Hey, I'm new here hoping for some help. I'm type 1 and my blood sugar is quite well controlled, but the last 2 times I've woken up to a hypo during the night, it has taken so long for my body to react to the hypo treatment, I've had to repeat the treatment 2/3 times, sometimes not seeing my reading rise until I've been hypo for around 30/40 minutes which is exhausting. Does anyone have any ideas that I could try to make it work a bit faster? Thanks in advance
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Night time Hypo's
- Thread starter LauraR
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John Gray
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What is the hypo treatment you are using?
It needs to have rapidly-available sugars, like: orange juice, non-diet Coke, jelly babies, glucose solution/glucose gel, and the like...
In the worst case, glucagon would be injected by a paramedic.
It needs to have rapidly-available sugars, like: orange juice, non-diet Coke, jelly babies, glucose solution/glucose gel, and the like...
In the worst case, glucagon would be injected by a paramedic.
Jasmin2000
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Hi @LauraR - firstly, do you use a CGM, such as Libre because there are alarms you can set to warn of hypos?
Secondly, it can take a while to get BG back up - how low were you and did you need help or could you work out what to do?
By 'treatment' I guess you mean glucose? Quickest is a glucose solution, such as Dextrose drink or similar, fruit juice, etc.
If it's a really persistent hypo you should talk to your GP about reducing your basal insulin or not inject any fast-acting too close to bedtime.
Secondly, it can take a while to get BG back up - how low were you and did you need help or could you work out what to do?
By 'treatment' I guess you mean glucose? Quickest is a glucose solution, such as Dextrose drink or similar, fruit juice, etc.
If it's a really persistent hypo you should talk to your GP about reducing your basal insulin or not inject any fast-acting too close to bedtime.
Yes I have the libre. I set it so I get an alert at 4.2 so I know to expect a hypo, but both times during the night I've got up straight away and it's gone down super fast, I normally drink full sugar Coca-Cola, but I have tried fresh orange, lift glucose drinks and Smoothies. Eventually my glucose level does go up it just takes longer than it does through the day if that makes sense.
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Hello @LauraR
Welcome to the forum!
Bah! Night time hypos - they are the worst aren’t they!
A few questions -
It was rejigging my basal that helped me 🙂
Welcome to the forum!
Bah! Night time hypos - they are the worst aren’t they!
A few questions -
- Which basal insulin do you take, and when do you take it?
- What time is your evening meal?
- What rapid insulin are you on (I’m assuming you are on MDI not mixed insulin!)
It was rejigging my basal that helped me 🙂
Jasmin2000
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Hmm.. sounds like you're taking too much basal or have taken fast-acting or done strenuous exercise before bedtime.
How low does it get? My basal sometimes takes me down to 3.0 and it takes 15-30 mins to get it back in range. The extended time taken makes sense when you're fighting the insulin still circulating. Never seen so many cop shows at 3 am!
Hi I take Levemir 26 units AM and 14 units PM. I take fiasp rapid acting with meals. I normally have my evening meal around 5/6pm. I dont have that many hypos through the night but when I do, my glucose takes so much longer to go up than it does during the day which is really annoying
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I absolutely feel your pain!
Sounds like you are working really hard at it. My experience wad that I could tweak and tailor my basal, but maybe 3 nights a month my insulin needs would just randomly nose-dive. Setting my CGM alarm to high 4s, low 5s helped a bit, but to be honest, the only thing that has really worked is a sensor-augmented / hybrid closed loop insulin pump.
Now when on those 10% of days my pump just adapts and reduces the basal dose to next to nothing. And it does it whenever needed. The rest of the time, my ‘usual’ dose just works as needed!
Inka
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- Type 1
Set your Low alarm higher. That way you can ward off hypos and avoid that horrible low feelings. I set mine at 5.6 on the Libre. The fastest glucose I’ve found for bad hypos is the Lift GlucoShots. They’re not fizzy or acid and come in tiny bottles so you can drink them easily. They work very quickly.
Inka
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What time do you take your Levemir in the evening. Sometimes changing the time can help. Also, do you have a bedtime snack if you’re below a certain level? That can help too.
I will try them out, thank you for your suggestion
I take it before I go to bed, around 9.30. I would have a snack if it's below 9/10
rebrascora
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Hi. Sorry to hear that you have had a nasty nocturnal hypo. I get them a lot despite often not taking any evening Levemir sometimes. Thankfully mine are very easily treated but sometimes I drop a second time, even with no evening Levemir. I am particularly susceptible to exercise causing them and whilst I don't need any or very few carbs whilst exercising, my muscles seem to wait until I sleep and then suck the glucose out of my blood to replenish their stores. Thankfully mine are not low hypos but if I don't wake up when the alarm goes off I can be low for several hours until I drop low enough to wake me. I think for me, part of the problem is that Libre reads lower than my BG meter so whilst it might say I am 3.4 I could very easily be 4.2.
