Night time lows

[John__ch]

Hi all,
I have been on 28 units of Tresiba for the last 4 year (I was on 40 but managed to drop that after doing the DAFNE course) but in the last few month I have been having night sweats, bloods came back ok and could not see any problem when I scanned with the Libre.

On Tuesday I started the Dexcom G6 trial offer and It’s been waking me up with low alarms as my levels were dropping to 4.2. I then got the urgent low alarm to say my levels would be < 3.1 in the next 10 min.
I have been watching and it seams to be dropping every night around 1:30am!
I am going to cut back my Tresiba to 24u and see if that helps.
What would cause a need to reduce my basal insulin? I was off work for 5 months due to shielding and holidays. Would being sedentary for a long pirio

 

[Kaylz]

As a Type 1 my insulin needs change all the time, both my Tresiba and my Novorapid for meals, so I don't see why it would be any different for an insulin dependat Type 2, generally more exercise leads to needing a reduction rather than being less active but if you had more stress back then that could have also been a factor in needing more, basically everything can have an effect on our insulin needs unfortunately so when things like this do arise you just have to watch the patterns and adjust as best you can xx

 

[John__ch]

Thanks Kaylz, I finally got my diagnosis changed to Type 1 a few year ago (after I moved to NI and the consultant done more tests and looked at my history).
yeah, so after basically doing nothing for all that time and suddenly back to work ( it is physical job and constantly running around) it would possibly need a reduction?

 

[Kaylz]

Ah sorry your profile states you as a Type 2 so I assumed thats what you were, I do apologise

Do you also take a rapid acting insulin too then?

Yes that could certainly lead to needing a reduction, remember also that Tresiba takes at least 3 days to take effect after adjustments so take caution and say have a biscuit before bed xx

 

[John__ch]

it’s not a problem, just got to work out how to change my profile! I am also starting on the Omnipod Dash next month, so that may help a bit!

 

[John__ch]

Fixed it! Yeah, I am also on Fiasp but as I said will be changing to the pump next month. So glad I got the Dexcom! We are looking at our budget and hopefully continue on it after the months trial is up!

 

[Kaylz]

That's better, saves confusion now! Haha

That's great news, me personally am not interested in a pump at the moment but each to their own

Libre does me enough although partner has said when he's back at work he'd get me Dexcom to try, I wouldn't say no but we couldn't afford it long term and certainly not at the moment as he's off until October on sick pay lol
xx

 

[John__ch]

A pump will work for me due to my job, and I know how you feel about the cost, after the trial is over we will have to sit down and see what the financial situation is! It’s just a pity that the Libre 2 was not here yet!

 

[everydayupsanddowns]

Glad you fixed it @John__ch

Moving to an omnipod will add real detail and subtlety to your basal dose, because you can adjust your profile hour by hour (generally setting a basal change 1-2 hours before you want it to act).

Of course it does need ongoing tweaking and fiddling on a month-by-month basis, as insulin needs rise and fall through the year.

 

[trophywench]

Does the 1-2 hrs also apply to Fiasp Mike? - dunno cos I've never used it, Novorapid starts to work in about 10 minutes for me so anything quicker acting would be a nightmare LOL

 

[mark king]

Hello Mike I'm not understanding what you are referring to when you say (generally setting a basal change 1-2 hours before you want it to act)?
I have 9 time slots through the 24 Hrs with a Basal setting for each time which dribbles away in the back ground.
On top of that at each meal time I do a Bolus calculation through the PDM which gets added to my pump.
My meal time doses all act over 4 hrs from pumping in.
I use only FAST ACTING INSULIN for both the BASAL & BOLUS which starts to do its work right away. eg I couldn't set up a meal dose and then not eat as I'd soon be in trouble due to my BG dropping down.

Best

 

[everydayupsanddowns]

Does the 1-2 hrs also apply to Fiasp Mike? - dunno cos I've never used it, Novorapid starts to work in about 10 minutes for me so anything quicker acting would be a nightmare LOL

Fiasp stopped working for me before I had enough time to see really. @Pumper_Sue would most likely know though?

 

[everydayupsanddowns]

Hello Mike I'm not understanding what you are referring to when you say (generally setting a basal change 1-2 hours before you want it to act)?

It was guidance I got from forums or a DSN or pumping insulin (can’t remember which now!) which was that if you can see that *something happens* at a particular time to your BG that is basal-related, you should make sure that the change in your basal pattern is made at least an hour before.

Each basal micro-dose has its own onset-peak-tail, and the durstion is likely to be 4-5hours. So the micro-dose delivered at, say, 3am when your BG is dipping (or whatever you’ve spotted) will be layered over all the other micro-doses that have been made over the last 4 hours at whatever basal rate you had set then. So the effect of the basal rate change doesn‘t suddenly klonk down to the new rate because all the basal that was being fed in earlier is still acting... the new rate gradually feeds in as the previous micro-doses from hours ago fade away, and the new (lower) micro-doses begin to act.

So you give the transition a little time to take effect. An hour‘s headstart would mean that a quarter(ish) to a half of the previous rate’s doses would have disappeared and the new ones replaced them. 2 hours would mean that much more of the new rate would be acting at your intended ‘switchover point’ because insulin activity curves aren’t exactly linear, and more than half the dose seems to happen in the first 2-3 hours.

Not sure if that makes it clearer if just confuses you more!

 

[trophywench]

Have to say that my own DSN, the pump manual and my online personal pump adviser (AKA @Pumper_Sue ) all agreed when I got my first pump, on 2 hours before you want to see the change take effect - so that's what I did then and still do now, because it works!

