Blood Sugar Plummeting at Night

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Tulip29

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Type 1.5 LADA
Hello everyone, My Blood sugar has been plummeting down to 3 at around 4am every night for the last ten days even though I'm going to bed with really high readings i.e. 13-17. I've stopped my evening basal which was only 2 units anyway but that made no difference. My DNS suggests eating a biscuit before bed but who in their right mind eats a biscuit when their blood sugar is 13-17?!!!! Has this happened to any other Type 1s (LADA) and if so what is the solution? I'm at my wits end and fed up of being woken by my Libre 2 alarm every night. All advice gratefully received. N.B. I have my evening meal at about 6pm. Thanks from Tulip x
 
Tulip29 said:
Hello everyone, My Blood sugar has been plummeting down to 3 at around 4am every night for the last ten days even though I'm going to bed with really high readings i.e. 13-17. I've stopped my evening basal which was only 2 units anyway but that made no difference. My DNS suggests eating a biscuit before bed but who in their right mind eats a biscuit when their blood sugar is 13-17?!!!! Has this happened to any other Type 1s (LADA) and if so what is the solution? I'm at my wits end and fed up of being woken by my Libre 2 alarm every night. All advice gratefully received. N.B. I have my evening meal at about 6pm. Thanks from Tulip x
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Are you checking the low reading with a finger prick to check it is a genuine low
 
Which basal insulin are you on?
Are you double checking the Libre lows with finger pricks? If you lie on the sensor it can give you a false low known as a compression low.
Are you doing a lot of exercise?
Have you tried eating a bit later?
I find protein is really good for stopping my levels from dropping during the night. Cheese or nuts or a boiled egg at bedtime would do it for me.
Are you treating the lows and if so with what and what are your waking levels like?
How long have you been diagnosed?
 
Hi @Tulip29 I am sorry to read of the difficulties you are having.

If you are happy to do let us know which insulins you are using. It would also be helpful to know how long ago you were diagnosed. If you are still in the honeymoon period that can cause muddles in our management.

If you are taking your readings from a Libre and they are problematic it would be useful to check these against blood glucose readings.

Come back to us and we can try to help.
 
rebrascora said:
Which basal insulin are you on?
Are you double checking the Libre lows with finger pricks? If you lie on the sensor it can give you a false low known as a compression low.
Are you doing a lot of exercise?
Have you tried eating a bit later?
I find protein is really good for stopping my levels from dropping during the night. Cheese or nuts or a boiled egg at bedtime would do it for me.
Are you treating the lows and if so with what and what are your waking levels like?
How long have you been diagnosed?
Click to expand...
Thanks for your reply and suggestions.. My basal insulin is Levemir. I am not double checking but will do so as you suggest. My sensor is on the opposite arm to the side I sleep on so I never lie on the sensor. I don't do a lot of exercise. just walking and gardening. I did wonder about eating later so I will try that tomorrow. I treat the lows with 200ml orange juice plus a Ryvita crispbread as well if very low. My waking levels are good. i was diagnosed 13 years ago.
 
I use Levemir and I absolutely love it because it is so flexible. Sometimes I don't need any at night and still hypo overnight but it is usually due to exercise. I need a lot in the morning though so there will still be some of my morning dose active up until the middle of the night. I tend not to worry about these lows anymore once I know that I don't have any active insulin in my system and in some respects it is normal for levels in non-diabetic people to drop below 4 in the darkest hours. It is always important to double check any lows with a finger prick though as Libre is not always reliable and generally tends to read lower at low levels, so if Libre says I am 3.5, I will usually be 4.5.
PS. Don't underestimate gardening and walking as they are some of the best activities for lowering BG levels. Alcohol can also have a lowering effect. Not sure if it is relevant in this case and I imagine you probably know that if you have 13 years experience.
 
Yes I too am happy with Levemir. Did try Tresiba for a bit but it turned me into an angry monster so returned to Levemir. Last night my BG was 19 on Libre and 15.8 on FP at 10.30pm(4 hours after dinner). I gave a correction dose of 1 unit to bring it down by 2.5. At 4.26am BG was 4.4 on Libre and 4.6 on FP. I did nothing and it came up to 6.3 by 7.45am.
I did have surgery for breast cancer 8 weeks ago and was wondering if my body is still working hard to repair itself every night but this situation has only been going on for the last fortnight. I'm also now taking Letrozole (oestrogen suppressor) as part of my treatment which is notorious for raising cholesterol. Perhaps that is something to do with it?
 
Have you tried keeping cooler at night...ie less thick duvet, no hot water bottle etc. I find this can stop repeated little dips throughout the night.
You say you have dropped your basal at night...but when do you inject your bolus, and when to you inject/eat? I wonder if doing a low carb evening meal may help?
I too would feel odd about a night time snack then blood sugars are already over 10
 
Sorry to hear about your overnight dips @Tulip29 :(

3am is often the time when cortisol levels are at their lowest, and BG is naturally at it’s lowest point, even in people without diabetes.

How long have you been living with LADA? Do you think you may still be in the ‘honeymoon’ phase with some beta cells still remaining? I wonder if the high levels at bedtime are stimulating whatever home-grown insulin production you still have, which is perhaps working overtime?

Do you get the same level of reduction if you are nearer to being in the 6-8mmol/L range at bedtime, and if you have your evening meal by about 7pm latest so that your rapid acting insulin has pretty much run out of steam?
 
What's your BG doing during the daytime? and anyway between evening meal and bedtime?

It's a fallacy that the 2 daily doses of Levemir need to be taken at set times especially first thing in the morning and bedtime. My middle of the night hypos disappeared by taking the second dose between my 6.30pm-ish evening meal and 11 to 11.30pm bedtime - so 9 to 9.30pm ish.

Borne out when I eventually said bugger this, can I have a pump please? and thereby discovering I need masses more basal insulin from c.11pm to c.1.30am than I do the rest of the day/night. Still do. No way Jose would any proprietary basal administered by injection be able to deliver that for me.
 
Hello everyone,
Just reporting back to say that I've finally got it sorted! I did it by increasing my morning basal from 12 to 14. Then adjusting my mealtime ratios down (to increase dose), as well as eating my evening meal later. I have also been rigorously testing 2 hours after meals to assess efficacy of the new ratios and adjusting accordingly. So I ended up giving more for evening meals which in turn stopped the BG plummeting. Have had several nights now with a fairly flat line and a good reading upon waking. It's a daily struggle as you know but am hoping to keep it that way. Starting some more breast cancer treatment tomorrow so will be keeping a sharp eye on things. Thanks to everyone who shared their wisdom and experience. Much appreciated. Tulip x
 
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