Early morning hypo

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Hughes87

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Relationship to Diabetes
Type 1.5 LADA
Morning!

I’m in/coming out of the honeymoon period but not on any long last insulin yet. I just have novorapid before meals.

Usually I go low around 3/4am but generally don’t need to treat it as l wake up and my bloods start to rise or I have something small to eat, maybe something around 6g of carbs

The last two mornings I’ve woken up with bg levels of 2.3 and dropping and I have no idea why? It doesn’t even seem to be rising when I wake up either.
 
When do you eat your evening meal @Hughes87 ? And what’s your blood sugar when you go to bed? Sometimes in the honeymoon period our own insulin will come in too late and overreact by producing too much. However, your 2.3 is very low.is this a Libre reading? If so, did you finger prick to check it?
 
Just a thought...i wss going low at about that time of night, no rapid acting insulin in me, and found swapping to a lower tog duvet stopped it.
Do you have a libre or other cgm? May be time to set those alarms or adjust them to you don't get that low...assuming it was 2.3 and not a libre compression low
 
I have my evening meal quite late. I think I ate around 8.30 and was low after so I snacked (a lot more than normal). I went lower again (I was around 4.3) so I snacked more and had toast. And I seemed to stay around 4.5 before bed. I dropped again about 2am and had two snacks and I went up to around 8 and that lasted until 7 this morning when I woke up at 2.3

i normally wake up around 6/7 but the last three mornings I’ve been 4.4 and under. I’m eating quite a lot in the evenings and I’m injecting correctly for my carbs but I’m dropping super quickly once I inject so I’m having my meal plus all evening snack in one go rather than meal, little break and then a snack. Hope this makes some sense
 
@Hughes87 do you confirm that low with a finger prick to check that it is not a CGM compression low (false low caused by applying pressure to the sensor)?

If you are waking lower than usual, are you doing more exercise or drinking alcohol? Both can effect our levels up to 48 hours later.
And have you tried lowering your NovoRapid dose?
 
*I’m injecting correctly for my carbs but I’m dropping super quickly once I inject*

@Hughes87 If you’re dropping that low so quickly, you’re not injecting correctly for your carbs. It looks like your ratio needs adjusting. That’s not unusual 🙂
 
@Hughes87 If you are genuinely dropping that low (as oppose to a compression low where Libre reports a false low when you lie on the sensor) before you get up in the morning as well as dropping low after your meal and after you go to bed, then it sounds like your basal insulin is also too much. Which basal do you use and when do you take it?

The key thing about diabetes management is that nothing is set in stone, so you might be injecting the basal dose or right amount of bolus for the carbs you are eating that worked last week, but these things change, both up and down in response to a large number of factors. Alcohol is one and exercise is another which can cause these sort of drops and will have an affect for much longer than the time you participate in them. I always have to reduce my evening basal insulin dose after exercise otherwise I will hypo every time. I seem to be much less responsive to alcohol and hardly see any effect but others have to eat unbolused carbs with their alcohol to prevent hypos.

If you are on a very long acting basal insulin like Tresiba or Toujeo, then you are limited in how much you can adjust them for exercise and alcohol and you probably need to reduce your evening bolus more and perhaps push your levels up high before you go to bed to counteract the drop in BG through the night. If you are on a shorter and more flexible basal insulin like Levemir or Lantus, you can reduce the dose accordingly once you figure out what the factor is which is dropping your levels and therefore when you are likely to experience these drops.

I have Levemir as my basal and whilst my daytime (morning) dose is fairly stable, my evening dose is the one that I need to adjust to compensate for any exercise I have done during the day. You gradually just get a feel for what works for you but it tends to be quite intuitive rather than calculated.....it is for me anyway. My evening dose can range anywhere from 0 to 5 units. My morning dose is mostly 22units but can go up to 24 or down to 20. If I have adjusted my evening dose, it is generally not a good idea to also adjust my morning dose as that is usually too much in one day.

It is also important to understand that exercise is not necessarily formal exercise like running or going to the gym but any prolonged physical work like gardening or washing the car etc.
 
rebrascora said:
@Hughes87 If you are genuinely dropping that low (as oppose to a compression low where Libre reports a false low when you lie on the sensor) before you get up in the morning as well as dropping low after your meal and after you go to bed, then it sounds like your basal insulin is also too much. Which basal do you use and when do you take it?

