• Please Remember: Members are only permitted to share their own experiences. Members are not qualified to give medical advice. Additionally, everyone manages their health differently. Please be respectful of other people's opinions about their own diabetes management.
  • Diabetes UK staff will be logging into the forum at various times throughout this Bank Holiday weekend, however, if you require emergency medical assistance or advice please call 999, or if it is less urgent then please call the 24 hour NHS 111 service on 111. Alternatively, please speak to your GP or healthcare team.
  • We seem to be having technical difficulties with new user accounts. If you are trying to register please check your Spam or Junk folder for your confirmation email. If you still haven't received a confirmation email, please reach out to our support inbox: support.forum@diabetes.org.uk

In need of advice about night time levels

Status
This thread is now closed. Please contact Anna DUK, Ieva DUK or everydayupsanddowns if you would like it re-opened.
G

garymarshall

New Member
Relationship to Diabetes
Parent of person with diabetes
Hi My 6 year old has type 1. We are managing to control his levels overall but struggle at night time. We are having to wake him up at about 2am to feed him as his levels seem to drop sharply. We have tried all sorts of evening meals/snacks but have not managed to find anything that will keep his levels stable at night. Has anyone got any suggestions or found anything that works? Would appreciate any advice. We are all very tired!
 
Hi Gary, welcome to the forum 🙂 How long has he been diagnosed, and what insulin regime is he on? It sounds very much as though his insulin doses need reducing. What numbers is he normally going to bed on? Most people experience a drop of some extent around 2-3 am due to the liver being least active at this time in releasing glucose into the blood.
 
Hi Gary

As Northerner says it sounds as if he has too much insulin on board over night. Once we know what regime your son is on we will have more idea of what is going on. There are lots of strategies that you can use to sort this out, so let us know more about how you are treating his Diabetes.
 
Hi thanks for the reply. He was diagnosed about 3 years ago. We have tried different types of insulin (he is currently on Degludec) by injection. The Doctors recommend he goes to bed about 10 but he is usually in the 10-15 range (at 8pm). He is on I unit per 15g which seems to be perfect during the day. The Doctors have recommended a high protein/fat snack last thing (ham sandwich/cheese & biscuits/pork pie) but it has not really helped....
 
garymarshall said:
Hi thanks for the reply. He was diagnosed about 3 years ago. We have tried different types of insulin (he is currently on Degludec) by injection. The Doctors recommend he goes to bed about 10 but he is usually in the 10-15 range (at 8pm). He is on I unit per 15g which seems to be perfect during the day. The Doctors have recommended a high protein/fat snack last thing (ham sandwich/cheese & biscuits/pork pie) but it has not really helped....
Click to expand...
I'm not sure I understand - is he just on degludec (aka Tresiba)? Or does he take a separate fast-acting insulin with his food? Degludec is a basal insulin so is meant to 'cover' the background glucose constantly trickled out by the liver - doses should not be adjusted according to carbs consumed otherwise there will be times throughout the day and night when he is not eating and the insulin will be too high. In an ideal situation the basal insulin should keep him steady and rarely need adjusting, and it shouldn't be necessary for him to go to bed in double figures. What other insulins has he tried and what problems has he encountered?
 
Sorry his background of 9 units is Degludec and he gets novorapid with meals. The Doctors thought it might be the background insulin that was effecting night time. We inject his background -degludec after breakfast. We moved it from the evening on the doctors advice. He has always be on Novorapid with meals
 
garymarshall said:
Sorry his background of 9 units is Degludec and he gets novorapid with meals. The Doctors thought it might be the background insulin that was effecting night time. We inject his background -degludec after breakfast. We moved it from the evening on the doctors advice. He has always be on Novorapid with meals
Click to expand...
Ah, thanks, makes more sense! 🙂 It certainly sounds like his degludec dose is too high if he is dropping overnight and/or needing snacks to see him through. The problem is that, as it is just one injection to cover the whole day and night then it's very difficult to adjust if it is suiting his requirements well during the day. Has an insulin pump been suggested? With that you would be able to adjust the insulin so that it matches his needs more closely. Has he tried levemir? That is a basal insulin that can be 'split' over 24 hours into two injections with some success if nighttime requirements are lower than during the day. Trying to feed him to maintain levels overnight can't be a long-term solution and will keep his levels higher than they need to be.
 
