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Night hypo

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WigseLove

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Hi everyone
My husband is type 1 diabetic and has been for 19 years now. He was put on Toujeo a couple of years ago, and takes novorapid throughout the day. The issue we have now is he is regularly fighting going high so is injecting more than is needed according to the food he is eating, so we deduced he must need more toujoe HOWEVER he has not increased his toujoe dose as he is also having hypos in the night.
So he doesn’t eat any carbs later on an evening and doesn’t inject any novorapid, have his toujoe at around 10pm, goes to bed at a good blood sugar level then has a hypo in the night (doesn’t wake up) and then wakes up in the morning high! We just can’t fathom it out and are really stuck with how to stop it.
any advice or thoughts would be greatly appreciated
 
Hi and welcome.

Sorry to hear your husband is having problems. Was he able to manage his diabetes better before he was switched to Toujeo and if so why was his basal insulin changed? Has he discussed the problems he is having with his nurse or consultant?
I believe that @Michael12421, who is in Spain is also using Toujeo and having similar problems with unexpected and unpredictable hypos through the night but unfortunately he doesn't have any option to change.
I would suggest taking it in the morning rather than at night and then at least any hypos that occur when it kicks in, will be easier to deal with when he is awake. Also, generally, basal insulin needs are greater for most people through the day so if he is getting a spike of insulin activity 4 or 5 hrs after taking it, then that might even be beneficial during the day.
Either way, he needs to discuss his problems with his Health Care Professionals to find a solution as his current regime is not suiting him and either change back to his previous insulin if Toujeo is not suiting him or alter when he takes it and see if that works better or try something a different basal insulin.
Out of curiosity, how do you know he is having hypos through the night if he doesn't wake up? Does he have a Freestyle Libre or other CGM and how low is he going?

I should say that I have no personal experience of Toujeo or any medical training.

I use Levemir and inject 16 units at 8am and 7 units at 11pm as basal insulin (so pretty well twice as much basal insulin for the day compared to the night) as well as Fiasp for my meals and find that having the flexibility to alter daytime and night time doses of basal insulin to suit my individual needs/activity of the day etc is a huge bonus, and would highly recommend split dose Levemir if your husband has the choice of it.
 
rebrascora said:
Hi and welcome.

Sorry to hear your husband is having problems. Was he able to manage his diabetes better before he was switched to Toujeo and if so why was his basal insulin changed? Has he discussed the problems he is having with his nurse or consultant?
I believe that @Michael12421, who is in Spain is also using Toujeo and having similar problems with unexpected and unpredictable hypos through the night but unfortunately he doesn't have any option to change.
I would suggest taking it in the morning rather than at night and then at least any hypos that occur when it kicks in, will be easier to deal with when he is awake. Also, generally, basal insulin needs are greater for most people through the day so if he is getting a spike of insulin activity 4 or 5 hrs after taking it, then that might even be beneficial during the day.
Either way, he needs to discuss his problems with his Health Care Professionals to find a solution as his current regime is not suiting him and either change back to his previous insulin if Toujeo is not suiting him or alter when he takes it and see if that works better or try something a different basal insulin.
Out of curiosity, how do you know he is having hypos through the night if he doesn't wake up? Does he have a Freestyle Libre or other CGM and how low is he going?

I should say that I have no personal experience of Toujeo or any medical training.

I use Levemir and inject 16 units at 8am and 7 units at 11pm as basal insulin (so pretty well twice as much basal insulin for the day compared to the night) as well as Fiasp for my meals and find that having the flexibility to alter daytime and night time doses of basal insulin to suit my individual needs/activity of the day etc is a huge bonus, and would highly recommend split dose Levemir if your husband has the choice of it.
Click to expand...
Hi , thank you for replying.
He was taken off Lantus and put on toujoe, the doctor told him Lantus was outdated, his control was poor so he didn’t mind changing. In the night his levels are regularly reaching around 2.8.
he started using freestyle libre sensors which has highlighted the extent of the problems really, before using it we didn’t know he was having hypos most nights, which is really scary.
he doesn’t actually have a nurse or consultant working with him, he is going to speak to a gp tomorrow about his issues that I mentioned.
what you said sounds reasonable regarding the levels of basal needed and night/day time and would explain the hypos. I think it will be worth a try changing to morning injection just to see how it changes his reads.
we will discuss other options with the gp, your Levemir sounds good if it’s an option to try.
Thank you
 
You really should ask for him to be referred to a clinic where he will get expert advice and they will see from his Libre readout exactly what the problem is. GPs have little understanding of diabetes and the action of the various insulins.
If he does decide to change to morning injection, he will probably need a half dose the evening before and a few units less than his normal dose the first morning and it will probably take a few days for his levels to stabilise after changing, but at least most of the wobbles will be through the day and far easier to spot and deal with. You will need to make sure he doesn't accidentally take an extra dose in the evening out of habit until he gets into a new routine of course.
It certainly is worrying that he is sleeping through the 2.8s.

If you do change to morning injection and it resolves the problem can you get back to us and let us know as Michael in Spain is reluctant to change and it might give him the courage to try it if he reads of someone else's success.... or conversely, if it doesn't work, can you let us know and I will not push him to try it anymore. 🙂
 
Sorry to hear that your husband’s experience with Toujeo hasn‘t been great so far.

Having hypos regularly overnight really isn’t good for you - I speak from experience as one who significantly mangled my hypo awareness with overnight hypos.

Toujeo is designed to be very flat in its profile - but that isn't ideal if your husband’s insulin needs are lower overnight. In which case a splittable basal insulin like Levemir may well be worth considering.

Page 26 here compares the action of Lantus vs Toujeo. Lantus has a shorter action, and is peakier... but nevertheless it sounds like the dose of Toujeo is simultaneously too much and not enough 🙂
 
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