night time low glucose

[PLast]

Hi I'm a newbie on here and would like some advice please.
my type 2 diabetes is monitored with a sensor and the low glucose warning alarm keeps going off in the night.my level when I go to bed is usually between 9 to 11 but drops off steeply when I'm asleep.
Any suggestion please for a long acting carb I can have before going to bed to stop this?

 

[Inka]

Welcome @PLast 🙂 Are you confirming these lows with a fingerprick? The Libre is prone to compression lows where it gives a falsely low reading if you lie on it. Obviously this is more likely at night.

I see you’re Type 2. Can you tell us a little about what diabetes meds you take and when?

 

[PLast]

Welcome @PLast 🙂 Are you confirming these lows with a fingerprick? The Libre is prone to compression lows where it gives a falsely low reading if you lie on it. Obviously this is more likely at night.

I see you’re Type 2. Can you tell us a little about what diabetes meds you take and when?

Hi Inka my diabetes team have already adjusted my meds and told me of the compression lows. I just wanted some suggestions for a carb snack to keep my levels on a more even keel during the night. Thanks

 

[Inka]

The carb snack would partly depend on your meds @PLast - eg what’s active overnight if anything, whether you’re on bolus insulin, etc.

 

[PLast]

I'm currently on 31 units levimir and 5 units humolog with evening meal. I also take 2 metformin in evening.

 

[Inka]

@PLast Ok, so it’s likely you’ve been given a number to be at at bedtime to help avoid lows overnight. I always used 8mmol but some people need to be a little higher. I’ve found good snacks are a small bowl of puffed wheat, two or three oatcakes and peanut butter, a plain digestive or two, a slice or two of bread and peanut butter, etc. The amount will depend on your needs - ie how many grams carbs you need. My bowl of puffed wheat was around 16g carbs, but you might need more or less. I also made sure to eat it at a similar time every night. (I’m using the past tense because I have an insulin pump now so slightly different).

You could also look at your Levemir. If you’re having the 31 units once a day, it might help to split it, some morning, some evening. NB the split doesn’t have to be equal, eg you could have less in the evening to help you avoid lows overnight. The other thing to mention is to watch the time of your evening meal because the Humalog lasts a few hours and if you were to eat late, eg 8pm, the 5 units of Humalog could still be acting when you go to bed. I generally aim to eat 6pm-ish. Humalog also has a kick in the tail that can cause a drop between 3.5 to 5 hours later, so that’s something to be aware of too.

 

[rebrascora]

Hi Inka my diabetes team have already adjusted my meds and told me of the compression lows. I just wanted some suggestions for a carb snack to keep my levels on a more even keel during the night. Thanks

You don't answer the question about whether these lows during the night have been double checked with a finger prick or not? It is all very well being told about compression lows, but are you checking them to know if they are genuine lows or not. Otherwise you likely don't need anything to stabilize your levels because they are already stable but the Libre is just making it look like they are not.

 

[PLast]

You don't answer the question about whether these lows during the night have been double checked with a finger prick or not? It is all very well being told about compression lows, but are you checking them to know if they are genuine lows or not. Otherwise you likely don't need anything to stabilize your levels because they are already stable but the Libre is just making it look like they are not.

Thanks Barbara
No I'm not having lows as such have checked with finger pricks. It's just the sensor alarms goes off, I have it on the lowest setting. Just trying to find something to stop this happening and keep the level a bit higher. Its disturbing my sleep and making me feel so washed-out next day.

 

[PLast]

@PLast Ok, so it’s likely you’ve been given a number to be at at bedtime to help avoid lows overnight. I always used 8mmol but some people need to be a little higher. I’ve found good snacks are a small bowl of puffed wheat, two or three oatcakes and peanut butter, a plain digestive or two, a slice or two of bread and peanut butter, etc. The amount will depend on your needs - ie how many grams carbs you need. My bowl of puffed wheat was around 16g carbs, but you might need more or less. I also made sure to eat it at a similar time every night. (I’m using the past tense because I have an insulin pump now so slightly different).

You could also look at your Levemir. If you’re having the 31 units once a day, it might help to split it, some morning, some evening. NB the split doesn’t have to be equal, eg you could have less in the evening to help you avoid lows overnight. The other thing to mention is to watch the time of your evening meal because the Humalog lasts a few hours and if you were to eat late, eg 8pm, the 5 units of Humalog could still be acting when you go to bed. I generally aim to eat 6pm-ish. Humalog also has a kick in the tail that can cause a drop between 3.5 to 5 hours later, so that’s something to be aware of too.

Thanks Inka I'll try some of this.

 

[Inka]

Thanks Barbara
No I'm not having lows as such have checked with finger pricks. It's just the sensor alarms goes off, I have it on the lowest setting. Just trying to find something to stop this happening and keep the level a bit higher. Its disturbing my sleep and making me feel so washed-out next day.

If they’re not actually lows, just the sensor playing up (and I know how annoying that is!), then could you switch off the Low alarm temporarily? Or, if the sensor is reading persistently low, get it replaced.

When I was on the Libre, I found some sensors would sound Low alarms a number of times during the night when I wasn’t actually Low. For particularly annoying sensors, I’d fingerprick and turn the Libre alarm off.

 

[rebrascora]

If you are not actually low but the Libre is giving false lows, then nothing you eat will fix a "compression low".

I found I learned to adopt a different sleeping position to prevent them. When I lie on the arm with the sensor, I place my other hand under the arm with the sensor on just above the elbow to raise it off the mattress enough for it not to compress, but also better placement of the sensor on my arm, more towards the back of the arm.

Can you post a photo of a daily graph showing these lows.
What do you have your low alarm set at? Perhaps consider setting it lower for through the night. Bit of a faff changing it every night and morning, or alternatively switching the low alarm off over night as @Inka suggests.