Night time hypo

[Paul1973]

Hello and this is my first time writing so apologies in advance.
My son has a hypo same time every night. We have changed his meal time insulin but this made no difference. We give him glucogel jelly babies orange juice all the usual but nothing works. Then about 2 hours later his blood finally starts to go up. Can anyone tell me why this is happening and why the usual sugar stuff doesn’t work for hours. Thank you

 

[Sally71]

Maybe you need to change his basal insulin dose or change the timing of it? What insulins is he on?
If he's on a pump then you just need to reduce the basal rate a bit for 2-3 hours before. Please speak to your medical team if you're not sure, how long has your son been diagnosed?

I find night time hypos are a pain in the backside too, my daughter has less now but on the odd occasion that she does have one at bed time it can take anything up to an hour to come back up again, not nice at all for her and not fun for me either when I just want to relax and enjoy my evening and not be camped out in her room just to make sure she's safe! And then she'll probably go high later, as if the stomach has been on a go-slow and then all that sugar suddenly hits the blood stream at once. I have no idea why this happens, that's diabetes for you, sometimes it refuses to follow rules and logic and just does what it wants

 

[Thebearcametoo]

Give us some more info. What are his numbers? What basal (long acting) is he on and how long after his meal is he having the hypo?

please get your DSN involved

 

[Paul1973]

Give us some more info. What are his numbers? What basal (long acting) is he on and how long after his meal is he having the hypo?

please get your DSN involved

Hello and thank you for replying, he is on lantus with a dose of 8, if was 10 and we reduced it. I have changed the time of when we do this but the same result and roughly the same time. Changed meal times and it is a good 2 hours plus before we do the night time injection. Just confused and don’t understand why the sugary stuff doesn’t kick in. He is very sleep deprived and had too keep him off school so he could catch up. Any advice would be grateful

 

[Paul1973]

Also his numbers are dropping to about 2.7-3.8 and then peaks later at about 15

 

[Thebearcametoo]

How long are you waiting on retesting before giving more (a second) hypo treatment? When my daughter (9) was first diagnosed we were told to test after 10 minutes and then give more hypo treatment if she still wasn’t above 4. Now she’s grown a bit we notice that waiting 15 minutes means we don’t over treat and then end up with her at 14/15 afterwards.
It sounds like something is off with either his fast acting or his Lantus and it may take a bit of jiggling around to get it right. If you have the on call numbers for your team I would chat with them today about what to do this evening. If you give them the numbers from the last few days they’ll be better able to fine tune it for you than we can. It’s not an emergency but it is still an appropriate call to make today rather than knowing he will be in a similar position tonight so do call them.

Don’t forget exercise can have an effect on glucose levels for 24 hours or more afterward so that may also factor into it

 

[Paul1973]

How long are you waiting on retesting before giving more (a second) hypo treatment? When my daughter (9) was first diagnosed we were told to test after 10 minutes and then give more hypo treatment if she still wasn’t above 4. Now she’s grown a bit we notice that waiting 15 minutes means we don’t over treat and then end up with her at 14/15 afterwards.
It sounds like something is off with either his fast acting or his Lantus and it may take a bit of jiggling around to get it right. If you have the on call numbers for your team I would chat with them today about what to do this evening. If you give them the numbers from the last few days they’ll be better able to fine tune it for you than we can. It’s not an emergency but it is still an appropriate call to make today rather than knowing he will be in a similar position tonight so do call them.

Don’t forget exercise can have an effect on glucose levels for 24 hours or more afterward so that may also factor into it

Thanks again for advice, really appreciate it. I have been waiting for 15 mins then blood testing as well as libre sensor. Results are low I repeat the glucogel or jelly babies. This process goes on until the levels reach an acceptable level, then he falls asleep and when I check in the morning you can see the spike. Awaiting a call from the diabetic nurse.

 

[Thebearcametoo]

For what it’s worth we use lucozade sport or dextrose tablets as they’re both fast acting (and she hates the gel) and always have a drink of water too as it helps the glucose to be absorbed quicker (plus rinses the teeth a bit). Hope the on call nurse can help out.