If these are Libre lows, are you double checking them with finger pricks, particularly your 15 min post hypo treatment recovery check because the nature of the algorithm in Libre means that Libre will usually show that your levels are continuing to drop 15 mins post treatment when a finger prick will usually show your blood has come back up and Libre will take a further 15 mins at least to catch on that your levels have stopped falling and are in fact now in range, so it is always important to ignore Libre once you are hypo and finger prick to assess recovery. If you are doing this and your 15 min post treatment finger prick is still showing you are low, my thoughts are that your chosen hypo treatment is not being very effective. I was going to suggest that you chew your hypo treatment well rather than a couple of chews and swallow it down as it is quicker for your body to absorb glucose in your mouth and will get to the brain quicker, than gulping stuff straight down, so perhaps swill it around in your mouth a bit if you are using a liquid before swallowing.
I was a little surprised that you get out of bed. Is that so as not to disturb your partner because you are probably safer and expending less energy(glucose) staying in bed provided that you have hypo treatment by the bed within arm's reach, than getting up to fetch something and you definitely don't want to be going downstairs when you are hypo if it can be avoided, so always best to keep hypo treatment next to the bed.
When you had successfully treated this hypo did you eventually go high or were you still well within range when you woke up. Just wondering if the problem is the glucose not being absorbed quickly enough and therefore the extra treatments taking you high later or if you genuinely needed the extra treatments and you woke up in range.... ie there was significantly too much basal insulin.
Are you taking any other new medication which might be affecting your levels or had you done much exercise the previous day? I always have to reduce my night time Levemir when I have done more exercise or activity and if I exercise 2 or 3 days in a row I have to keep reducing it night after night until I have a more sedentary day, which is how I often get down to a zero dose. I have also been prescribed Amitriptyline for the last 3 months and my nocturnal hypos have increased significantly as a result of that even though it isn't a known side effect and again I have had to reduce my dose down to zero and still experience nocturnal hypos, but just mild ones.
Anyway, those are my thoughts. I also want to make sure you are aware that Libre is vulnerable to what we call "compression lows" where lying on the sensor causes it to drop into the red and indicate you are hypo when you are not and again it takes about 30 mins after you release the pressure for it to recover. It doesn't sound like this was a compression low as it sounds like you felt genuinely hypo, but important to know about this flaw/quirk of the system.
If these are Libre lows, are you double checking them with finger pricks, particularly your 15 min post hypo treatment recovery check because the nature of the algorithm in Libre means that Libre will usually show that your levels are continuing to drop 15 mins post treatment when a finger prick will usually show your blood has come back up and Libre will take a further 15 mins at least to catch on that your levels have stopped falling and are in fact now in range, so it is always important to ignore Libre once you are hypo and finger prick to assess recovery. If you are doing this and your 15 min post treatment finger prick is still showing you are low, my thoughts are that your chosen hypo treatment is not being very effective. I was going to suggest that you chew your hypo treatment well rather than a couple of chews and swallow it down as it is quicker for your body to absorb glucose in your mouth and will get to the brain quicker, than gulping stuff straight down, so perhaps swill it around in your mouth a bit if you are using a liquid before swallowing.
I was a little surprised that you get out of bed. Is that so as not to disturb your partner because you are probably safer and expending less energy(glucose) staying in bed provided that you have hypo treatment by the bed within arm's reach, than getting up to fetch something and you definitely don't want to be going downstairs when you are hypo if it can be avoided, so always best to keep hypo treatment next to the bed.
When you had successfully treated this hypo did you eventually go high or were you still well within range when you woke up. Just wondering if the problem is the glucose not being absorbed quickly enough and therefore the extra treatments taking you high later or if you genuinely needed the extra treatments and you woke up in range.... ie there was significantly too much basal insulin.
Are you taking any other new medication which might be affecting your levels or had you done much exercise the previous day? I always have to reduce my night time Levemir when I have done more exercise or activity and if I exercise 2 or 3 days in a row I have to keep reducing it night after night until I have a more sedentary day, which is how I often get down to a zero dose. I have also been prescribed Amitriptyline for the last 3 months and my nocturnal hypos have increased significantly as a result of that even though it isn't a known side effect and again I have had to reduce my dose down to zero and still experience nocturnal hypos, but just mild ones.