 

[SB2015]

Hello Mike I'm not understanding what you are referring to when you say (generally setting a basal change 1-2 hours before you want it to act)?
I have 9 time slots through the 24 Hrs with a Basal setting for each time which dribbles away in the back ground.
On top of that at each meal time I do a Bolus calculation through the PDM which gets added to my pump.
My meal time doses all act over 4 hrs from pumping in.
I use only FAST ACTING INSULIN for both the BASAL & BOLUS which starts to do its work right away. eg I couldn't set up a meal dose and then not eat as I'd soon be in trouble due to my BG dropping down.

Best

Hi Mark

When you say you are in fast acting, is that FIASP or another quick acting insulin. The pumps all work with quick acting and like others I was advised to make a change between 1 and 2 hours before I want the impact to kick in, as all the quick acting insulins still take a bit of time to get going.

When I used FIASP for 6 moths I did change to making adjustments 1 hour before the change needed. I also reduced the timing of my pre Bolus for meals. Like Mike I stopped using FIASP as for me it simply hurt too March and I ended up with lots of skanky sites. I am back to Novorapid and I pre-Bolus for all my meals but the timing varies according to my BG and Libre arrow, time of the day, the fat content of the meal (and whether I remember to do it!!!)

It is a juggling act however we manage our levels, and all we can do is the best that we can. The Libre or other sensors give us a lot more info and enable us to improve things (most of the time)

 

[Pumper_Sue]

Does the 1-2 hrs also apply to Fiasp Mike? - dunno cos I've never used it, Novorapid starts to work in about 10 minutes for me so anything quicker acting would be a nightmare LOL

Not Mike but yes change the basal 2 hours before needed. I had to reset my basal pattern when I went on to Fiasp and set the duration for 5 hours. It does have a slight kick in it after about 4 1/2 hours.

 

[Pumper_Sue]

Hello Mike I'm not understanding what you are referring to when you say (generally setting a basal change 1-2 hours before you want it to act)?
I have 9 time slots through the 24 Hrs with a Basal setting for each time which dribbles away in the back ground.

Simple answer is, if you hypo on a regular bases at 2AM in the morning then you drop your basal down at midnight.

n top of that at each meal time I do a Bolus calculation through the PDM which gets added to my pump.
My meal time doses all act over 4 hrs from pumping in.

I suspect that is why you are going hypo so quickly after a bolus, you still have insulin on board/active. You need to change it to 5 hours.

I use only FAST ACTING INSULIN for both the BASAL & BOLUS which starts to do its work right away. eg I couldn't set up a meal dose and then not eat as I'd soon be in trouble due to my BG dropping down.

Pumps only use fast acting insulin.

It sounds to me as if you need to do some serious basal testing as you should not be dropping like a bomb after bolusing for a meal. If using Fiasp and you are on the low side then yep it does happen unless you use a split dose.
Novo and Humalog take 15/20 mins to work hence why the instructions are to pre-bolus for meals.

 

[mark king]

Thanks for your info Pumper Sue.
What does FIiasp or is it FLASP stand for?
I have discussed this with my SDN and she says it is down to my background insulin and my natural body workings so we have set it to minimal 0.9m amounts from midnight to six am daily and this has helped considerably. I have 10 time slots for my basal doses over 24 hrs now.
From 8am until midnight I am rock steady 90% of the time between 4 & 10 BG meaning my Basal and Bolus doses are ok.

My evening meal is between 8 and 9 pm so this should be out of my insulin dose by midnight to 1am [4hrs]. However I now have to be about 13 BG at that time to allow for my decay after 2am, it seems no mater how little insulin I add to my body I still have the same dip profile.

We are reviewing my profiles to see if my body is possibly managing to produce inulin during the night and even during the day which I am looking after by snacking as I do check frequently then. My insulin doses are all in single figures so I'm not over injecting.

I add to this after my next review.

Best

 

[Pumper_Sue]

What does FIiasp or is it FLASP stand for?

This is fiasp https://www.drugs.com/uk/fiasp.html

My evening meal is between 8 and 9 pm so this should be out of my insulin dose by midnight to 1am [4hrs]. However I now have to be about 13 BG at that time to allow for my decay after 2am, it seems no mater how little insulin I add to my body I still have the same dip profile.

This is not correct. You need to check your duration of insulin Novo lasts about 5 hours in most people.

In all honesty it seems to me as if you are playing a guessing game with your basals.
Take the simple step of doing a proper basal test. Instructions to be found as a sticky in the pump forum 🙂

We are reviewing my profiles to see if my body is possibly managing to produce inulin during the night and even during the day which I am looking after by snacking as I do check frequently then. My insulin doses are all in single figures so I'm not over injecting.

If you are snacking then yes you are over injecting.
Your basal should hold you steady with no need to snack/eat to correct a low. If your target is 6 then you should be staying within 2 points of this if using a pump. If you are not then you and not your DSN should be changing your pump settings.

 

[mark king]

fiasp -- never ever been discussed as a treatment for me type 1 for 37 years.

[Insulin acting for 4hrs]. This is not correct. You need to check your duration of insulin Novo lasts about 5 hours in most people. My insulin active profile is 4 hrs so no guessing there.

If you are snacking then yes you are over injecting. My DSN and me will be reviewing this as yes insulin does reduce your BG so I don't need so much.

I await my DSN instructions.

Thanks