Night time Hypo's

[SimonP]

If I go low overnight post-exercise I can sometimes get a 2nd or 3rd innings (of going low). Usually I can see that once I go to sleep I'd dropped and bumped along just above the hypo alarm value before it decides to go off, so my assumption is that the combination of hepatic glycogen depletion from the previous exercise (it can take 12+h to completely recharge supplies) plus my liver then doing what it can to prevent me going hypo means there's nothing left in the proverbial tank.

 

[Jasmin2000]

If I go low overnight post-exercise I can sometimes get a 2nd or 3rd innings (of going low). Usually I can see that once I go to sleep I'd dropped and bumped along just above the hypo alarm value before it decides to go off, so my assumption is that the combination of hepatic glycogen depletion from the previous exercise (it can take 12+h to completely recharge supplies) plus my liver then doing what it can to prevent me going hypo means there's nothing left in the proverbial tank.

Trying to work out how you're not rocketing to a hypo here!

You have your basal in the background, have done exercise causing the liver to suck up all your blood glucose to replenish glycogen and have gone to bed, which itself reduces stress and can cause a BG drop. I've done the same but only after a banana sandwich - still get mild hypos at 12-1 am.

The 2nd and 3rd hypos are likely just basal kicking you back down, but where is the glucose coming from in the first place - do you think you've entered keto and are metabolising fat?

 

[rebrascora]

If I go low overnight post-exercise I can sometimes get a 2nd or 3rd innings (of going low). Usually I can see that once I go to sleep I'd dropped and bumped along just above the hypo alarm value before it decides to go off, so my assumption is that the combination of hepatic glycogen depletion from the previous exercise (it can take 12+h to completely recharge supplies) plus my liver then doing what it can to prevent me going hypo means there's nothing left in the proverbial tank.

I get this even without any evening basal (Levemir) I can push my levels up to 9 at bedtime and go to sleep and they will steadily drop down into the red and then level out. I wake up at 3 or 4am, eat a single JB which should raise me 1.5mmols because there is no active insulin in my system, go back to sleep and I will dip down below 4 again and possible even a third time before the alarm goes off at 7am. Each time, it levels out rather than continuing to drop, but if I eat carbs it will suck the glucose up again and drop me back down.

My current TIR is 8% below range for the last 90 days because of these recurring mild nocturnal hypos. I don't want to push my levels any higher at bedtime as I don't sleep well above 8 and with no basal insulin it will occasionally swing the other way and I wake up through the night tossing and turning and needing a correction.

My night time Levemir dose varies between 0 and 5u depending upon a number of factors and can vary from one night to the next and needs adjusting multiple times during a week both up and down, whereas my daytime needs are pretty stable at either 22 or if I have been really active for 3 days or more on the trot, I can drop it to 20u.

 

[SimonP]

Trying to work out how you're not rocketing to a hypo here!

You have your basal in the background, have done exercise causing the liver to suck up all your blood glucose to replenish glycogen and have gone to bed, which itself reduces stress and can cause a BG drop. I've done the same but only after a banana sandwich - still get mild hypos at 12-1 am.

The 2nd and 3rd hypos are likely just basal kicking you back down, but where is the glucose coming from in the first place - do you think you've entered keto and are metabolising fat?

Oh no, I meant even after treating the first hypo I'd then go low again, and again (if I don't do a good enough job of it the second time around). Response to the OP, sorry for the confusion!

P.S. Or perhaps you mean why don't I go low immediately? In which case the answer is that this only ever happens after being out all day (and pretty rarely - e.g. first long ride after the winter), and I definitely need/want to eat when I get home. So I will eat supper and take bolus for it (which I always split and usually reduce anyway depending on how I feel BG will react, then monitor BG over the course of the evening and correct if needed.) The lows are after the bolus & food have worn off/been absorbed (I realise this is not necessarily an easy thing to estimate), so as you say they are (predominantly - see earlier comment) related to basal being overly effective and liver + muscles mopping up glucose to replenish glycogen stores.

 

[Jasmin2000]

Oh no, I meant even after treating the first hypo I'd then go low again, and again (if I don't do a good enough job of it the second time around). Response to the OP, sorry for the confusion!

P.S. Or perhaps you mean why don't I go low immediately? In which case the answer is that this only ever happens after being out all day (and pretty rarely - e.g. first long ride after the winter), and I definitely need/want to eat when I get home. So I will eat supper and take bolus for it (which I always split and usually reduce anyway depending on how I feel BG will react, then monitor BG over the course of the evening and correct if needed.) The lows are after the bolus & food have worn off/been absorbed (I realise this is not necessarily an easy thing to estimate), so as you say they are (predominantly - see earlier comment) related to basal being overly effective and liver + muscles mopping up glucose to replenish glycogen stores.

Makes sense. For me nighttime hypos come and go early on, but are back just before I wake up long after any fast-acting/food have worn off and are due to Lantus.