Anyway, those are my thoughts. I also want to make sure you are aware that Libre is vulnerable to what we call "compression lows" where lying on the sensor causes it to drop into the red and indicate you are hypo when you are not and again it takes about 30 mins after you release the pressure for it to recover. It doesn't sound like this was a compression low as it sounds like you felt genuinely hypo, but important to know about this flaw/quirk of the system.
Thanks so much for all of this, I'm getting so much important information which really makes sense. I normally have a sugary drink then wait 10 minutes and have a sugary snack and some long acting carbs (normally toast) I genuinely didn't realise there were so many flaws with the libre, however, I have had a call Abbott to send new sensors out a few times due to sensor errors.
I dont normally get up when my alarm goes off, I have sugary drinks and mars bars near my bed for night time hypos but the hypos in question required much more food/drinks than I had in my room, the first one was so bad I woke my husband to sit with me untill it passed.
Inka
Well-Known Member
- Relationship to Diabetes
- Type 1
Levemir can have a little peak around the 4 hour mark. Our insulin needs normally decline around 1 or 2am, so if the Levemir peak coincides with that, it can sometimes cause hypos.
I have a pump and have barely any basal insulin around 1am. I do take pump breaks and use injections sometimes, and then I’m always aware of that period during the night when most of us need less insulin. So, for example, I might have my basal injection closer to 11pm so the peak coincides with the rise in my insulin needs around 3/4am.
Generally on injections I try to be above 7 or 8, so if you’re having to be above 9/10, it might just be that you need a little less Levemir at night.
rebrascora
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So you don't follow the "rule of 15" then when treating hypos.... which is if your Blood Glucose (finger prick) or Libre plus you genuinely feel hypo, eat 15g of fast acting carbs, wait 15 mins and then retest with a finger prick. Do not rely on Libre for this post treatment test as it is not reliable. If your finger prick test shows you are still below 4, you have another 15g of fast acting carbs, wait another 15 mins and test again with a finger prick. Once you are back above 4, you may want to follow up with a small slower acting carb like a digestive biscuit. I would not use a Mars Bar as a hypo treatment because the fat content slows the absorption of the sugar and a Mars Bar is more than 15g so it is too much. I always use jelly babies, personally and they work really well for me if I chew them thoroughly and swish them around my mouth.
You didn't say if you ended up too high after this event or if you woke up the next morning in range?
I know we all need different amounts of insulin but your Levemir doses seem a little towards the higher end of normal for a Type 1. I consider my Levemir dose quite high compared to many here and I take 22 in the morning and anywhere from zero-5units on an evening. It is unusual to have quite such a significant disparity between day and night time dose as I do, but this is right for me and whilst the daytime one is pretty stable, the night time dose needs very regular adjustment, due to exercise and hormones can also influence it. Getting your Levemir doses right for your body is key to good diabetes management. Since you are female, I wonder if these lows tie in with your monthly cycle. Many female members have different doses of basal insulin for different times of their cycle. I am thankfully past that now, but even just replacing my HRT patch a few days late can have a noticeable impact, so that is something else to consider.
You didn't say if you ended up too high after this event or if you woke up the next morning in range?
I know we all need different amounts of insulin but your Levemir doses seem a little towards the higher end of normal for a Type 1. I consider my Levemir dose quite high compared to many here and I take 22 in the morning and anywhere from zero-5units on an evening. It is unusual to have quite such a significant disparity between day and night time dose as I do, but this is right for me and whilst the daytime one is pretty stable, the night time dose needs very regular adjustment, due to exercise and hormones can also influence it. Getting your Levemir doses right for your body is key to good diabetes management. Since you are female, I wonder if these lows tie in with your monthly cycle. Many female members have different doses of basal insulin for different times of their cycle. I am thankfully past that now, but even just replacing my HRT patch a few days late can have a noticeable impact, so that is something else to consider.
rebrascora
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@Inka makes a very good point. I take my evening dose about 11pm too except for the odd spell when my levels start to rise in the evening and then I bring it forward to 7pm. That usually happens for a few weeks around Christmas for some reason. I also take my morning dose as soon as I wake up and before I get out of bed so it can get working ASAP as my levels rise rapidly as soon as my feet hit the floor on a morning due to my liver releasing a big surge of glucose into my blood stream often referred to here on the forum as Foot on the Floor syndrome but is a part of the Dawn Phenomenon process, but a little easier to deal with.
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