Ask for a pump, this would solve the problem.
 
He was on Levemir but the doctor moved him to degludec. I did not know Levemir could be split? Can Degludec? The consultant thought a pump would not be any better. His average is stable at 7.5 which we are told is excellent but the great trend after breakfast and during the day is not maintained at night when he is too high after supper and falls too much at night. When I tested him at 12.30am last night he was 8.7 by 3.30am he was 2.7
 
garymarshall said:
He was on Levemir but the doctor moved him to degludec. I did not know Levemir could be split? Can Degludec? The consultant thought a pump would not be any better. His average is stable at 7.5 which we are told is excellent but the great trend after breakfast and during the day is not maintained at night when he is too high after supper and falls too much at night. When I tested him at 12.30am last night he was 8.7 by 3.30am he was 2.7
Click to expand...
I don't know a great deal about degludec, but it is supposed to have a'flatter' profile and last longer than other basals, so can be suitable for some people. However, levemir is often given in split doses, and often an uneven split e.g. 5 units morning, 4 units evening. I would fundamentally disagree with the consultant's assessment that a pump would not be better, I'm afraid that is nonsense! Basal doses can be adjusted on an hourly basis, up or down - impossible on injections. Pumps are particularly helpful for young, active,growing children, so I would definitely push for the option. Have a look at the Input website for information about pumps: http://www.inputdiabetes.org.uk/

Levels should not really vary by more than 2 mmol/l between bedtime and waking if the basal insulin is set correctly.
 
Thanks for the advice. A 2 mmol/l variation would be fantastic. I will go back the consultant to try to sort this out. As you say this cant go on long term
 
garymarshall said:
Thanks for the advice. A 2 mmol/l variation would be fantastic. I will go back the consultant to try to sort this out. As you say this cant go on long term
Click to expand...
Good luck Gary! This should be solvable, so don't take no for an answer! 🙂 A pump would give him (and you) so much more flexibility. They aren't a simple solution, and do require some work to get things adjusted correctly, but the rewards can be very great 🙂
 
p.s. didn't really answer your question! I used to find that toast and peanut butter was a good snack before bed - carbs and protein, and the fat in the PB slowed the digestion so there was no 'spike' in levels and a slower release. But get onto your consultant as soon as you can 🙂
 
I think it strange that your consultant did not suggest splitting. The Levemir as this is the most common way of taking it and it does allow flexibility with doses, as Northener mentions that way you could keep day time levels and lower night time dose. Also agree with Northerner, a pump would offer much more flexibility and control and while not an easy solution, seems like it would be the best option in your case.
 
Splitting Levemir made so much difference to me for my basal. It gives flexibility to adjust doses overnight to get that right, and also to adjust the morning dose for what is planned for the day. That still does not address the common problem of the drop that a lot of us get around 3:00 am.

So I am with others in saying that a pump would make all the difference. That way you can adjust the co background insulin hour by hour.
 
Ps
Are you using a half unit pen. That gives a tighter adjustment to doses. I know that these are available from novopen. Not sure who else makes them.
 
SB2015 said:
Ps
Are you using a half unit pen. That gives a tighter adjustment to doses. I know that these are available from novopen. Not sure who else makes them.
Click to expand...
The Sanofi one is the Juniorstar. I use it with my Lantus, but I don't know if you can use Tresiba in it.
 
Robin said:
The Sanofi one is the Juniorstar. I use it with my Lantus, but I don't know if you can use Tresiba in it.
Click to expand...
I don't know, but I've a feeling that Tresiba is only available in pre-filled pens, not cartridges - if it is available in cartridges then it would probably fit in a novopen echo as it's made by Novo Nordisk. Tresiba is further complicated by being available in different strengths.
 
If half unit pens are not available for the insulin you are using is it available in a more diluted strength so that you adjust doses more accurately. Sorry not to be more knowledgable ii used Novorapid and Levemir and used them both in half unit pens which was great.
 
Status
This thread is now closed. Please contact Anna DUK, Ieva DUK or everydayupsanddowns if you would like it re-opened.
Back
Top