant of us getting it wrong occasionally, so don't sweat any errors you make, just experiment, learn from them and find what you can improve on but otherwise, move on and forget it.

Thank you very much, that's really kind of you to tell me , some tips on pre bolusing. I do feel I'm so alone sometimes with it, and this and forum gives me confidence and reassurance. I'm going to try those tips you have written. Thanks again

 

[rebrascora]

Another example just now as I am about to have lunch.... some cheese and an apple (lots of fat from the cheese and and fibre from the apple will slow the the sugars from the apple down so if I was in the 5s I could get away with injecting my Fiasp and eating straight away as I usually do for this lunch. Also, it is pretty low carb at about 15g carbs so it is not going to spike me above 10 anyway, from 5. Unfortunately, despite a quite exertive walk this morning which required 1 JB to keep my levels decent I am now on 7.1 so I will have to wait 15-20mins before I eat my cheese and apple today.

 

[Proud to be erratic]

Thank you very much, that's really kind of you to tell me , some tips on pre bolusing. I do feel I'm so alone sometimes with it, and this and forum gives me confidence and reassurance. I'm going to try those tips you have written. Thanks again

@chezpez, in his book "Think Like a Pancreas" the author Gary Scheiner comments that Diabetes is "Complicated, Confusing and Contradictory". This so true. He could also have added,as far as I'm concerned, "Lonely and Frightening" - but they don't alliterate and I'm too lazy to try to find equivalent words beginning in C.

In 2 yrs and 11 months on this forum I've never considered myself alone with my D and almost daily I'm surprised by the gentle yet knowledgeable helpfulness of forum members. So please don't hesitate to ask for help or advice. There is something strangely reassuring about the privacy of the relative anonymously coexistence of us all yet caring responsiveness.