Avoiding a night hypo

[MollyBolt]

Thank you so much for your messages - this group is so generous with its expertise.

I have a freestyle and I’ve just got a notification it’s lost contact with the sensor. I’ve tried turning Bluetooth on and off and also turning phone off and on. Is there any other trick that I could try? It feels a bit rash to insert a new one?!

 

[DianeD]

As you are on your first cgm I wanted to underscore @rebrascora comments about reducing your levels slowly. It's easy to panic in the early days and attemp to stay in the green area immediately. Please don't do this. It can effect your eyes and finer blood vessels adversely so take your time and slowly lower it. Your body has been used to high levels for some time and will need to adjust to lower levels.
Eat the way you have been and follow your teams direction with insulin doses and don't panic about the numbers. Then as things improve (they will) you can look at different strategies that suit you to improve your TIR.
ATB

 

[rebrascora]

Thank you so much for your messages - this group is so generous with its expertise.

I have a freestyle and I’ve just got a notification it’s lost contact with the sensor. I’ve tried turning Bluetooth on and off and also turning phone off and on. Is there any other trick that I could try? It feels a bit rash to insert a new one?!

Have you scanned the sensor with your phone so that you get a reading via NFC if Bluetooth has lost contact?

 

[PhoebeC]

Thank you so much for your messages - this group is so generous with its expertise.

I have a freestyle and I’ve just got a notification it’s lost contact with the sensor. I’ve tried turning Bluetooth on and off and also turning phone off and on. Is there any other trick that I could try? It feels a bit rash to insert a new one?!

Yes if you just click the icon in the top right, as circled here and hold backside of the phone/reader to the libre on your arm it should work.

If you move out of range (like go upstairs without the device as an example) you will need to rescan. But it won’t happen that often and easier just to scan again.

 

[PhoebeC]

As you are on your first cgm I wanted to underscore @rebrascora comments about reducing your levels slowly. It's easy to panic in the early days and attemp to stay in the green area immediately. Please don't do this. It can effect your eyes and finer blood vessels adversely so take your time and slowly lower it. Your body has been used to high levels for some time and will need to adjust to lower levels.
Eat the way you have been and follow your teams direction with insulin doses and don't panic about the numbers. Then as things improve (they will) you can look at different strategies that suit you to improve your TIR.
ATB

Yes slowly make changes and you will get there. It’s about long term changes and health not just now, and we all have times when it all goes belly up again due to other circumstances it’s not about being perfect every day or immediately.

You will get there. Don’t panic and carry on as you are doing learning and adapting. And we are here for you. Even if we don’t know the answer (someone here will) we support you and get how it feels,

 

[SimonP]

Thank you so much for your messages - this group is so generous with its expertise.

I have a freestyle and I’ve just got a notification it’s lost contact with the sensor. I’ve tried turning Bluetooth on and off and also turning phone off and on. Is there any other trick that I could try? It feels a bit rash to insert a new one?!

Sometimes the sensor Bluetooth fails. Sometimes it comes back (though usually it's rather hit and miss from that point on and will eventually fail completely). Out of interest what phone are you using (though having switched if off and back on ought to have sorted out anything on that side of things)?

Edit: added sensor for clarity - I'm not talking about your phone dying!

 

[MollyBolt]

I’m now a couple of days into having the sensor (which is paired with my Apple phone). I find the link to my phone drops several times a day but I can make it sync through the advice above (embarrassed I didn’t spot where to press on the app - thank you so much Phoebe!). Three thoughts / questions (and then another one!):

1. I find that I basically am looking at the app ALL THE TIME. It identified hypos before I did and I feel quite angsty when not looking at it. I assume I’ll chill out in a few days but any thoughts on how to do so would be welcome.

2. I was having a hypo at one point and then triangulated with a fingerprick test which was even lower. I assumed this was due to the time lag between sensor and finger prick hit it never ended up matching up (as in the sensor was always higher). Any thoughts on why?

3. Without trying massively I am in range 83% of the time. (Obviously I’ve only been doing this about 5 minutes!). But (a) I seem to have a hypo around 11.45 in the morning (does this mean I should be bringing the Levemir down a bit?) and (b) given all the warnings above I worry that I am going to end up with problems (ie of the blood vessel / eye variety). Advice would be helpful.

Final question which is basically a silly one: I was in the middle of a work convo and saw a hypo alert on my phone. I felt a numpty saying “excuse me I have to go and eat jelly babies” so I sort of shuffled off awkwardly afterwards but having left a longer lag between seeing the alert and acting than I’d have liked. This is bizarre because I’ve been v open with colleagues about my T1 diagnosis. I guess I just don’t like to make a fuss. Any advice on this?

