I am trying to remove some rather annoying night hypos that in truth I’ve been plagued with for rather a long time. (Says he up at half three after one)
Its made all the more complex by the fact my blood sugar always goes Up in the morning so I wake about 12mmol/l (actually slightly lower if I ever get it right) and if I test before I go to bed I also need to be on the high side to avoid one.
I suspect they are caused by rather to much Lantis but its very difficult to get right, when I can only tell if I’m getting it wrong (when I wake up at 3am) not when I get it right (when I sleep though the night, and in all probability am still too high or too low) However if I’m far too high I will still wake up in the middle of the night. (usually after eating the wrong thing and not taking enough insulin)
For someone happy on MDI I can think of two things that ‘might’help that I know have worked for me or others.
Firstly splitting your langue to two doses can flatten out the spikes a little. I tried this last year and it helped me before I moved to a pump.
Secondly have you tried Levemir instead of Lantus? It’s got a different profile so may assist.
Obviously for both of these you’ll need discussions with your DSN and I hope you have a good one.
When I was on MDi I also had this problem with night hypos – my solution was to move my entire Lantus dose to the morning. (Left me with a minor dawn phenomenon due to the Lantus not being a 24 hour insulin, rather more like 22ish for me, but I dealt with that by having a dose of novorapid immediately I woke up, regardless of meals etc.
I didnt go down the split dose route due to my digestive problems (injecting at night, however much, when I had an ‘episode’ where I stopped digesting anything was a recipe for hypos), but that would have dealt with the dawn thing, so its definitely worth talking to your DSN about trying it.
Hi Peter, I tried the splitting of my Lantus years ago and it worked for a while. You could try changing your Lantus injecting time so that any peaks or troughs are not during the night and therefore can be adjusted for in the day by short acting insulin. Again as Dave says discuss with your DSN. Hope your not disturbed tonight lack of sleep due to hypos makes me not think clearly!
@peterchilds I used to split my Lantus dose to avoid middle of the night lows. For me, it was an improvement on taking it all in one go, but the pump was a significant improvement on that.
You could try the joys of basal testing – setting your alarm for every couple of hours during the night to see what your BGs are doing. This would give you a fuller picture of what’s happening. Or see if your clinic can lend you a CGM for a week, so you can get a proper look over several nights at whats happening while you’re asleep.
I used to split my Lantus dose but it didn’t really make any significant difference, so I stopped doing it after 6 months or so.
Your problem sounds pretty much like my old problems with Lantus and I found the best cure was a pump – which isn’t much help perhaps I tried injecting Lantus earlier, later, larger doses, smaller doses but it was just too crude a mechanism for my wonky basal requirements. Said wonkiness is illustrated by my current pump basal settings:
That’s interesting @Tim – your peak is 1am, my lowest point is 2.30am. My peak is early morning, you start dropping down then. Fascinating how different basal requirements can be – especially overnight as I assume we’re both doing exactly the same thing then, sleeping.
When I was attempting to wrestle Lantus into submission I tried a split (but the waking hypos returned after a few weeks) and ended up, as others have said, shifting Lantus to breakfast time. When taking it at approx 10pm the mini-peak of activity that Lantus often shows at approx 5hours post-injection was exactly times to collide with what I can now see it my need for less basal. Breakfast lantus did properly mess up readings after toast (since it was still in onset and DP was wading in) but I tried to beat that down with extra rapid and a 45 minute delay before eating breakfast.
Infinitely tweakable basal profiles vs my ongoing struggles with Lantus were a big part of my decision to go for a pump. My morning readings have never been better since the switch.
Tim & Alison,
those basal rates are very interesting for the likes of me to see, I’m still on one 24 hr basal rate but change it depending on how sporty or not I am. Its’ still early days but don’t you find that the basal rates change depending on where the cannula is situated and/ or how active your day has been etc?
Yes, my basals dont change with cannula site, and I change for exercise etc using temporary rates.
My lowest basal is between 1 and 3 am, and my highest is at 7pm.
Brings something to mind – I read (in an issue of Diatribe, that should therefore be fairly accurate, but obviously isnt) that everyone’s basal rate profile should have just one peak and one trough (similar to @Tim ), and if yours didnt, you’d got it wrong. I ignored it, because mine didnt, but there was no way I’d got it wrong (many basal tests proved that), but I did wonder if many people actually had this theoretical ideal (that the doctor said was the only correct way). I dont, @alison doesnt, @Tim does. Anyone else?
@annette Nope! Much wobblier than that here. Still a bit of a work in progress, but multi-basal-test confirmed low points in the early hours and late afternoon, with a big (problematic) splurge needed ‘a bit’ before I crawl from under the duvet and a smaller boost later in the evening
So far I’ve managed to reduce my lantis down to 20 units (from 30) with no detrimental effects, (I tried 25 first) I was 7 this morning so I guess thats an improvement but I guess its going to take a few days to settle down….
@Wendy my friends daughter has lows in her sleep which she isn’t awake for but you can hear her thrashing about. You may only find out about these lows if your high when you wake up the next morning. Generally the body kicks in and the glucogen stored in your liver starts to replace the missing glucose. (Do correct me guys if I’m wrong in the naming of said liver store) …but Wendy don’t panic. I suppose it is worth once in awhile setting the alarm for every two hours to test to find your pattern(boring!) I wake up and find it difficult to get back off to sleep after 1/2 hr I get fed up and test and yes I’m low.
They’ve not long changed his meds from humalin to lantus and humalog and advised no snacks but ever the worrier i let him eat before bed. he usually wakes up in the morning with bms around 7 so i figure the lantus is doing its job and the bedtime snack is having no adverse affect. its a fine balancing act
Well – these are my basal requirements – I have been plagued by hypos in the night my entire life – my parents resorted to a baby alarm in my bedroom, which I was very resentful about all through my teenage years! Only the pump has resolved matters – I still have problems, but not as bad as they were. note the first setting!