The key thing about diabetes management is that nothing is set in stone, so you might be injecting the basal dose or right amount of bolus for the carbs you are eating that worked last week, but these things change, both up and down in response to a large number of factors. Alcohol is one and exercise is another which can cause these sort of drops and will have an affect for much longer than the time you participate in them. I always have to reduce my evening basal insulin dose after exercise otherwise I will hypo every time. I seem to be much less responsive to alcohol and hardly see any effect but others have to eat unbolused carbs with their alcohol to prevent hypos.

If you are on a very long acting basal insulin like Tresiba or Toujeo, then you are limited in how much you can adjust them for exercise and alcohol and you probably need to reduce your evening bolus more and perhaps push your levels up high before you go to bed to counteract the drop in BG through the night. If you are on a shorter and more flexible basal insulin like Levemir or Lantus, you can reduce the dose accordingly once you figure out what the factor is which is dropping your levels and therefore when you are likely to experience these drops.

I have Levemir as my basal and whilst my daytime (morning) dose is fairly stable, my evening dose is the one that I need to adjust to compensate for any exercise I have done during the day. You gradually just get a feel for what works for you but it tends to be quite intuitive rather than calculated.....it is for me anyway. My evening dose can range anywhere from 0 to 5 units. My morning dose is mostly 22units but can go up to 24 or down to 20. If I have adjusted my evening dose, it is generally not a good idea to also adjust my morning dose as that is usually too much in one day.

It is also important to understand that exercise is not necessarily formal exercise like running or going to the gym but any prolonged physical work like gardening or washing the car etc.
Click to expand...
The OP said he was not taking any basal insulin which seems a bit odd and only taking bolus insulin.
That may alter your comments.
 
I have novorapid only and never more than 10 units, at the min I’m 10g to 1 unit ratio (I don’t have half units on my pen)

My morning I walk and then inject around 10.30/11am - 2-3 units
Exercise pre lunch and then inject around 2.30-3pm again, 2-4 units (usually lunch plus a snack)

Evening injection varies but I eat quite late, generally between 7.30-8.30. Again still a ratio of 1 unit for 10g. I’ve been having around 30g for tea (we have meal prep so everything is weighed out) plus 10g-20g for snacks

Tonight I had 4 units for 30g tea plus 10g snack. I was around 8.9 for a while then around 2-3 hours later, I went low twice and needed at least 20g extra carbs. It’s odd that my morning and afternoon ratio is fine but the evening ones are different

I have been pin pricking and it’s accurate when I’m low and I do and have been exercising slightly more but nothing too unusual
 
No, it’s not odd at all @Hughes87 ! It’s very normal to have different ratios for breakfast, lunch and tea. You need less insulin for your evening meal. You’re trying to counteract your later lows by incorporating your snack into your evening meal but you’re injecting for it, thereby rendering its hypo-fighting ability useless.

This is what I’d do:

- reduce your evening ratio. You could try 1:12g but as you’re going quite low, you could try 1:13 or 1:14 or 1:15. You also need a half unit pen.

- eat your evening meal earlier - it’s so much easier to get things right if you do

- have your snack at bedtime as needed
 
My ratios go from 1:8 to 1:19, depending on time of day (breakfast is different from other meals) and if i am working that day.
I agree eating earlier til you have your rstios pinned down will save disturbed sleep
 
Hughes87 said:
I don’t have half units on my pen
Click to expand...
Ask for one.
I don't know how I ever managed without.
I believe they are only available for reusable pens but that is no bad thing. Reusable pens are more robust, cartridges take up less space in your fridge and luggage when traveling, they have a reminder on the end and produce less waste.
Just make sure you have a spare.
 
Thanks everyone. I wasn’t aware about different ratios at times of the day. It’s really so confusing.

I tried one unit less for tea last night and ended up running a little too high. Definitely going to speak to the gp about the half units.

Thanks again!
 
The half unit pens will make things a lot easier for you.
It is a juggling act that we do each day and having more sensitive adjustments make life a lot easier.
 
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