Low BG during night

[Lily123]

Hi

I’ve had trouble for a while now trying to not hypo during the night. My numbers either go high at about 8 or 9 o’clock up to 14+ and I’ll do a correction or they’ll start on a good number and I’ll have a snack. I’ll hypo either way.

This week I’ve had 2 nights where I’ve needed 4 cans of coke (4 hypos not one massive one)

I’ve tried adjusting dinner insulin but that makes me go low then high anyway. If I do less correction it doesn’t seem to work and I can’t adjust the basal as it’s Tresiba and will run higher throughout the day. Attached a few graphs from over the past few weeks.



If anyone has any suggestions, greatly appreciated

 

[Tdm]

Ok...most of the time you are 4 or above at night. A couple of times you are getting false lows (where the dots are below the graph). But i am not sure overnight is your issue
I might concentrate of the evening peaks...i think they may be setting you up for issues overnight. What do you eat? I find lowish carb is easier to manage...i also find taking a walk straight after eating helps. I also find a 20 min walk or 5 min on excercise bike brings bs down qucker, and more reliably, when i have some insulin on board than taking a correction dose. I may be unusual in that.
Do you prebolus? I have to prebolus 25-30 min for morning muelli.
What do you do for your midday meal, because that seems to stay in range...can you make breakfast and evening meal more like your midday meal, cos if you could you'd be near 100% time in range?

 

[Lily123]

Thanks for your reply

Lunch is a packed lunch at school (sandwich,fruit) and isn’t really ideal at dinner.

Dinner can vary from a stir fry to something like a roast dinner. I prebolus about 10 minutes and this works at lunch and is all I can manage at breakfast and dinner.

The reason lunch doesn’t spike is the prebolus seems to work then and a 1 mile walk at 3 o’clock. This walk also helps bring the breakfast one down (sometimes a correction as well) as it is the walk to school so it’s more routine

 

[Bruce Stephens]

The reason lunch doesn’t spike is the prebolus seems to work then and a 1 mile walk at 3 o’clock. This walk also helps bring the breakfast one down (sometimes a correction as well) as it is the walk to school so it’s more routine

I find a walk after eating helps a lot. It's just harder to persuade myself to go for a walk after dinner, unfortunately.

 

[Lily123]

I find a walk after eating helps a lot. It's just harder to persuade myself to go for a walk after dinner, unfortunately.

That’s what I find. I know that I have to do that walk to and from school but otherwise I can’t be bothered

 

[rebrascora]

Hi. I am not actually seeing hypos on your graphs (?), but there does look to be an overnight downward trend on at least 2 out of the 3 overnight periods. The one from Monday skyrockets at 6am. Was that after drinking coke or do you have breakfast at 6am or just a very strong Dawn Phenomenon?
I wonder if a change of basal insulin might be helpful if this is a recurring trend. Levemir would allow you to adjust your night time dose separate of your daytime one. I know I could not manage on Tresiba because I need so much less at night than I do during the day, but there are many people who find Tresiba works for them and I am guessing it has for you in the past, but perhaps your circadian rhythm is changing and it is no longer suiting you. It is something to think about and discuss with your nurse.
I would also consider having slower release carbs during the night if you are drinking coke when your Libre alarm goes off rather than when you are actually hypo.... Not sure what your low alarm is set at, but a biscuit or two (maybe a KitKat) might keep your levels afloat better than the coke (and probably not as bad for your teeth) if you are not actually hypo. Obviously if you are below 4 then coke or whatever other hypo treatment is essential, but just with the graphs not actually showing you hypo through the night, it makes me wonder if you are treating the "alarm" as a hypo.

 

[Lily123]

Thanks for your reply
It’s less actually hypos but the Libre and I do always double check with a finger prick and that’ll tell me about 4.5 or so and I’ll have a coke anyway so I’m not low within minutes. The alarm is set at 4.2.

The spike at 6 o’clock was a can of coke when a finger prick read 4.3. I have breakfast at 6:40.
I use a straw for cokes as did get told off by the dentist for that one today!
I do have a long acting carb ( a few small cookies… the snack pack size) but they don’t sustain it for very long.

