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Lows

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Inka said:
That’s probably a big part of the problem then @Woodywoodpecker Some Type 1s need a bedtime snack but they have that without insulin. If you have insulin with it,you’re undoing its purpose of making sure you don’t drop too low overnight.

Why are you needing to eat so early at 4.30pm? Is this because of work?
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Always had tea 4.30 - 5,
helli said:
I disagree.
A snack at 7:50 is unlikely to be bedtime snack - it is supper when tea is at 4:30 (and the reason for her eating times is irrelevant - diabetes needs to work around her day not the other way around).
I interpret Woody's comment that it is what she does regardless of diabetes not something to maintain BG throughout the night.
(Apologies @Woodywoodpecker if I have misunderstood)

Plus even a "slow" NovoRapid is unlikely to be the cause of a low more than 5 to 7 hours later.
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yes your right I have always had supper at that time, not a bed time snack don’t usually eat again till breakfast
 
@helli The problem is that that bolus for the bedtime snack could be taking her down to 4.5 or 5 at 1am and then there is very little wriggle room for the Levemir's action, which is why the bedtime suggestion of about 8mmols, at least in the early stages of managing diabetes is recommended with no bolus insulin active. If you go to bed on 8mmols but with active NR in your system, you could easily end up too low. I am not saying not to have supper ever again, but perhaps do some testing without it or with something low carb like a boiled egg to see if the Levemir is holding reasonably steady overnight or if the Levemir dose is too high. Or bolus for that snack but aiming to have a level of 8 when the NR runs out..... which might be tricky as you won't know where your levels would be from the previous meal's bolus. There is likely still some home produced insulin in the equation too.

I totally agree with your comment about alarm fatigue. I have my low alarm set at 4.5. Any higher and I have more hypos because I don't want to nudge my levels up above 5 all the time and I sleep best in the 4s and 5s. We are all different and each person has to find what works well for them as an individual. I think being advised to set it below 4 is quite surprising though, particularly for nocturnal hypos which seems to be the thing clinicians worry most about.
 
rebrascora said:
The problem is that that bolus for the bedtime snack
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My point is that it is NOT a bedtime snack!

And there is no reason why you cannot calculate a bolus dose with a different target BG in mind in the evening than during the day if you are concerned.

rebrascora said:
do some testing without it or with something low carb like a boiled egg to see if the Levemir is holding reasonably steady overnight
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Ok, some testing without the snack (which maybe difficult if the last time she eats is 4:30) could help to single out Levemir effect. But I would caution against a low/no carb snack like a boiled egg because this can still raise BG if the body breaks down the protein inthe absence of carbs. That could skew the results.
 
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rebrascora said:
@helli The problem is that that bolus for the bedtime snack could be taking her down to 4.5 or 5 at 1am and then there is very little wriggle room for the Levemir's action, which is why the bedtime suggestion of about 8mmols, at least in the early stages of managing diabetes is recommended with no bolus insulin active. If you go to bed on 8mmols but with active NR in your system, you could easily end up too low. I am not saying not to have supper ever again, but perhaps do some testing without it or with something low carb like a boiled egg to see if the Levemir is holding reasonably steady overnight or if the Levemir dose is too high. Or bolus for that snack but aiming to have a level of 8 when the NR runs out..... which might be tricky as you won't know where your levels would be from the previous meal's bolus. There is likely still some home produced insulin in the equation too.

I totally agree with your comment about alarm fatigue. I have my low alarm set at 4.5. Any higher and I have more hypos because I don't want to nudge my levels up above 5 all the time and I sleep best in the 4s and 5s. We are all different and each person has to find what works well for them as an individual. I think being advised to set it below 4 is quite surprising though, particularly for nocturnal hypos which seems to be the thing clinicians worry most about.
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My bedtime is early but I like to watch tv and snuggle in. Usually don’t go to sleep till 10.30, I checked libre on phone and it was between 8-9, so thought no need for another snack
 
Woodywoodpecker said:
My bedtime is early but I like to watch tv and snuggle in. Usually don’t go to sleep till 10.30, I checked libre on phone and it was between 8-9, so thought no need for another snack
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So, you will still have a little active NovoRapid on board when you go to sleep as it tends to last about 4 hours but it will be tailing off so I would not be concerned by 8 - 9 mmol/l at 10:30 (but I have no medical training). If it drops more than 4 mmol/l after that by 1am (to hypo), I still think Levemir is more likely to be the issue than the Novo~Rapid with your 23g snack.

