Before Bed readings?

[Injecto]

Alright, I haven't had a real diabetes question in some time (opinions yes, questions No).

In theory, 4 hours after a meal bolus you should be back to normal range. Especially by 5 hours. With that in mind, I would assume my before bed readings should be below 7.0 (126) (and I prefer between 5 and 6.0 (90 - 108). My diabetes instructor says that if at bed time your reading is betweeb 7-10 (126-180) you are suggested to have a small snack and that below 7 (126) you are REQUIRED to have a snack. My problem is, I can only achieve my goal of normal range (below 7.0/126) about 50% of the time. I won't snack unless I'm below 5.5 (99) because I can stay stable all night, but like I said, that doesn't happen all the time.

What do most of you go to bed at? And at what point do you snack?

[Gangrel]

With the way things have been going with me, I'm aiming for 7.0 at bedtime, and usually have been waking up at 5-6.0 lately.

If I'm below 7, I'll have something small to eat.
I won't take any correction doses unless I'm over 10.

[belyro]

Well, typically I only snack if I'm below 6.0 (and only a couple of crackers or something, unless I'm actually low)...but lately I've been dropping at night, so that rule is out the window. But that did work for me for a long time.

I was doing a small correction dose if I was 10.0 or higher, but that's changed now too.

Oh well....pump tomorrow and EVERYTHING'S going to change then.

IMO, you don't HAVE to have a snack unless it's clear from YOUR knowledge of how YOUR body acts that you will need one. That said, if your ability to make it through the night without a hypo is inconsistent, you should probably err on the side of caution and have a little snack - or at least test part way through the night.

[shabbie6247]

Alright, I haven't had a real diabetes question in some time (opinions yes, questions No).

In theory, 4 hours after a meal bolus you should be back to normal range. Especially by 5 hours. With that in mind, I would assume my before bed readings should be below 7.0 (126) (and I prefer between 5 and 6.0 (90 - 108). My diabetes instructor says that if at bed time your reading is betweeb 7-10 (126-180) you are suggested to have a small snack and that below 7 (126) you are REQUIRED to have a snack. My problem is, I can only achieve my goal of normal range (below 7.0/126) about 50% of the time. I won't snack unless I'm below 5.5 (99) because I can stay stable all night, but like I said, that doesn't happen all the time.

What do most of you go to bed at? And at what point do you snack?

my nightime basal is pretty stable so i aim for 5.5 to 6.5 at bedtime. in the morning i wake and its exactly the same as my bedtime BG.

currently i am eating later in the evening so i tend to have insulin on board by the time i go to bed. i dont like to correct unless i have to, but my corrections dont usually work well at that time of night anyway for some reason. with all that lot going on my morning BG's are around the 7's.

its very rare for me to have to snack as i tend to go higher in the evenings. i would never snack unless my Bg is under 5.5, but thats purely based on my basal stability overnight.

injecto you know your D body better than anyone else.
if my BGs went up overnight i would get my Bgs right down before bed. and if they go lower overnight then you gotta stock up depending on how much lower you go. you can only tell by looking at your own patterns.

[Gary_W]

I can't say what the standard of diabetes education is like over there, but over here I've never been told how to properly set basal rates, never been told what basal insulin actually does and never been told how to do a fasting test.

In the absence of the above information, telling a patient to snack before bed is a great way to help ensure that the local emergency dept don't get too many people as all of those who have too much basal insulin (which will be almost half of them, as in the absence of education you'll have more chance of being too high or two low than you have of striking lucky) will be helped out by the snack and hopefully get through the night. For those with a properly set basal rate and a predicatable body it will do nothing but make you high in the morning and cause weight gain. For the educated, the stable and the lucky, I don't think the advice holds up. If you try for a 10 (180) at bedtime, you can work as hard as you like on your daytime numbers but you'll struggle to get a decent HBA1c.

I think in the old days with NPH this was not bad advice because of the peak. It would also be good advice for anyone on Lantus / Levemir who do suffer a noticable peak and need help dealing with it. For anyone with a flat response or anyone with a flat response until DP kicks in then I would argue that snacking at bedtime causes more harm than good.