I do keep meaning to ask about Levemir because I need less basal during the night than during the day. Just a case of forgetting to mention at clinic

 

[Bruce Stephens]

I do keep meaning to ask about Levemir because I need less basal during the night than during the day.

Yes, makes sense to consider that.

 

[rebrascora]

I think it would be helpful to show in the notes on your Libre that you are taking hypo treatments through the night because it will not be immediately apparent to your DSN or consultant that you are having to head off a lot of nocturnal hypos unless you log them in the notes. This will then give you clear evidence because at the moment, they may just look at your graphs and think you are doing fine because that is what it looks like..... but if you have apple symbols regularly appearing through the night, then that will highlight the problem.
I always make a list of questions before my appointment of things I want to discuss and I write them on my appointment letter, as and when I think of them, so that I have them with me when I attend or have phone appointment.

 

[Lily123]

I will start adding notes, that’s a really good idea thanks!

I shall definitely write a list of questions for my next appointment

 

[Spathiphyllum]

... It’s less actually hypos but the Libre and I do always double check with a finger prick and that’ll tell me about 4.5 or so and I’ll have a coke anyway so I’m not low within minutes. The alarm is set at 4.2.

The spike at 6 o’clock was a can of coke when a finger prick read 4.3. I have breakfast at 6:40. ...

Barbara's right-- always make notes in your Libre 'Logbook'! It's a bit of a pain sometimes, but it's the only way your diabetes team can know what's going on.

On the main issue, though ... Why do you set your alarm at 4.2? ... That's not actually hypo, so you may be taking a lot of 'hypo corrections' you don't actually need.

It's not uncommon or unhealthy for normal people's BG to go down to high 3s or low 4s overnight, while they sleep. My DSNs and my diabetes consultant have all talked about this; none of them are diabetic but all of them have worn the Libre for a fortnight, so they could know what it's like for patients. They've all reported occasional readings below 3.9 (and a few way below) while sleeping.

As for the "spike at 6 o'clock"-- your finger prick was 4.3, you were going to have breakfast soon, and you still had a can of coke? ... I'm wondering how long you've been Type 1, and whether maybe you've had bad experiences with real hypos in the past, which have made you overcautious now?

 

[Leadinglights]

Barbara's right-- always make notes in your Libre 'Logbook'! It's a bit of a pain sometimes, but it's the only way your diabetes team can know what's going on.

On the main issue, though ... Why do you set your alarm at 4.2? ... That's not actually hypo, so you may be taking a lot of 'hypo corrections' you don't actually need.

It's not uncommon or unhealthy for normal people's BG to go down to high 3s or low 4s overnight, while they sleep. My DSNs and my diabetes consultant have all talked about this; none of them are diabetic but all of them have worn the Libre for a fortnight, so they could know what it's like for patients. They've all reported occasional readings below 3.9 (and a few way below) while sleeping.

As for the "spike at 6 o'clock"-- your finger prick was 4.3, you were going to have breakfast soon, and you still had a can of coke? ... I'm wondering how long you've been Type 1, and whether maybe you've had bad experiences with real hypos in the past, which have made you overcautious now?

I don't know if you realise but Lily is pretty young, still at school, and for her age has a brilliant understanding of diabetes and I'm sure will take any suggestions on board.

 

[JJay]

On the main issue, though ... Why do you set your alarm at 4.2? ... That's not actually hypo, so you may be taking a lot of 'hypo corrections' you don't actually need.

Actually, quite a few of us have our alarms set at above "hypo level". The idea is to take action (if necessary - depends on the direction of the arrow) to avert a hypo!

 

[Inka]

Yes, my Low alarm is set in the 5s - two reasons I) to take action early 2) because Libre isn’t always accurate, especially if blood sugar is falling fast. It often reads higher than you actually are.

Levemir would be a good solution @Lily123 It really helps having the ability to adjust day and night separately.

 

[Lily123]

Barbara's right-- always make notes in your Libre 'Logbook'! It's a bit of a pain sometimes, but it's the only way your diabetes team can know what's going on.

