Need advice badly, nighttime hypo

[corwin]

Last night, I took my 18u of lantus at night as usuall, tested an hour later and I'm 93 then I went to bed. 2 hours later I woke up feeling something is very wrong. I tested and I'm 53, my lowest ever. I went overboard and ate 50g carbs. I realized it was way too much but I didn't want to mess with fast acting insulin so I set an alarm 2 hours later, waited 15 minutes, tested 94 then went back to bed. When my alarm clock woke me up I tested 273. Then I took 1u of novo, which normally should've brought me down to about 150 and went back to bed. I woke up at my usuall time 4 hours later and I'm 72. Obviously I'm not feeling my best this morning and I'm trying to figure out what went wrong. It also might be worth mentioning that the previous day I woke up 70, a bit lower then I like.

Is there any other explanation to this other then my lantus is too high? I'm going to keep a close watch on my BG today to see if it goes down when I don't eat for few hours. Even if it is too high, isn't a drop from 93 to 53 in just 2 hours a bit too much? Should I lower it tonight already or should I wait to see if it happens again? I really wish to avoid something like that again tonight if I can. Also how much should I lower it? From 18 to 16? 17?

Please give any advice you can, I really wish to sort this out and make this terrible feeling as rare as possible.

Thank you in advance,

Corwin.

[befni]

hi corwin, i would suggest not panicking, it may be that you did a bit extra physically yesterday or perhaps you are starting with a cold or something? i often find that if i have one night hypo i keep a check the following day and it doesnt happen again. However if it does continue i would suggest dropping your lantus to 16u for a couple of days or make sure you have a snack before going to bed, good luck and hope this helps

[DeusXM]

Like Befni said, I would drop the Lantus by two units, but bear in mind it'll take a couple of days for your body to fully adjust. With Lantus, it's better to make changes of a couple of units each time - because it's so flat and long-acting, 1u won't really make much difference.

As for why your BG dropped so much after taking 1u of Novorapid, that's because usually after a hypo your body is much more sensitive to insulin for a while.

If it's any consolation, last night I had a nasty little nighttime hypo and like you I ate far too much, and woke up again at 4am with a BG of 12.2 (220). So I jabbed in 5u (because I'm an idiot and forget that my comp bolus works out at 1u per 3mmol/l) so of course I woke up again at 8am with another hypo.

[seacomp]

From your description, I would suggest a possibility. Your drop seems too sharp and dramatic to be caused by a small error in dosage. Rather it sounds like what might occur if you inject 28 u rather than 18 u, or inject the dose twice.
If you had been on your current dosage for a while with the same level of carb intake and activity without problem, then the likelyhood of an injection error is greater. If it was an injection error, the problem should not reoccur.
If the problem continues, then do change dosage in small amounts with time to adjust to each change, as the others suggest.

[corwin]

Thanks guys.

befni: Yeah I was panicing a little, I guess the first time is always the hardest. I didn't do anything out of my usuall routine so that can't be it. Also I really prefer not to have to eat a snack every time before going to bed, it seems like a sure method to get more lows when I forget.

Deus: Wow deus that sounds like a worse night then I had, I guess I'll eventually get casuall about this as well. Thanks for explaining the mystery of the major drop from 1u.

seacomp: I'm 100% sure I didn't mess up the injection, I did it once and I'm sure it was 18. I did however change the lantus vial and maybe that changed something? I will take your advice of giving it another night before lowering to 16u.

I didn't have breakfast today, I never do, and for 3 hours after I woke up my BG stayed in the 84-88 range testing every hour. (after raising it to 88 before driving to work). This seem to suggest my basal isn't off, I think. I guess I'll give another day to my 18u and see if it happens again, though I'd hate to repeat last night's adventure.

Any more suggestions? I still feel a bit lost and unsure how to avoid it in the future.

Corwin.

[LauRa Lu]

I'm another one who had a dreadful night last night.

I needed to get my prescription yesterday but it got taken to the wrong pharmacy, so i was out of test strips all evening and all night.

I decided to be as careful as can be, just eat what i needed to and take one unit less of my novorapid so that i was really unlikely to go low.

