Overnight hypo, and many of them!

[viranth]

So the last 10 days or so, I've had 3 overnight hypos (might have had one the last 6 months before that). And I haven't really given it any thought, I figured I had set too much insulin at my evening meal, but I recently upped my insulatard to 4 units (from 2) at 1330. Then I take 8 units at 2300 before bed.

Anyone thing the 4 units I take during the day affects my night levels?

Cause last night, I woke up at 0023 with 4.2 (went to bed at 2300 with 7.1). Ate food and had some juice, and set no insulin, had to wait 20 minutes or so before my BG was raising. Then three hours later (set an alarm) my BG was 3.9. This time I ate 3 slizes with strawberry jam(with sugar), had a little juice and a fist full of m&ms.

Then now when I wake up, my BG is 5.1.

Am I setting way too much insulatard at night, or is it because of the day dose too?

[owlyn]

I think you may be taking too much insulin with your evening meal. The action curves of the long-acting insulins doesn't really fit what you are describing. What time is your evening meal, what do you eat, and how much insulin do you take? Also, do you know your insulin:carb ratio?

[xMenace]

It's the obvious villain. Why did you increase it?

Many people do drop while sleeping. You need to discover your real tendancy. These get real fun when your insulin sensitivity goes to pot :eek: You can't go by your before and after numbers. You need to get up several nights and test different hours, or pick a night and stay up all night to test every hour or better.

[owlyn]

Coreection to my previous post- if Insulatard is the same as NPH (is it cloudy?) then it has a really strong peak at about 4 hours, and could easily be the source of your hypo. This is why since Lantus and Levemir became available, NPH isn't prescribed as much.

[Lizzie G]

Coreection to my previous post- if Insulatard is the same as NPH (is it cloudy?) then it has a really strong peak at about 4 hours, and could easily be the source of your hypo. This is why since Lantus and Levemir became available, NPH isn't prescribed as much.

yup it is. i use it in small quantities to cover my DP (on top of my usual basal which is lantus). 4 units taken as late as possible works pretty well but if i take it too early its not ideal. id say its a really poor insulin to use as a basal and strange that V seems to use as a combo of basal and bolus but its good for supplementary use!

[viranth]

My last meal is either 2030 or 2130, depending if I work out or not.

So the fast acting insulin should be out of my system before I go to bed.

I don't know my I:C ratio, I keep a log, so I know how much I should set for x amount of potatoes/rice/pasta and stuff like that. The reason I don't have a I:C ratio, is because it seems I react different to the same amount of carbs in different products.

I already decreased my daytime insulatard, so hopefully it'll get better tonight.

[viranth]

Coreection to my previous post- if Insulatard is the same as NPH (is it cloudy?) then it has a really strong peak at about 4 hours, and could easily be the source of your hypo. This is why since Lantus and Levemir became available, NPH isn't prescribed as much.

It must have a very strong peak, because it dropped me in the same rate as too much novorapid does.

[owlyn]

It must have a very strong peak, because it dropped me in the same rate as too much novorapid does.

Yes, it is a very strong peak. I used to go hypo every day at 11 am after a 6:00 am injection. That's why it works well for DP for some people. That's about the only thing it's good for. Hmmm, maybe pizza and other high fat meals... now there's an idea...

[Gary_W]

My last meal is either 2030 or 2130, depending if I work out or not.

So the fast acting insulin should be out of my system before I go to bed.

I don't know my I:C ratio, I keep a log, so I know how much I should set for x amount of potatoes/rice/pasta and stuff like that. The reason I don't have a I:C ratio, is because it seems I react different to the same amount of carbs in different products.

I already decreased my daytime insulatard, so hopefully it'll get better tonight.

I wouldn't bank on all the fast acting being gone; most fast acting insulins take 4-5 hours to be completely gone (in most people). So this could also be a factor. If you are inkecting this for your evening meal at 20:30 or later and then going to bed 2.5 hours later, you are going to bed just after the short acting insulin has peaked. Not a safe thing to do.