On the main issue, though ... Why do you set your alarm at 4.2? ... That's not actually hypo, so you may be taking a lot of 'hypo corrections' you don't actually need.

It's not uncommon or unhealthy for normal people's BG to go down to high 3s or low 4s overnight, while they sleep. My DSNs and my diabetes consultant have all talked about this; none of them are diabetic but all of them have worn the Libre for a fortnight, so they could know what it's like for patients. They've all reported occasional readings below 3.9 (and a few way below) while sleeping.

As for the "spike at 6 o'clock"-- your finger prick was 4.3, you were going to have breakfast soon, and you still had a can of coke? ... I'm wondering how long you've been Type 1, and whether maybe you've had bad experiences with real hypos in the past, which have made you overcautious now?

I had a can of coke because otherwise I would have been low at breakfast.

It may be normal for people without T1 for their BG to drop below 4.0 but the saying is “4 is the floor” and otherwise I would actually go hypo and have to wait the 10 minutes to come back up to actually be able to sleep again.

I’ve been T1 seven years, no really bad episodes but have been 1.7 and only felt like I would have at 3.9

 

[Lily123]

Yes, my Low alarm is set in the 5s - two reasons I) to take action early 2) because Libre isn’t always accurate, especially if blood sugar is falling fast. It often reads higher than you actually are.

Levemir would be a good solution @Lily123 It really helps having the ability to adjust day and night separately.

I might get my parents to email the diabetes team and ask anyway, just to get the ball rolling.

 

[Bloden]

Actually, quite a few of us have our alarms set at above "hypo level". The idea is to take action (if necessary - depends on the direction of the arrow) to avert a hypo!

Mine’s set at 4.4 cos I want to know if there’s a low on the horizon. I’m sick of hypos - brain fog, can’t get on with my day for at least half an hour, feel rubbish, etc. - so I decided to avoid them altogether. In your face, hypos! 😉 🙂

I liked Tresiba @Lily123 but found, like you, that if I tweaked it to stay hypo-free overnight I was lacking basal throughout the day. I can’t remember if you’ve asked about a pump. That would be the best solution, but Levemir comes a close second. 🙂

 

[Lily123]

Mine’s set at 4.4 cos I want to know if there’s a low on the horizon. I’m sick of hypos - brain fog, can’t get on with my day for at least half an hour, feel rubbish, etc. - so I decided to avoid them altogether. In your face, hypos! 😉 🙂

I liked Tresiba @Lily123 but found, like you, that if I tweaked it to stay hypo-free overnight I was lacking basal throughout the day. I can’t remember if you’ve asked about a pump. That would be the best solution, but Levemir comes a close second. 🙂

I’m definitely going to ask about Levemir.

I asked about a pump last February and went to the pump info day in April. The diabetes team said they were 100% on board thinking it was a good idea. It hasn’t been mentioned since apart from they said they would put in an Individual Funding Request as I don’t qualify under the NICE guidelines (don’t think so anyway) but the diabetes nurse has been off a while with an injury so everything has slowed down with communication

 

[Bloden]

I’m definitely going to ask about Levemir.

I asked about a pump last February and went to the pump info day in April. The diabetes team said they were 100% on board thinking it was a good idea. It hasn’t been mentioned since apart from they said they would put in an Individual Funding Request as I don’t qualify under the NICE guidelines (don’t think so anyway) but the diabetes nurse has been off a while with an injury so everything has slowed down with communication

I found that everything ground to a halt after I’d done the pre-pump carb counting course, so after a month waiting and wondering I sent an email to the clinic and that got things moving again. Very unlike me to be pushy...but I really wanted a pump! I hope you don’t have to wait too long to find out. 🙂

 

[Lily123]

I found that everything ground to a halt after I’d done the pre-pump carb counting course, so after a month waiting and wondering I sent an email to the clinic and that got things moving again. Very unlike me to be pushy...but I really wanted a pump! I hope you don’t have to wait too long to find out. 🙂

My next appointment is March so will ask again then.