Bedtime snacks for type 1 diabetic

[janedent]

Hi.
I'm 68. I was diagnosed with type 1 diabetes in March and on Abarsaglar and Novorapid. At first things went quite well and I seemed to be avoiding hypos. But now I'm getting a lot of hypos at night. I eat berries and soya yoghurt before bed. May it's too low carb. Does anyone have any suggestions for a bedtime snack that you've found keeps your blood sugar OK through the night? Any suggestions much appreciated. Thank you.

 

[Lucyr]

It would be better to correct your insulin dose then you don’t have the lows. Is there a reason that isn’t an option for you?

 

[CliffH]

Hi.
I'm 68. I was diagnosed with type 1 diabetes in March and on Abarsaglar and Novorapid. At first things went quite well and I seemed to be avoiding hypos. But now I'm getting a lot of hypos at night. I eat berries and soya yoghurt before bed. May it's too low carb. Does anyone have any suggestions for a bedtime snack that you've found keeps your blood sugar OK through the night? Any suggestions much appreciated. Thank you.

Even more than thinking about what you're eating last thing, I'd be looking at when you're taking your last shot of insulin - and how much you're taking.

 

[Inka]

Perhaps your Abasaglar dose is a bit too much @janedent ? Or maybe you’d find a twice daily insulin would suit you better (because you can have less at night).

Good bedtime snacks are carby things like oatcakes, digestives, etc.

 

[rebrascora]

Are you using a Constant Glucose Monitor like Libre or Dexcom? Just wondering if you are having genuine hypos or if these are possibly compression lows, where lying on the arm with the sensor on it causes it to give false low readings? If they are CGM low alarms, are you double checking them with a finger prick? My concern is that you might be relying on a CGM and it is perhaps recording false low readings and making you worry about hypos that are not actually happening. Do you wake up feeling hypo? Usually you can tell by looking at your graph as Compression lows will generally be quite a sharp dip whereas a genuine low through the night will usually be a slow steady descent.

It is however not uncommon for your remaining beta cells to go through a bit of a revival after insulin treatment is introduced and they start releasing more home grown insulin, so your doses may need reducing, if they are genuine hypos that you are experiencing.

What level have you been advised to go to bed on? Ie. The general advice can be, to make sure your BG is above a certain level , usually 8mmols during the early months of diagnosis, so if you were say on 6mmols at bedtime, then 8-10g carbs should push you just up above 8mmols, so a digestive biscuit or a ryvita with some peanut butter. If you were a bit lower, say on 5mmols then maybe a slice of toast with peanut butter.

First and foremost though, you need to be certain that these are definitely hypos you are having and not a glitch in your sensor system by double checking with a finger prick if you don't feel hypo.

 

[everydayupsanddowns]

Sorry to hear about your overnight lows @janedent

When are you next due a chat with your nurse? Perhaps they could advise you of an appropriate tweak to make to your Absalgar dose as your insulin needs ebb and flow through the year (downwards if having hypos, or upwards if waking above range). As more years pass by you’ll get used to your insulin needs changing in different directions, often just as you seem to have got things set ‘just right’ 🙄

 

[janedent]

It would be better to correct your insulin dose then you don’t have the lows. Is there a reason that isn’t an option for you?

Thanks Lucy. I have now changed my basal dose, from 4 to 3. The hypos are much less frequent, hardy at all in fact. Generally my BS numbers are slightly higher than they were, which is the trade off I suppose. Thanks again.

 

[janedent]

Perhaps your Abasaglar dose is a bit too much @janedent ? Or maybe you’d find a twice daily insulin would suit you better (because you can have less at night).

Good bedtime snacks are carby things like oatcakes, digestives, etc.

Thanks Inka. I've reduced my Abasaglar from 4 to 3 units. That seems a good idea, splitting the dose. I might give that a go.

 

[janedent]

Are you using a Constant Glucose Monitor like Libre or Dexcom? Just wondering if you are having genuine hypos or if these are possibly compression lows, where lying on the arm with the sensor on it causes it to give false low readings? If they are CGM low alarms, are you double checking them with a finger prick? My concern is that you might be relying on a CGM and it is perhaps recording false low readings and making you worry about hypos that are not actually happening. Do you wake up feeling hypo? Usually you can tell by looking at your graph as Compression lows will generally be quite a sharp dip whereas a genuine low through the night will usually be a slow steady descent.

It is however not uncommon for your remaining beta cells to go through a bit of a revival after insulin treatment is introduced and they start releasing more home grown insulin, so your doses may need reducing, if they are genuine hypos that you are experiencing.

What level have you been advised to go to bed on? Ie. The general advice can be, to make sure your BG is above a certain level , usually 8mmols during the early months of diagnosis, so if you were say on 6mmols at bedtime, then 8-10g carbs should push you just up above 8mmols, so a digestive biscuit or a ryvita with some peanut butter. If you were a bit lower, say on 5mmols then maybe a slice of toast with peanut butter.

First and foremost though, you need to be certain that these are definitely hypos you are having and not a glitch in your sensor system by double checking with a finger prick if you don't feel hypo.