I try and go to bed between 4.5 and 6.0 (81-108). If I am 6.1 (110) or above, I will actually give rapid insulin as a correction shot before bed as I know that at that time of night 1u of insulin drops me by 2.0 (36) or less if it's feeling like it, so I know it is safe to do so as I will not go below 4.0 (72). The only thing I typically have before bed is a glass of water. If I do fancy milk or something else, I'll have it but will definately inject for it. A glass of milk contains around 10g of carbs and will raise me by 2.0 (36) if I don't bolus for it, so I bolus for it.

I say if you are 100% confident of what your body likes and going to bed as a 5.0 suits you then go with that. If you wake up low on the odd occasion then go with your educators advice until you can find the cause. If you can't fix the cause, stay with the advice he's giving :) We are all different. I'm currently lucky with how predictable my nights are which is why I do the above. If it changed, I'd rethink my stratergy.

Just to cause your educator some stress, tell him you know of some fool in England that injects before bed if he's above a 6.0 and see what the response is.

Gary

[xMenace]

I'm with you 100% Gary.

The only time I now have trouble is when I eat a late dinner or snack. I'm not that refined with my evening bolus rates yet, but my overnight basals are near perfect.

[ngueld]

I find if I ate a bigger or later dinner my bloog sugar will rise during the night, where if I exercised in the evening my blood sugar will drop at night. If I exercised I'll have like a 15g carb snack about 2 hrs before I go to bed and usually I wake up between 5-8.

I always have trouble when I ate a big meal for supper or ate supper later that evening. Its really hard for me to get my morning sugars on track in that case.

[RobiJo]

I'll eat about 10-15grams without coverage if I'm under 90 before bed. Other than that I cover every crumb that enters my mouth. I correct for anything over 120 at bed. (110 the rest of the day).

IMO if your basals are correct and you didn't over bolus at dinner you shouldn't need to snack before bed--unless you are lower than your comfortable with.

[Gordonm]

When I was on MDI Iwould not go to sleep with anything under 120. Now with the pump I have gone to sleep in the 80s and had no problem. I prefer in the 100 range but don't hesitate if it is lower. I usually wake up in the 80s this way. If I snack and don't bolus Iwill wake up to high. My night time basal has been pretty good for the last 6 months.

[Emm]

I'm happy going to bed on just about any number within the normal range, so long as i'm aware of my trends. If I've had more exercise than normal I want it over 6, if I've eaten some sort of long acting crud food, I want it lower in case I go up overnight.

My general rule is that anything over 5 is ok. I trust my Lantus to keep my base insulin flatline. Anything over 7 and I take a correction before I go to bed - always a very small careful one! I can't sleep properly if I'm high. I can't get comfortable and I keep waking up for toilet breaks. 5 - 7 might sound like a tight fit but it works for me.

I don't snack before bed unless I'm hungry. I really don't get this thing of snacking before bed to keep BGs stable. Surely you shouldn't have to if your insulin is worked out right?

[grace girl]

Through lots of basal testing I know that on a "normal" night I'll drop around 30 points or less...so I tend to want to be between 120-140 when I go to bed. If I'm below 120, I might have a couple of crackers...nothing much.
However, there are some circumstances where I have found that I will have much larger drops over night...like on days when I'm super active. On those nights I usually go to bed around 150 and have crackers and peanut butter.
I can't reduce my lantus any more than it is in order to stay normal the rest of the day, so I'm stuck with this routine at the moment.
I personally don't think you should have to eat a snack unless you KNOW you need one. A lot of that comes down to testing, and know what you're insulin is going to do and what it's not.

After 4 years on mixed insulin and being required to have a snack at bedtime whether I wanted it or not, I love not having to have one any more, but I've found the habit of it to be very difficult to break.

[peej07]

If I make sure I eat like a "good" boy and try not to eat much after 8pm I'll wake up in the morn pretty much where I was before bed. I remember the old days when you were always eating a snack. No wonder I love to eat now.