[LiveNormal]

I am puzzled. My 3am BS for 2 consecutive nights was low and I don’t what caused it.
By right, the dinner Humalog should be out of the body after 5hours, so it could be due to the NPH. However, for the second night, I used 2 units less NPH and the 3am reading was still low… and apparently the 2 units less NPH was not enough to cover me till I wakeup.

5/30:
1930: 5.2 mmol/L, bolus 5 units of Humalog for dinner
2147: 11.1 mmol/L (correct with 2 units and add 2 units to cover water melon)
2314: 9.2 mmol/L
2330: 8 units of NPH before sleeping
0303: 2.3 mmol/L (ate 7.5 g raisin)
0802: 5.2 mmol/L

6/1:
2003: 2.8 mmol/L, bolus 5 units of Humalog for dinner
2200: 3.6 mmol/L (3/4 of orange)
2326: 7.2 mmol/L
2330: 8 units of NPH before sleep
0303: 2.5 mmol/L (ate 7.5 g raisin)
0826: 11.1 mmol/L

Anyone has any idea what gives?

With regards to activity level, comparatively speaking I was more active on 5/30.

[xMenace]

Originally Posted by LiveNormal

Anyone has any idea what gives?

Yes.

You naturally bottom out in the night then wake up with a hormone dump that makes you insulin resistant. It's very common. I'm the same way if not more extreme.

nighttime basal patterns - Google Search Check out the first result - the BD workbook.

dawn phenomenon - Google Search

Oh, and those doctors, DEs, and drug reps who claim our basal needs are flat are wrong!

[morrisma]

John's right. Flat basals are almost always wrong. On a pump, I get pretty fine control. On MDI, you might try splitting the NPH between morning & night to smooth out the curve a little.
Mike

[Subby]

^^^ What they said. Another tactic well worth trying with your current regimen, is to eat a decent snack of long acting, low gi food just before bed. Now, it's common medical opinion that eating before bed isn't the best of ideas, but us diabetics often have another set of "evils" to choose from, and keeping BG steady overnight rates highly, yep? Something like a serve of porridge with milk and with a light sprinkle of dried fruit to flavour, will give you sustained, steady release of energy over 2 - 5 hours and provide a little upper to your metabolic downer. This helped me immensely to keep my overnight BG stable when I was on Lantus.

[LiveNormal]

Thanks for all of your input.

I have tried taking a 15g bedtime snack and reduced NPH but it ended up with an extreme high morning BS (21mmol/L). I used to think that by switching the rapid insulin from regular (Actrapid) to fast (Humalog) insulin will solve the problem of me going low during midnight. Guess that is just my wishful thinking. Well, used to be ok with using Actrapid for dinner and waking up with good fasting BS, and now this!! Tried to analyse what has changed and besides getting older, I have to admit that I do less exercise nowadays (hardly any in a week). Will that matter?

[TenderVittleS]

NPH is a pretty old insulin and in my experience you will never get it right. I would suggest Lantus as its much more predictable and don't have to worry about unexpected lows. It has drastically improved my life.

[Subby]

Tend to agree that gettiing NPH right for me was a fruitless task as well. As for what to do with current regimen I have to say though that:

On one extreme you don't snack at night and go low

On the other end of the scale you tried snacking (and reducing dosages) and woke up very high....

Common sense dictates that fiddling with these parameters, you might find a better outcome somewhere in the middle! A smaller and/or/lower gi snack... (or with higher fat, delays the absorption), less reduced dosages... Working with those parameters would be my approach if sticking with the NPH.

I also see you've eaten high GI fruit last thing, in your examples. Again, it's probable the orange or watermelon will go through you very quickly, they are hardly complex carbs. You need a different evening snack that will last longer and help get you over the dip a bit later. Try something different like bread, cereal, rice, milk.

I cautiously recommend Lantus as well, watch for side effects if you do (talked about ad-nausium around the place). It improved my control a great deal overnight, then again a few years on I felt it was responsible for messing with my head a bit.

Last note, many of us find that basal requirements just change, there may be obvious reasons, or useful theories, or there may be no apparent reason or logic at all. You just gotta change your approach with them.