Nocturnal hypos

[KleboldKlan]

Since 12th October I've been having hypos in my sleep, they upped my insulin from 18 novorapid to 20, I am also on 22 tresiba. I don't want to lower it as my blood sugars have been dropping and I have been feeling better in myself. I want to know if there is anyway I can stop the hypos without lowering my insulin.

I lowered my Tresiba to 20 but it just went back to being high, when it use to be high I stopped taking my insulin completely as I was disappointed in myself. I only use to take it when I felt ill or had ketones. I don't want to go back to that point as like I said I have been feeling better in myself, more positive and I am also checking my sugars a lot more than I use to.

This morning it was 4.9. It's never been that low. I tried getting into the doctors this morning to see if they had any advice and suggestions, but once again the NHS has let me down. I know nocturnal hypos are dangerous, my DSN has said. But as the NHS doctors aren't doing a lot to help me with this, there isn't a lot I can do.

I have also tried to contact my DSN, but no response, I sent them my diary of my blood glucose levels, but not bothered getting back in touch, soon going to give up with trying to get help for it, so this is my last resort.

Any suggestions or advice??

 

[novorapidboi26]

It sounds like you don't have mach personal knowledge of dose adjustment so you really need to get that sorted before you can receive anything meaningful from anyone here.....

the assumption can be made that nocturnal hypos are down to the only insulin that will be in your system at that time......and thats the tresiba......so the first thing to do would be to drop that down....

you have said you dropped it to 20 and you were high......when were you high exactly......? when you are going low overnight, when is that happening exactly...?

the novorapid could be having an effect but only if you were having something to eat immediately before bed...

you really need to start testing your doses and get it written down somewhere for your team to help you, at least until you can get educated...

 

[everydayupsanddowns]

Hello @KleboldKlan

Sorry to hear you have been struggling a bit - and from the sounds of things you don't seem to have had the best support from your clinic.

Really great news that you have been taking your insulin regularly and have been checking BG more regularly. Those are really good steps in terms of getting your BG a bit more where you want it so keep doing those!

4.9 is a pretty great number to wake up on. A tiny bit higher (say 5s or 6s would be absolutely perfect, but that's onlt because of the increased risk that you might have had undetected night-time low BG when you wake up in the 4s.

We can't really advise about doses directly, because none of us knows your medical history, or has any medical qualifications, but when I was on Lantus I know that a 2u correction often made too much of a difference to me, and I needed to change by 1u. I wonder if there's a 1u pen you could use so that you could try 21u and see if that's better.

You are absolutely right to be worried about those nocturnal hypos. They really need sorting, and the longer they go on the less you will notice them

You might find this write-up interesting about what your basal insulin is for and a suggestion of how to adjust your dose: http://www.diabetes-support.org.uk/info/?page_id=120

When you say your Novorapid was changed from 18 to 20 - what do you mean by that? Have you been taught how to match the Novorapid you take to the amount of carbs you are eating?

 

[everydayupsanddowns]

I also wonder if you've ever been offered a course in how to fit diabetes into your life more easily (adusting for different foods, exercise, illness. alcohol etc...)

There are different ones in different parts of the country, DAFNE or BERTIE are well known to the forum, but there are others too.

Might be worth asking if there is something you could go to which would help you adjust things yourself, as you seem to be finding it difficult to get hold of your clinic for advice.

 

[HOBIE]

Good luck KleboldKlan. As said wright it all down & show Drs 🙂

 

[SB2015]

Welcome Kleboldklan

Well done for starting to test more, and wanting to get things adjusted. As others have said it is good to get your Diabetes to fit round you and one of the education courses can help you to do this. You can then start to make your own adjustments to the insulin to match what you want to eat.

Where I had difficulty managing levels during the night, I found it helped when my cnsultant helped me to spli the background insulin (Tresiba for you). I don't know how this would work with the insulin you are on but it may be worth discussing this with the DSN.

With your increased t sting , if you keep records f what you have done, what you have eaten, this will make it easier for the DSN to help you make changes.

 

[TheClockworkDodo]

Hello @KleboldKlan and welcome to the forum. As everyone has said, please do keep trying to get hold of a DSN or a consultant who can advise you, though I know what a pain it is when they don't get back to you, as mine is not great at that either. Maybe you could ask to be referred to someone different if you can't get any help from your current DSN?

But one way or another you need to stop those night-time hypos, as you say, they are dangerous - and it's likely to be too much Tresiba which is the problem (unless you are injecting Novorapid late at night), so you may need to tweak that dose down a little. You really should discuss this with a medical professional though, if you don't know about dose adjustment yourself.

I wonder if there's a 1u pen you could use so that you could try 21u and see if that's better.

Not only is there a 1 unit pen, there's a half unit pen - I am on Tresiba and Novorapid, and the Novopen Echo fits both Tresiba and Novorapid cartridges and measures doses in half units. You should be able to get your GP to prescribe these (both pens and cartridges) for you, but you will need a DSN to show you how to use them if you've only ever used disposable pens. It's much easier to fine-tune your doses if you can drop or raise them a smaller amount at a time though, so well worth making the effort to get hold of some half-unit pens.

In the short-term while you're trying to get hold of a DSN, it might be worth trying eating something with a small amount of carbs and fat when you go to bed - eg a yogurt, or a couple of TUC biscuits with some cheese. This is not an ideal solution in the long term, but it might reduce the risk of overnight hypos a bit for now.