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problems after severe nocturnal hypo

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In reply to a few of your suggestions, I actually take my long acting insulin on a morning which I have done for years now - but it still doesn't seem to be working - what's even more strange is I take less basal now than I have ever done Im on 14 units.

Hi again @sheshops What basal insulin are you taking? Is it Lantus? When you say it’s not working, what do you mean? Would you consider trying a different basal? For me, my nocturnal hypos were caused by my basal insulin and no basal insulin worked because none could match my needs during the night (very, very low need early on then rising as dawn approaches).

Have you considered a pump? With a pump your basal needs can be matched exactly and you won’t have a ‘lump’ of basal insulin sitting there releasing itself when you don’t need it. Pumps use bolus/fast insulin and can allow you to have tiny amounts. My pump changed my life. That’s not an exaggeration.
when I say its not working I mean that I think I am still having too much with these night time episodes but when I lower it further my blood sugars are really high. I know a pump would change my life but I really dont think I could live with one as I'm really squeamish and hate anything being attached. I dont even like the libre to be honest. Im on Lantus yes my diabetic team have told me there are others they can try but I'm nervous to try anything new as years ago they put me on Humalog which really didn't agree with me at all. But I guess as you get older things do need to be switched about a bit so I may have to try other insulin's
 
Hi there @sheshops. I’m so sorry to hear about your recent hypo and they way it’s left you feeling.

My post is about Lantus - I took it for about 8 years, I think. Eventually, I had to switch because of overnight hypos - the info I read about Lantus stated that hypos were likely either 3 or 6 hours after injecting (I was taking it at 10pm) and my hypos had started to fit this pattern. I switched to Tresiba which has a much flatter profile, for me anyway (we’re all different).

Have you asked about CGM? (I don’t know much about the Libre 2 - I use the Libre 1).
I hope you’re able to put this awful episode behind you and get a good night’s sleep. 🙂
 
You could try Levemir. You have two injections of that a day but importantly you can split the injection as needed. So, just as an example, say you needed 12 units of the Levemir in total per day, you could have say 8 units in the morning and 4 units at night and that can reduce your risk of hypos, as you can imagine. It also gives you more flexibility.

You say the Humalog didn’t suit you. Some people really don’t get on with human analogue insulins like Humalog because they find they have more sudden, less ‘spottable’ hypos. That might just be another thing to keep in your mind as a possibility because there are other types of insulin like the original non-analogue human insulin and the very original animal insulin (that was used for decades).

I’m squeamish too but a pump is no more scary than injections IMO. In fact I think it’s less scary as you don’t have to do injections, only change the cannula every 3 days. The cannula is tiny, like a pen needle but made of plastic. I didn’t want a pump because I thought it would be like a ball and chain. In fact, it gave me my freedom back. Quite the opposite of what I was thinking! Even if you decide you still don’t want one after consideration, do take a look on YouTube and have a read about them. I honestly don’t feel my cannula or even notice my pump at all (I have a tubed pump which is very unobtrusive).
 
when I say its not working I mean that I think I am still having too much with these night time episodes but when I lower it further my blood sugars are really high. I know a pump would change my life but I really dont think I could live with one as I'm really squeamish and hate anything being attached. I dont even like the libre to be honest. Im on Lantus yes my diabetic team have told me there are others they can try but I'm nervous to try anything new as years ago they put me on Humalog which really didn't agree with me at all. But I guess as you get older things do need to be switched about a bit so I may have to try other insulin's
Hi sheshops,

So...you've now got the amazing freestyle libre (2 too!).

What have your overnight libre traces (graph) being showing for last few nights? The libre should make it very clear to you what is happening and when? Have you noticed anything? Is there anything you can do to avoid any issues occuring?

Have you done an overnight basal test, making sure your last meal and bolus is all finished before you go to sleep (i'm on humalog for bolus and this last up to 6hrs so my last meal would have to be about 5pm to be able to get to bed for 11pm). This should show you what the problem is. Ideally, blood glucose should remain level during the night (say around 7mmol), if it's not level, then that could point to a basal insulin problem or it could be increased insulin sensitivity due to some excercise during the day which is causing a dip during the night.

It's tricky, cos there are so many variables, but if you have a libre, that would be a very good starting point to start looking at making any changes and is brilliant for having something to show and discuss with the diabetic nurse or consultant.
 
