Preventing hypos in the night

[DancingStar]

I keep getting hypos in the middle of the night when I'm asleep - my Libre alarm alerts me that my blood glucose has fallen below 3 mmole - usually around 2/3 am. This happens several (>3) times a week. When I go to bed it's usually somewhere between 6 and 7 mmole.

What can I do to prevent this? Would something like a milky drink before bed be adequate?

 

[Tdm]

Have you checked with your blood monitor to verify you are actually going low? By the way, 3 is v low for an alarm given below 4 is a hypo. I have my alarm at 5 to allow me time to turn it around before i go hypo

 

[helli]

Are you double checking the Libre readings with a finger prick?
If I was getting hypo alarms in the night, my first assumption would be that these were compression lows. When pressure is applied to a sensor such as when you lie on your arm when asleep, the sensor will be a false low. These can usually be spotted by a drop in your graphs quickly followed by a rise when you move and remove the pressure on the sensor.
The other thing to remember is that CGMs are designed to be most accurate at normal levels. Therefore, highs and lows should be double checked with a finger prick before treating.

If finger pricks confirm real lows, I would be reviewing my day to understand why the low happened. Was it a day when I did more exercise? Did I drink alcohol? Did I eat later?
It is important to recognise these things so you do not over treat a potential hypo on a day when you do not exercise, for example.
If the low is happening every day (or most days), I would look at my insulin dose. Assuming you are on a basal bolus insulin regime, do you have too much long acting insulin?

 

[Wendal]

Morning DS,
Would agree with others about need to finger prick check to confirm lows and set your alarm higher ( have mine set at 5) to forewarn me.
Also check re compression lows and what you may be doing later at night so late meal/any fast acting insulin less than 4 hours before bed/exercise etc.
I consider your 6-7 pre bed levels are pretty good and what I aim for but my BG levels are pretty stable until about 3am then I get a slight dawn rise and the only time I get anywhere near 4 at night is if I have had a big late meal etc when my normal routine is disrupted say if on holiday.
So is your low the result of a drop following an evening spike and I would look to get advice on getting your overnight level as stable as possible.
BW

 

[Wendal]

Should add when I have a big late meal and then try and counteract it by taking more insulin/ exercise and my BG levels are more volatile.

 

[Inka]

I keep getting hypos in the middle of the night when I'm asleep - my Libre alarm alerts me that my blood glucose has fallen below 3 mmole - usually around 2/3 am. This happens several (>3) times a week. When I go to bed it's usually somewhere between 6 and 7 mmole.

What can I do to prevent this? Would something like a milky drink before bed be adequate?

You do need to finger prick to check it’s a real low. Pressure on the Libre at night (eg lying on it) can cause false low alarms when your blood sugar is actually ok. If you are finger-pricking and these are real hypos, then raise your Low alarm to the 5s. You might also want to aim to be at least 8 before bed and have a small snack if needed, eg oatcakes, a digestive, etc.

What time do you eat your evening meal and what basal insulin do you take and when? Is it still Lantus? If so, you could ask to change to Levemir twice daily. You could then reduce your evening Levemir dose if needed.

 

[trophywench]

Assuming one is a bog standard 100% normal human being, without diabetes or anything else identifiable, the time the body has it's lowest natural BG is around 2 to 3am in the morning whilst fast asleep.

 

[DaveB]

Hi. It sounds like your Basal may be too high. Also going to bed with BS between 6 & 7 is a bit low. Might be worth tweaking it up a bit?

 

[helli]

Hi. It sounds like your Basal may be too high. Also going to bed with BS between 6 & 7 is a bit low. Might be worth tweaking it up a bit?

No it is not if you have your insulin sorted.
it gives you at least 2mmol/l to fall.
I aim for similar levels with no problem. Much higher and I cannot sleep due to an overactive mind and restlessness.

 

[Inka]

To be fair, it’s easier on a pump. When I take a pump break and go back to MDI, I aim to be around 8 at bedtime as my insulin needs drop significantly overnight during a similar period.

 

[Amity Island]

I keep getting hypos in the middle of the night when I'm asleep - my Libre alarm alerts me that my blood glucose has fallen below 3 mmole - usually around 2/3 am. This happens several (>3) times a week. When I go to bed it's usually somewhere between 6 and 7 mmole.

What can I do to prevent this? Would something like a milky drink before bed be adequate?

Hi,

I find the libre is really useful for avoiding hypo's. I set mine to a 5.5 low alarm. I can decide then at the time how I need to react (if at all) by checking graph trend plus the direction the arrows are pointing. I prefer not to go hypo to try and preserve my hypo awareness.

The regular 3am lows you are having seem linked to your bodies natural circadian rhythm, that and too much insulin, too little food, incorrect insulin to food ratios or too much excercise during the day?

One thing I do as often as I can to avoid nightime hypos is to eat tea no later than 6pm. This gives the bolus dose time to run its course before I go to bed. You could try this. If you still go hypo, might be your basal that needs reducing a little bit.

It's all individual and trial and error.