I don't think it has been mentioned that it is very common to need less basal overnight than during the day and the benefit of Levemir over longer acting basals, like Tresiba, is that you can adjust your basal dose for morning and night to accommodate this.
 
helli said:
So, you will still have a little active NovoRapid on board when you go to sleep as it tends to last about 4 hours but it will be tailing off so I would not be concerned by 8 - 9 mmol/l at 10:30 (but I have no medical training). If it drops more than 4 mmol/l after that by 1am (to hypo), I still think Levemir is more likely to be the issue than the Novo~Rapid with your 23g snack.

I don't think it has been mentioned that it is very common to need less basal overnight than during the day and the benefit of Levemir over longer acting basals, like Tresiba, is that you can adjust your basal dose for morning and night to accommodate this.
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Thank you I always check before going to sleep, if it was lower would have a digestive. Yes I know Less at night, on the days I work have to take less as well as active job
 
I referred to it as a bedtime snack @helli because @Woodywoodpecker called it ‘a snack I have before bed’. I took that to mean within an hour or so of bed/sleep - ie at bedtime.

With the children, I sometimes eat as early as 5pm, so there’s nothing wrong with having an evening meal at 4.30pm @Woodywoodpecker For myself, I have a substantial meal then, and only a small non/low carb snack at bedtime. I find it easier not to go to bed with a bolus active.
 
Inka said:
I referred to it as a bedtime snack @helli because @Woodywoodpecker called it ‘a snack I have before bed’. I took that to mean within an hour or so of bed/sleep - ie at bedtime.

With the children, I sometimes eat as early as 5pm, so there’s nothing wrong with having an evening meal at 4.30pm @Woodywoodpecker For myself, I have a substantial meal then, and only a small non/low carb snack at bedtime. I find it easier not to go to bed with a bolus active.
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Sorry for the confusion, was going to put supper but some people class supper as evening meal
 
Woodywoodpecker said:
Sorry for the confusion, was going to put supper but some people class supper as evening meal
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It's a minefield! For example, since moving to Scotland I've discovered that 'a fish supper' simply means what I, as a mere Londoner, call "fish and chips" - and can be had at any time of day 🙄.
 
CliffH said:
It's a minefield! For example, since moving to Scotland I've discovered that 'a fish supper' simply means what I, as a mere Londoner, call "fish and chips" - and can be had at any time of day 🙄.
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We have a lot off weird sayings. Used to travel to work with a guy from England, we say yeah ken a lot, he asked who’s the Ken ur always talking about
 
Woodywoodpecker said:
Sorry for the confusion, was going to put supper but some people class supper as evening meal
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We had an embarrassing situation when invited for supper which we assumed would be coffee and a small snack as it would have been up north so had dinner and then went and were horrified to find that it was indeed a full meal.
It does seem to be a southern expression to mean dinner. Easy to get confused.
 
Leadinglights said:
We had an embarrassing situation when invited for supper which we assumed would be coffee and a small snack as it would have been up north so had dinner and then went and were horrified to find that it was indeed a full meal.
It does seem to be a southern expression to mean dinner. Easy to get confused
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A wud off thought same as you. For us dinner is lunch time, evening meal is tea time. Hope you had plenty room for the meal
 
Woodywoodpecker said:
Dropped levimer to 5 last night, no alarm nice to get full nights sleep
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Great stuff @Woodywoodpecker

Hope your half unit pen comes through before too long to give you a little more flexibility if things change as the Spring approaches (as it often does for me!)
 
Woodywoodpecker said:
Where are you in Scotland, think every area has their own language
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Stirling - although "Help ma boab" is from the 'Oor Wullie' comic strip, written in Dundee. Having said that, when I worked in Dundee a couple of years ago, I never heard anyone say it!
 
CliffH said:
It's a minefield! For example, since moving to Scotland I've discovered that 'a fish supper' simply means what I, as a mere Londoner, call "fish and chips" - and can be had at any time of day 🙄.
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Seriously, did you never read Orr Wullie or The Broons as a child.

Breakfast dinner tea supper, that's what we were brought up on.
 
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