I don’t know how long your son has been diagnosed but the only certainty we’ve found it that sometimes you just can’t get it right. Hope his hypos stop.

 

[Paul1973]

For what it’s worth we use lucozade sport or dextrose tablets as they’re both fast acting (and she hates the gel) and always have a drink of water too as it helps the glucose to be absorbed quicker (plus rinses the teeth a bit). Hope the on call nurse can help out.

I don’t know how long your son has been diagnosed but the only certainty we’ve found it that sometimes you just can’t get it right. Hope his hypos stop.

Thank you so very much, your comments have made sense and I will try the lucozade. First time on here and can’t believe how helpful everyone is. Long journey ahead but help like this is so positive. Thank you once again.

 

[trophywench]

Everyone's BG drops at approx. 3am - the A&E staff (or indeed anywhere with a night shift) on duty at that time usually need to eat about then - even if it's only grab a Mars Bar to help em continue to function efficiently. Trouble is with hypos, if BG has been low enough for long enough - as well as treating the hypo the liver kicks in and releases some of its own store of glucogen, which exacerbates the rise in BG. However none of us knows either when it will do that or how much glucagen (or is it glucagon?) it will release or how much that will increase the BG by. It's merely one of the things the human body does so no point in pondering about it. But no point in relying on it either cos sometimes it doesn't do that hence we absolutely must err on the high side of the equation if we want to stay alive!

Now then - Lantus is far from 'level' in the way it releases into the body after injecting it. It typically 'spikes up' its performance after about 4 or 5 hours, but again one can't pin that down more exactly since every human body will be different just cos they are and it will also depend on that we did that day or the day(s) before, and precisely what we happened to eat at which exact times, our emotional state and whether we have been in contact with any infections viruses etc. AAAaaaaaaaaaaarrgghh!!!!

Don't be surprised if nursey suggests changing the Lantus for something else - I'm a huge fan of Levemir myself but I don't know whether it works as well for children, I'm sorry.

Something needs changing, clearly and frankly - I'd much rather he had a pump!

 

[rebrascora]

Hi

Does he take the Lantus on an evening or in the morning? If it is pm then I wonder if swapping to a morning injection would help with this problem as then the peak will occur during waking hours. You would need to discuss this with your DSN.
I am also a fan of Levemir as it is split into 2 doses, morning and evening and you can therefore adjust the evening dose to cater for this sort of problem.

The other thing that might be occurring is if he is eating quite fatty food like pizza for his evening meal. The fat delays the breakdown of the carbohydrates which means that the Bolus insulin can hit the system before the carbs do causing a hypo and then the delayed carbs and hypo treatment both send the BG skyward later. It would depend on when the hypos are happening. If they are late evening then it may be the evening meal bolus. If it is through the night then likely the Lantus peaking.

I would be inclined to wait a bit longer with the hypo treatment before repeating, especially if he has a Libre fitted as you should be able to see if he is still dropping or if his BG is levelling off or starting to rise. If it is level or starting to increase then give it another 5-10 mins before considering giving more hypo treatment. I appreciate that Libre is about 10 mins behind a BG reading but it should give you an indication of whether it is safe to wait a bit longer before hitting the hypo with a second treatment or imperative to give it without delay.

 

[everydayupsanddowns]

Like @rebrascora I am wondering if he is taking Lantus in the evening. I had lots of overnight hypos until I switched to taking it at breakfast. It wasn’t perfect then for me (a pump is much better) but it was the best I ever got Lantus to work.

 

[trophywench]

I tried changing it but then I'd be hypo before lunch instead - and I already had a permanent 12 -1 lunch hour.

Tried splitting it and never knew where I'd be whatever time it would be.

Hence the change to Levemir. My BG always increases around 11pm ish so I need higher basal then to cover it. Such things you don't actually discover until you have a pump and had it long enough to get all long-acting insulin out of your own body - and the test test test, review and adjust!