It is also possible that the NPH is hurting you too. What can be said with certainty is that you have too much insulin active at night; if you ate 3 rounds of toast with jam (which is at least 70g of carbs, possibly more if you cut the bread as thick as I do) and only rose by a point then you have way too much insulin floating around at night.

Have you considered pumping? I am under the impression that they are a little easier to come by in Scandinavia than other parts of Europe. Much more predictable than NPH and will suit your late eating habits rather better.

Gary

[viranth]

Have you considered pumping? I am under the impression that they are a little easier to come by in Scandinavia than other parts of Europe. Much more predictable than NPH and will suit your late eating habits rather better.
Gary

Decreased my night time insulin last night (from 8 units to 5 units) and woke up with 5.4, then an hour later 4.9 (sunday, slept a little longer).

Pumps are "easy" to get, but you need to have a valid reason for it. Mostly they are given to kids and people with problems, I doubt I will get one because I have good control (hba1c at 4.9%). But if it was 8.9% I would get it asap.

Kind of unfair, but that's the way it is I guess.

[Lizzie G]

Decreased my night time insulin last night (from 8 units to 5 units) and woke up with 5.4, then an hour later 4.9 (sunday, slept a little longer).

Pumps are "easy" to get, but you need to have a valid reason for it. Mostly they are given to kids and people with problems, I doubt I will get one because I have good control (hba1c at 4.9%). But if it was 8.9% I would get it asap.

Kind of unfair, but that's the way it is I guess.

with an hba1c of 4.9 (wow, well done that is amazing!) cant you use frequent hypos as a valid reason for getting a pump? its seems that many people 'with problems' tend to simply be less well informed and vigilant about control (sorry i know this sounds harsh but i have been around so many people like that who dont really understand how their insulin works and are up and down like a yoyo). anyhow, perhaps if these people that get pumps instead of you were to work as hard as you do, to test as often and to think things through as carefully THEY wouldnt have problems....so id say if you want the pump, push the issue!

[Gary_W]

Decreased my night time insulin last night (from 8 units to 5 units) and woke up with 5.4, then an hour later 4.9 (sunday, slept a little longer).

Pumps are "easy" to get, but you need to have a valid reason for it. Mostly they are given to kids and people with problems, I doubt I will get one because I have good control (hba1c at 4.9%). But if it was 8.9% I would get it asap.

Kind of unfair, but that's the way it is I guess.

There is actual national guidance in the UK that means that the people that get the pump most easily are those with the high numbers. Which does kind of suck if you are doing your best, know what you are doing and still cannot get MDI right. I was of the opinion that I'd never get a pump either, but if you don't jump into the ring you'll never know whether or not you'll win the fight.

At the time I got a pump earlier on this year, my HBA1c was 5.8. Still is as far as I know. Even if it's gone up a little I really don't mind as I feel so much better with the pump it's hard to believe.

My problem is huge differences in my basal needs in the night vs the day, and then it all changes every few weeks. In the end, it became very difficult to manage on MDI as the night hypos were getting to the point that life wasn't much fun.

It's not all about HBA1c why they give you a pump. It's about quality of life. With your numbers, you can show them that you clearly know what you are doing. Problem with this disease is that if your body changes and does weird things like your basals going up and down like a yo-yo then you are up against it and no amount of knowledge will completely solve the problem. If you have to fiddle around with different insulins to cover DP or avoid night hypos, you may find they look kindly on your case.

Gary

[shiftzor]

Really pumping comes down to the area you are in, some areas it’s easier to get a pump and other areas are really hard. Post code lottery, I am starting pumping and so really I don't see why you couldn't do the same. Don't ask and you will never know, so you don't have much to lose. Mention the hypos to your endo and see how it goes, I believe hypos are a good enough reason to start pumping for the NHS. ;)