 

[SimonP]

I’m now a couple of days into having the sensor (which is paired with my Apple phone). I find the link to my phone drops several times a day but I can make it sync through the advice above (embarrassed I didn’t spot where to press on the app - thank you so much Phoebe!). Three thoughts / questions (and then another one!):

Not an Apple user but I read that the app can be killed if it sits in the background for long enough (which would then stop the communications) - there is presumably a setting somewhere to prevent this happening (there is on Android phones)

1. I find that I basically am looking at the app ALL THE TIME. It identified hypos before I did and I feel quite angsty when not looking at it. I assume I’ll chill out in a few days but any thoughts on how to do so would be welcome.

I look at mine quite a lot when I'm not doing anything else, but I can also happily ignore it for hours if I'm busy. Having the data relayed to a watch is nice (and avoids looking at the phone which might be inconvenient/rude in some situations)

2. I was having a hypo at one point and then triangulated with a fingerprick test which was even lower. I assumed this was due to the time lag between sensor and finger prick hit it never ended up matching up (as in the sensor was always higher). Any thoughts on why?

Both finger prick test strips and the libre2 have their own allowable error ranges, they may not line up even if working within spec. Also remember that there's a lag for interstitial CGMs, so the fingerprick test and libre2 will not align unless your BG is flat, or you move one of the test readings to take the lag into account. Sometimes the libre2 calibration goes awry for me, but these are usually quite large under-readings (on the order of 4mmol/l or more), there are also sometimes smaller discrepancies on the order of 1.5mmol/l, but these tend to resolve themselves after a fast transient event (fast rise or fall of BG.)

3. Without trying massively I am in range 83% of the time. (Obviously I’ve only been doing this about 5 minutes!). But (a) I seem to have a hypo around 11.45 in the morning (does this mean I should be bringing the Levemir down a bit?) and (b) given all the warnings above I worry that I am going to end up with problems (ie of the blood vessel / eye variety). Advice would be helpful.

What and when did you eat this morning, what insulin did you take and when, what did you do (exercise, stress, etc.)? If your overnight BG is stable, then generally best to leave basal insulin alone (as this is the time period you can't easily monitor and fix unless you want disturbed nights).

Final question which is basically a silly one: I was in the middle of a work convo and saw a hypo alert on my phone. I felt a numpty saying “excuse me I have to go and eat jelly babies” so I sort of shuffled off awkwardly afterwards but having left a longer lag between seeing the alert and acting than I’d have liked. This is bizarre because I’ve been v open with colleagues about my T1 diagnosis. I guess I just don’t like to make a fuss. Any advice on this?

Tricky, I have the same issue when at work. For external customers I don't really want to interrupt a meeting unless I really need to, especially if it's relatively short. If it's multiple hours then it's easiest to just say up front and get it out of the way. Going low during meetings isn't very useful, I will often try to scoff a few Skittles on the side if I think I may head low, though not really possible in a one-to-one. Multi-person meetings make this much easier, as do Teams meetings!

I tend to try to make sure I eat and dose correctly such that I won't go low during meetings, easier said than done though!

 

[mashedupmatt]

Molly, I went through the rollercoaster of T1 diagoisis a couple of years ago and am still coming to terms with it - you defo shouldn't mess with your basal insulin straight away IMO - you need to look for patterns before adjusting and as you are so new to the rollercoaster that would not be wise - 83% TIR is fantastic (Well done!) - CGM is amazing and a lot more fun than finger pricks but definitely lags from what is actually going on - it's great that you have connected on this forum so soon after diagnosis (I wish I had sooner!)

 

[MollyBolt]

Thanks for the thoughts.

I take 12u Levemir in the morning and 8u at night which is why I was thinking about fiddling with the morning dose. But I’ll leave for now. I have Alpen for breakfast - yesterday I also went to a spin class at 6.30am before breakfast but that didn’t seem to have a great deal of impact (possibly because I didn’t spin that vigorously). On one day the hypo came when I was walking along the road, whilst yesterday I was just talking to a colleague in the office. I guess I keep an eye and see if it really is a patten and start preemptively eating then.

In other news, I had two glasses of wine yesterday early evening and woke up to find that I had spent the night hypo-ing and I hadn’t woken up and the alarm didn’t make a sound. When I’d gone to bed I was at 7 but I seem to have spent 2.30am - 6.30am below 3.8. I am quite traumatised - I thought I’d wake - and very sad my alarm didn’t make a noise. My phone is on silent but I’d changed the app settings to allow notifications from Libre. I must have done something wrong but I can’t think what. This is not going to help my desire to look at the app all the time! On the plus side, and given the fears which prompted the start of the thread, at least I’m not dead as a result.