I think @Inka ’s suggestion of a split Levemir might be worth considering if your preference isn’t for a pump - though maybe something like Omnipod might appeal more as it’s way less attach-y?

Levemir only last 12-14 hours-ish, so you can have quite different basal insulin levels running daytime vs night timeas it sounds like your basal needs take a big dip just after midnight like mine do

Lantus has a reputation for being a bit stubborn and sluggish to react to changes, whereas Lev is said to be more biddable.

I was planning to swap to Levemir, as I was really quite pump-averse, but in the end I decided to give an insulin pump a go for 6 months to see if I could cope with it. That was about 9 years ago! And like @Inka it has given me a huge degree of freedom and spontaneity back - but I recognise the idea doesn’t appeal to everyone.
 
You could try Levemir. You have two injections of that a day but importantly you can split the injection as needed. So, just as an example, say you needed 12 units of the Levemir in total per day, you could have say 8 units in the morning and 4 units at night and that can reduce your risk of hypos, as you can imagine. It also gives you more flexibility.

You say the Humalog didn’t suit you. Some people really don’t get on with human analogue insulins like Humalog because they find they have more sudden, less ‘spottable’ hypos. That might just be another thing to keep in your mind as a possibility because there are other types of insulin like the original non-analogue human insulin and the very original animal insulin (that was used for decades).

I’m squeamish too but a pump is no more scary than injections IMO. In fact I think it’s less scary as you don’t have to do injections, only change the cannula every 3 days. The cannula is tiny, like a pen needle but made of plastic. I didn’t want a pump because I thought it would be like a ball and chain. In fact, it gave me my freedom back. Quite the opposite of what I was thinking! Even if you decide you still don’t want one after consideration, do take a look on YouTube and have a read about them. I honestly don’t feel my cannula or even notice my pump at all (I have a tubed pump which is very unobtrusive).
Just to second Inka's point about the value of a pump. I find it good to be able to reduce basal to 0.05 units per hour for much of the night. Even so, the Libre suggests that blood sugar tends to go low during that time, though I have had no real problems during the four years of using the pump. I had suggested putting basal to zero, but consultants are suggesting that it would be better to have CGM sensors and a smarter pump to shut off the supply when I go low. One thing that I find a nuisance is that I don't always wake up fully if I go low in the early hours.
 
Hi there everyone

I'm new to this forum, I have been type 1 diabetic for 25 years and have sadly experienced severe nocturnal hypos quite a few times before. I had one on Sunday night / early hours Monday morning - luckily my boyfriend was staying with me and found me collapsed downstairs. The experience this time has left me feeling really depressed and almost suffering anxiety/flashbacks and a fear of the dark / being alone. This is very unusual for me as Im normally a very upbeat happy person. I believe I was out for a few mins before he found me. I just would like to know if anyone else has suffered like this after a similar experience and if its normal. Im sure that the pandemic and the current situation in the world at the moment are not helping me. Any advice from anyone is most welcome.

Dear Sheshops

well its an unpleasant experience isn't it.
I've had more hypos than proverbials until i got my (bog standard) pump. But even with this, as its not AI-sensor driven hypos occur, but less frequently. I think bcos pumps have less of a basal residue, it forces you to stay on top of mananaging your current glucose, otherwise it cumulatively drifts hi/ low.

Re the emotions from extremes, i guess its feeling of vulnerability and fate. However against that, i guess you know the steps to take to try prevent such situations. Many people talk about predosing with insulin. I don't. Precisely for the reason that can be an unpredictable gap between injecting and eating. And the more one predoses, the more one tries to flatten any glycaemia peaks by predosing ever earlier. Clearly such has risks, which by and large i've given up exposing myself to. If one lived in a single person household, predosing might be more manageable. But may your hypo wasnt from a gap between injecting and eating but exercise or ?
 
Hallo sheshops I have got the tee shirt read the book seen the film ,seriously i have not had a bad hypo in about 9 years since i went on a insulin pump which gives you far more control than you will ever get from pens ,with your record of bad hypos i am sure they will give you a pump in the uk, yours matchless.
 
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This thread is now closed. Please contact Anna DUK, Ieva DUK or everydayupsanddowns if you would like it re-opened.
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