Type 2 + basal insulin - Night time lows - how can i tell

[Jenny105]

Type 2 now taking basal insulin of 18 at 7am
Ive had a few lows in the daytime. No signs or symptoms except a croaky voice. I can get round these by snacking around mid morning or mid afternoon.

Recently Ive taken a few readings by finger prick in the night to check this out. eg {2.00am 5.8 7.00am 7.7 } no intervention ;
; { 2.21am 7.1 6.35 9.1 } ; 1.20am 4.8 (1/2 small can A ppeltise) , 2.15am 6.6 , 6.30 am 8.6 } no intervention

On the 2 occasions shown above where there was no intervention ( no sweet drink etc) why had the readings gone up when testing on waking ?

 

[everydayupsanddowns]

There's no clinical need to treat low glucose until it goes below 4.0 really. Even that still has a bit of a 'buffer zone' before true hypoglycaemia.

Rises between the early hours and waking are often the result of the Dawn Phenomenon - a natural hormone response to 'fire up the burners' for the day ahead that goes back to our cave-dwelling forebears. For some this happens in the early hours around dawn. For others it is triggered by getting out of bed (sometimes called 'foot on the floor').

 

[Jenny105]

Thanks everday us an downs . In the daytime my first low was 2.7 , others have been in the 3s. My nurse told me to treat a low of 5 if i was going to drive on holiday.
I guess i should leave testing til 11.30 - 12 in the day to check on the lows. Then treat if lunch isnt imminent
Forget the nights ? Ive had no symptoms in the day so I wondered what would happen if i went under 4@ night. My readings can drop 5 - 7 points between meals. Having been on the high side 13-27 b4 insulin the low readings looked pretty shocking and scary..

 

[Inka]

Didn’t you get any symptoms at all when you were 2.7 and 3.0 @Jenny105 That’s a bit worrying, especially as you’re fairly new to insulin. Your hypo symptoms should be pretty sharp.

Do you have a Libre? If not, how often are you finger-pricking? I wonder whether you’re dropping a bit low without realising and this has dulled your hypo symptoms.

 

[Lucyr]

Ive had a few lows in the daytime. No signs or symptoms except a croaky voice. I can get round these by snacking around mid morning or mid afternoon.

That isn’t the right way to get around repeated lows, if you’re getting repeated lows in the daytime you need to reduce your insulin.

For the other bgs, it’s normal for bgs to go up in early morning and wouldn’t be concerned about it.

 

[trophywench]

It's also dead normal for humans to have low BG at around 2am to 3am (ish) - those working permanent night shifts very often get 'the munchies' at around that time - my husband worked exactly that shift when he was a LOT younger and working at the Jag (ie one of the Jaguar car factories in Coventry) and confirms this - and the lower natural BG provided by natural circadian rhythm, is the clinical reason for it. All non diabetic people as far as we're aware.

Down so far and gradually, I wouldn't ever wake - not being of an age then when I needed a wee anyway during the night - BUT if it plummeted down fast, it would reliably wake me at 4.5 +/-. Once a day jab of Lantus was a bugger for this since it really does have a peak in activity at +5hrs-ish after you jab it in at bedtime. A right PITA.

I agree with Lucy, cos she's right - it is just not acceptable to be having hypos at any time of the day or night UNLESS it was caused by user error - that's exactly why each of us using insulin really MUST learn asap to analyse why it happened and thereafter attempt to eliminate the chances of a similar event happening again any time soon.

Please remind me - what basal insulin do you use?

 

[everydayupsanddowns]

My readings can drop 5 - 7 points between meals.

Dropping that much between meals, and having to snack to keep levels up (‘feeding’ the insulin) does sound like your insulin dose(s) might need adjusting @Jenny105

Can you contact your nurse to ask their advice?

 

[Jenny105]

Thanks everyone . I will send a note to Nurse , and to a private dietician. The pattern is as yesterday but this was the first for a week. 6.30am - 8.00 11am - 11 (after a pals snack -1/2 a nutri bar, 3 dried apricots; 3 brazil nuts) I put lunch back to 12.45 Test at that time 3.8. . There is often a drop of 5-7 points between 11am and 12 .
I was on 18 insulin but now do 17 / 18 alternate

 

[Inka]

Apologies if I’ve missed it, but what insulin are you taking @Jenny105 (full name inc any numbers or letters) ?

 

[RBZ5416]

Did you double-check the sub-4s with a repeat test? You should always repeat an unexpected result as it could just be a meter/strip error.

 

[Jenny105]

Did you double-check the sub-4s with a repeat test? You should always repeat an unexpected result as it could just be a meter/strip error.

Useful tip. There were several at the same time of late morning in one week. However they are receding now

 

[Jenny105]

Useful tip. There were several at the same time of late morning in one week. However they are receding now

What would constitute a hypo? Ive read about them but not sure how to recognise one without taking a fingerprick

Apologies if I’ve missed it, but what insulin are you taking @Jenny105 (full name inc any numbers or letters) ?

The insulin pan holds Levemir, Inka. I am using 17, 18 alternate days. I was on 18 but 17.18 seems to be consistent

 

[Lucyr]

What would constitute a hypo? Ive read about them but not sure how to recognise one without taking a fingerprick

You need to fingerprick to identify hypos. BG under 4 is a hypo.

 

[Jenny105]

Thanks, I get very little in the way of warning , maybe perspiration which if the weather is hot, maybe a slight croak of the voice or a feeling of hunger. At the moment my habit is to take a reading at vulnerable times eg 11am ; 4pm ; and/or have a slightly more sugary / carb snack about an hour before this.