 

[rebrascora]

Exercise will impact your levels for up to 48 hours afterwards, so your spin class together with the wine last night will be responsible for your lows overnight. I reduce my evening Levemir by a couple of units on days that I have done exercise because I am very prone to nocturnal hypos after exercise and I don't drink anymore. Alcohol will also drop your levels overnight if you drink it in the evening so you do need to be mindful of either and particularly both together.
If you are not confident of adjusting your Levemir yet, then have some slow release carbs with protein and fat as a bedtime snack push your levels up but talk to your nurse about this situation and is she happy for you to reduce your Levemir because ultimately there is not much point in having to eat to prevent hypos because your insulin dose is too high. Learning to adjust your insulin to your body's needs is key to good diabetes management and you have a basal insulin which is relatively flexible and therefore allows you to make those adjustments. Other longer acting insulins like Tresiba are much less flexible for this sort of adjustment. It is one of the reasons I absolutely love Levemir.

As regards not waking up below 3.8, most early hypo warning signs affect our conscious state. One of my earliest hypo warning signs is my peripheral vision starts to go blurry but if you are lying down in the dark with your eyes shut, asleep you simply won't pick up on that. Also you won't notice wobbly legs etc when you are lying down. Added to that, it is normal for BG levels to drop below 4 during the depths of the night even for non diabetic people. An "actual" hypo is technically below 3.5 I believe because non-diabetic people can naturally drop this low, but we try to treat anything below 4 as hypo to try to preserve our hypo awareness. What I am saying is try not to be too disheartened that you didn't wake up on this occasion. It is very likely that if you had dropped significantly lower you would have woken up, but obviously these situations are to be prevented as much as possible, so bumping your BG up a bit when you go to bed or reducing your evening Levemir are the two choices. When I have more sedentary days I need to adjust my evening dose back up again, so you gradually learn how to adjust it taking into consideration all thee factors and how your body responds to these situations.

In case you didn't know, alcohol is considered toxic and causes the liver to prioritize removing it from the blood over releasing glucose into the blood stream which is it's main function particularly overnight. It is one of the reasons why being hypo can be mistaken for being drunk, because they are in effect the same process. If you drink a lot your liver is so busy removing the alcohol from your blood that it stops releasing glucose and your BG levels drop and that is why people who are drunk crave a kebab or chips or whatever at 1am in the morning. So if you are going to drink alcohol as a diabetic, you need to eat some (unbolused) carbs with it or after it to provide the glucose that your liver can't because it is processing the alcohol. Something like cheese and crackers or a slice of toast with a good spread of peanut butter at bedtime is usually enough slow release carbs to tide you through the night.

I hope that makes sense.

 

[SimonP]

I take 12u Levemir in the morning and 8u at night which is why I was thinking about fiddling with the morning dose. But I’ll leave for now. I have Alpen for breakfast -

You might reduce your bolus for the Alpen.

yesterday I also went to a spin class at 6.30am before breakfast but that didn’t seem to have a great deal of impact (possibly because I didn’t spin that vigorously).

The effects can come afterwards - if the exercise itself is fairly energetic your liver will chip in and produce glucose, but your muscles will retain insulin sensitivity for some time after exercise (certainly for a few hours, potentially up to ~48h) as well as trying to replenish glycogen stores (and your liver will do likewise.) It all depends on what intensity of exercise and how long for, and how adapted to it you are. Everyone's different, and it also changes over time!

On one day the hypo came when I was walking along the road, whilst yesterday I was just talking to a colleague in the office. I guess I keep an eye and see if it really is a patten and start preemptively eating then.

Same time of day though?

In other news, I had two glasses of wine yesterday early evening and woke up to find that I had spent the night hypo-ing and I hadn’t woken up and the alarm didn’t make a sound. When I’d gone to bed I was at 7 but I seem to have spent 2.30am - 6.30am below 3.8. I am quite traumatised - I thought I’d wake -

You may not have actually been hypo (CGM inaccuracies, potentially sleeping on the sensor which produces false lows), how did you feel in the morning? You usually know from how hollow/grim (depending on how low you were) you feel, and also you'll tend to run lower the following morning as your liver looks to replenish glycogen stores.

and very sad my alarm didn’t make a noise. My phone is on silent but I’d changed the app settings to allow notifications from Libre. I must have done something wrong but I can’t think what. This is not going to help my desire to look at the app all the time!

There's usually a setting to allow an app to override "sleep" settings - I'm sure someone with an iPhone will chip in/there must be some comments somewhere on the forum as to how to enable this.

On the plus side, and given the fears which prompted the start of the thread, at least I’m not dead as a result.

lol, good good 🙂