I'd been planning all day to go out dancing with my friends and had a great time getting ready, avoiding the wine so that i didnt go low. When we got out I asked (well shouted more like so the bar girl COULDN'T get it wrong) for a vodka and 'DIET' coke. she heard me alright I could tell, and i was confident she was gonna give me what i asked for. It wasn't until i'd almost finished off the drink that i realised it was regular coke :/ But i thought never mind i'll dance it off. Was dancing for 2 hours solid, having great fun, but started to shake like crazy, my hands and my legs were like jelly. so i really thought i was low, took 2 glucose tabs and didnt help a thing so went home at 11:30pm.

Got back and felt worse still...crazy shakes... so i had some regular coke again. I couldnt test so had to go with the guess that i was low coz thats what i really felt. But was up in bed till 3 am feeling sicker and sicker, shakier and shakier, and reallly felt like i was going to pass out.

I was quite scared coz by now i'd decided i was super high not low and had made it worse. i went to sleep eventually i assume, but woke up with two crisp packets in my bed and cracker crumbs :dontknow: I only had the one drink but i feel like ive got the hangover from ****! Most awful night i've ever had!

[Cyborg]

I'm another one who had a dreadful night last night.

I needed to get my prescription yesterday but it got taken to the wrong pharmacy, so i was out of test strips all evening and all night.

I decided to be as careful as can be, just eat what i needed to and take one unit less of my novorapid so that i was really unlikely to go low.

I'd been planning all day to go out dancing with my friends and had a great time getting ready, avoiding the wine so that i didn't go low. When we got out I asked (well shouted more like so the bar girl COULDN'T get it wrong) for a vodka and 'DIET' coke. she heard me alright I could tell, and i was confident she was gonna give me what i asked for. It wasn't until i'd almost finished off the drink that i realised it was regular coke :/ But i thought never mind i'll dance it off. Was dancing for 2 hours solid, having great fun, but started to shake like crazy, my hands and my legs were like jelly. so i really thought i was low, took 2 glucose tabs and didnt help a thing so went home at 11:30pm.

Got back and felt worse still...crazy shakes... so i had some regular coke again. I couldnt test so had to go with the guess that i was low coz thats what i really felt. But was up in bed till 3 am feeling sicker and sicker, shakier and shakier, and reallly felt like i was going to pass out.

I was quite scared coz by now i'd decided i was super high not low and had made it worse. i went to sleep eventually i assume, but woke up with two crisp packets in my bed and cracker crumbs :dontknow: I only had the one drink but i feel like ive got the hangover from ****! Most awful night i've ever had!

Are you type 1 and insulin dependent? Sounds like you were flirting with major disaster last night. You are extremely lucky you didn't end up in the hospital. Hope you feel better today, but I also hope you learn from your mistakes. Next time you might not have a second chance.

[Cyborg]

Any more suggestions? I still feel a bit lost and unsure how to avoid it in the future.
Corwin.

Corwin, I had terrible problems with nighttime lows while taking my Lantus at nighttime. After speaking with my endo, we decided to move my Lantus injection to mornings and that helped tremendously. Perhaps you could talk to your doc about trying it.

[jen_slc]

Corwin, did you eat dinner soon before going to bed? Just want to rule out that maybe you overdosed for dinner... sometimes that happens to me if I eat late.

Also, I know people are recommending a 2 unit drop in your Lantus, but because you seem pretty sensitive to insulin, 1 unit might work. I am on 16 units a day (8u X twice) and am very sensitive to 1 unit changes. All you can do is experiment and see what happens. You can try dropping your dosage and if that fails, there are other options that we do (AM shots, splitting shots, etc).

I used to have awful nighttime hypos and didn't know it (I wasn't waking up), and it turned out my Lantus was too high: 26u vs my current 16u, so that was a big decrease. I kept dropping it until my bg stablized through the night till morning - for every 50 mg/dl my bg dropped, I decreased my Lantus by 1 unit until I woke up at the same bg I went to sleep with (in the beginning I was dropping 200 points through the night). Hopefully your 1-2 unit drop will work for you.

[corwin]

No, I forgot to mention it, I ate about 5 hours before going to bed and had no fast insulin or carbs in my system.

I'm thinking of setting an alarm to wake me up tonight to check if I'm going too low as early as possible, if that's the case I'll try lowering my lantus or one of the other method you guys suggested.

Thank you.