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ew7k

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Hi, I'd been managing my type 2 diabetes with medication for about 10 yrs but it was stopped after a recent hospital stay and I'm now on a daily Lantus injection and daily Metformin, until after surgery (could be a while) Have a Libre 2, which is v helpful but wakes me up in the early hours (between 1 and 3). I'd love some advice on before bed snacks to see me through the night! (Mainly veggie diet and low fat due to gall bladder infection)
 
Welcome to the forum
I'm sure someone will be along soon who can share their experience of dealing with this
 
Hello @ew7k, welcome to the forum.

Suggestions for bedtime or during the night snacks is simple enough, but it would be sensible to have a better understanding of what is going on.

For instance are these alarms caused by real hypos, verified by finger pricks? So do you need hypo response snacks or just want to start your sleep with a bit higher BG?​
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What is your Libre alarm set at?​

If your lantus is causing regular alarms because of your BG dropping most nights - you should consider reducing your lantus dose. 10% can be a possible amount, but first it would help to know:
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What is your daily lantus dose and taken in the morning or evening. It may be your Lantus dose is small and most likely you have a disposable insulin pen which dispense in whole units.​
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Are your overnight graphs broadly similar. Can you post a screenshot from a couple of mornings?​
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I should have added I'm not medically qualified and those newly starting with insulin should consider getting official advice from their medical sponsor for the lantus..
 
Proud to be erratic said:
I should have added I'm not medically qualified and those newly starting with insulin should consider getting official advice from their medical sponsor for the lantus..
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Thank you, I really appreciate your questions. I have an appointment this week and your input will help me ask the right questions. The alarm goes off below 3.9, and I don't do a prick test then. I take the Lantus at midday, as I understand it to keep underlying levels steady, and Metformin after breakfast (around 8am) to help regulate glucose input from food.
 
ew7k said:
Thank you, I really appreciate your questions. I have an appointment this week and your input will help me ask the right questions. The alarm goes off below 3.9, and I don't do a prick test then. I take the Lantus at midday, as I understand it to keep underlying levels steady, and Metformin after breakfast (around 8am) to help regulate glucose input from food.
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You would be wise to check those night time lows with a finger prick because Libre is prone to what we call compression lows, where if you lie on the sensor for too long it compresses the tissue that the filament is sampling and that results in false low readings. A compression low can sometimes be identified by looking at the Libre graph because it will usually cause a much sharper dip than you would expect from your Lantus causing a hypo, where levels tend to decline slowly and steadily. Generally we would advise that you double check any hypos that Libre alerts you to with a finger prick before treating, unless you feel obviously hypo.
The current hot weather has made people toss and turn a lot more and as a result I think more people have been experiencing them. I almost never have compression lows but the last couple of weeks I have had 2 and I am sure it is because I am uncomfortably hot and restless in my sleep.
 
ew7k said:
Thank you, I really appreciate your questions. I have an appointment this week and your input will help me ask the right questions. The alarm goes off below 3.9, and I don't do a prick test then. I take the Lantus at midday, as I understand it to keep underlying levels steady, and Metformin after breakfast (around 8am) to help regulate glucose input from food.
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I've no personal experience with Lantus. I understand it's performance profile is not exceptionally level across a 24 hr period and some people take it in the evenings to get the best of Lantus during the long night fast.

I would not recommend any Low alarm at 3.9 and even less so for someone new to all this. If it alarms genuinely at 3.9 then this is already too low and too late to do anything to prevent going hypo. This is akin to a fire alarm telling you it's too late to get out of the building. It's a shame the manufacturers call these "Alarms" rather than "Alerts"; because that is what they should be doing - alerting you to rapid changes and thresholds for your better BG management. I would have my alarm set at 5, at least, if I were in your situation and knowing what I now know after c. 4.5 years with no panc'y.

As @rebrascora has said it is sensible to fp whenever your CGM is indicating very low or very high and CONFIRM the tech is about right; it can be wrong at either end of the "range" between 4 to 10 and the small print in the blurb tells you this; also it's not a medical requirement for the licensing approval.

But, answering your original question, assuming you need snack suggestions just to nudge your BG up a little, a single plain biscuit could be good, even with a cup of tea or hot chocolate. This provides a slower conversion of carbs with a modest glycaemic index, into glucose and thus more enduring through the small hours. Even a small cereal bar is good. Smart use of your CGM and graphs will allow you to review what came from such a snack; trial and learning is fundamental to all of this. Part of making that trial and learning work is to log various actions at the right times with reasonably accurate data. Then any reviews for the learning process is made avlot easier. Hypo treatments, such as JBs or Dextrose provide a rapid response, but can fade quite quickly afterwards.

But, as I previously said, repeatedly going low at similar times is a clear indicator that you are carrying too much insulin; since the only extraneous insulin that you have "on board" is your lantus, you have a clear sign that you need less lantus to reduce or stop these lows.

It could be that even though your lantus taking is pretty new, it may already be giving an overworked pancreas some respite. That respite, with possble dietary changes you might be making, could allow your homegrown insulin to work more efficiently and even temporarily lower your own natural insulin resistance. In effect all sorts of modest changes could be helping your metabolism. These deductions are my thoughts and not necessarily medical facts. Good luck, do keep asking questions.
 
ew7k said:
Thank you, I really appreciate your questions. I have an appointment this week and your input will help me ask the right questions. The alarm goes off below 3.9, and I don't do a prick test then. I take the Lantus at midday, as I understand it to keep underlying levels steady, and Metformin after breakfast (around 8am) to help regulate glucose input from food.
Click to expand...

Lantus has a flattish profile with a little bump of activity after about 5hrs. It takes about an hour to get going, and usually lasts a little less or a little more than 24hrs in total (varies with dose and person). Generally advice is to take once a day at the same time. I struggled for years with occasional overnight hypos. I was taking mine at bedtime, and hadn’t realised the little 5hr ‘bump’ would coincide with the general drop-off in hormone production around 3am.

Switching to taking it at breakfast time helped me a lot.

Interesting what you’ve been told about Metformin. My understanding is that Met doesn’t really work directly on food - it mostly works in the background, reducing glucose output from the liver, and improving insulin sensitivity. It seems to ‘soak into’ your system gradually building up over weeks, rather than having a dose-specific onset/activity/tail pattern.

Hope you can manage to get the Lantus to help you during the days without doing too much at night. If you naturally need less insulin at night time, perhaps something with a shorter duration like Levemir, taken at breakfast and fading by bedtime (14-16hrs duration) might suit you better?
 
Thank you. I'll try to clarify my understanding at my appointment today (I'm just under 3 weeks into the Metformin) and trying to improve my food timings, too
 
Metformin is thought to have some effect in the intestines on food, and I've seen studies showing that if it's taken between 30-60 minutes before a meal there's a benefit for post-meal glucose. (Something to do with a peptide that it stimulates.)
 
Thanks for your input, and many thanks for everyone's comments. Really positive and helpful info, and reassuring to know there is so much support out there.
 
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