Thank you Rebrascora. I hadn't thought of checking my Freestyle Libre sensor was accurate. And i do sleep on that arm! I will check against the finger prick machine next time.

 

[trophywench]

It concerns me a bit when I hear the phrase 'on that arm' - inferring to me that you always have your Sensor on the same arm. I swap arms with each sensor and yes it is awkward with the other hand, but I'd have to do it if I damaged the other hand/arm anyway. When one needs to find a way - one does usually.

 

[janedent]

It would be better to correct your insulin dose then you don’t have the lows. Is there a reason that isn’t an option for you?

Thanks LucyR. I've started doing that plus adding half a banana to my bedtime snack. Things have improved a lot.

 

[mashedupmatt]

I get loads of compression lows unfortunately from laying on my sensor (regardless of which arm it's on, it's just the way I sleep!) - glad the small tweak to your basal insulin is working for now - I am on a twice-daily basal insulin and after switching that definitely helped me being too high or low at certain times but we are all different, and that would be down to your healthcare team to instigate - seems like you have made the right tweak for your needs right now though - well done

 

[janedent]

Sorry to hear about your overnight lows @janedent

When are you next due a chat with your nurse? Perhaps they could advise you of an appropriate tweak to make to your Absalgar dose as your insulin needs ebb and flow through the year (downwards if having hypos, or upwards if waking above range). As more years pass by you’ll get used to your insulin needs changing in different directions, often just as you seem to have got things set ‘just right’ 🙄

January 17th, but I'll email the diabetes team at the hospital and ask a few questions now I've had some new ideas from the forum. Half units especially. And yes, every time I think I've got the hang of this diabetes mallarkey, I get an immediate 'correction' to my sense of achievement. Aaargh.

 

[janedent]

I just wanted to say I've felt so much better since finding this forum. Learning from other people's similar experiences and feeling I'm not alone is a powerful combo. Thanks everyone.

 

[janedent]

It would be better to correct your insulin dose then you don’t have the lows. Is there a reason that isn’t an option for you?

Done that now. Much better and only one nighttime hypo in the last week. Thanks.

 

[Ttelmah]

Two comments here:
First the half unit thing is one that I suffer from. Speaking to a specialist pharmacist this week about whether a basal half unit dose might be possible. I find that a change of one unit makes the nighttime levels switch from hyper to hypo (or vice versa). Back in the old simple syringe days would use a half unit dose. With click dispensers you can't do this, unless you can find a suitable insulin that offers half unit measures. Very annoying....
One thing I use that works well is a simple oatcake. Gives a really nice low GI gentle baseline food intake in the night.
The other thing that everyone has to get their head round, is how 'other things' affect diabetes. So (for example), I tend to run hyper, when my body is fighting an infection. In fact with the modern testing this gives an immediate indication that this is still being fought. Years ago was in hospital and they stopped a penicilin. I said 'the infection has not yet been beaten', but they ignored this 48 hours later I was back on another antibiotic. This was a gastrointestinal problem, and speaking later to a friend who is a senior gastro specialist, and he said that they now do not stop till they have had a blood test showing the infection has been beaten, since events like mine encourage the growth of antibiotic resistance...
Glad you are finding things a bit better Jane. 🙂

 

[Lucyr]

Speaking to a specialist pharmacist this week about whether a basal half unit dose might be possible. I find that a change of one unit makes the nighttime levels switch from hyper to hypo (or vice versa). Back in the old simple syringe days would use a half unit dose. With click dispensers you can't do this, unless you can find a suitable insulin that offers half unit measures. Very annoying....

What basal do you take?

 

[janedent]

Two comments here:
First the half unit thing is one that I suffer from. Speaking to a specialist pharmacist this week about whether a basal half unit dose might be possible. I find that a change of one unit makes the nighttime levels switch from hyper to hypo (or vice versa). Back in the old simple syringe days would use a half unit dose. With click dispensers you can't do this, unless you can find a suitable insulin that offers half unit measures. Very annoying....
One thing I use that works well is a simple oatcake. Gives a really nice low GI gentle baseline food intake in the night.
The other thing that everyone has to get their head round, is how 'other things' affect diabetes. So (for example), I tend to run hyper, when my body is fighting an infection. In fact with the modern testing this gives an immediate indication that this is still being fought. Years ago was in hospital and they stopped a penicilin. I said 'the infection has not yet been beaten', but they ignored this 48 hours later I was back on another antibiotic. This was a gastrointestinal problem, and speaking later to a friend who is a senior gastro specialist, and he said that they now do not stop till they have had a blood test showing the infection has been beaten, since events like mine encourage the growth of antibiotic resistance...
Glad you are finding things a bit better Jane. 🙂

Thank you Ttelmah.
I'll get some oatcakes in, although not sure I can stop at one. I love em. Actually half a banana before bed seems to have solved the problem. And yes, I'm going to ask for my bolus insulin in half unit dispensers if that's possible - I take Novorapid.
By the way, I have 2 type 1 sisters actually. One still uses syringes, the old fashioned way (her choice, she refuses CGMs too).