So sometimes I’ll check before bed and my BG will be on the higher end - 120s-140s (I try to go to bed around 100). Since I don’t usually check during the night (and have no CGM), I’m always nervous to correct it (also still figuring out the corrections thing) and go straight to bed, but I also can’t physically stay up too late. Currently at 143 (darn cookie…). What would you do?
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I would leave it and go to sleep.
If I give my daughter a bolus at 11 PM then I set an alarm to check at 2 AM.
(that is with a cgm running as well)
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Depends on how sensitive you are to insulin. I’d correct that with 1u but that’s pretty conservative for me
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My sensitivity depends on what I’ve eaten, time of day, etc, etc, and I’m only just now getting really bold and actually trying to correct lower high BG (so still learning), so I’ll leave this one tonight; just was curious what others are comfortable doing.
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I’d hit it for sure. How much I’d take would depend on many things.
When you are ready to dose for a number like that, just start small and safe and work your way up as you get comfortable with dosing for something like that.
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She doesn’t have a CGM though, and she isn’t sure of her correction factor.
For me, it would depend upon how much IOB you have. No IOB - I would hit it but lightly. If IOB, without a CGM I’d think twice.
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I would leave it alone and go to bed until you get a CGM.
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Unfortunately, I think I’m going to just leave highs where they are before bed until I get a CGM, as long as my fasting levels the next morning are ok (was 85 this morning). It wouldn’t be as worrisome to try to bring it down if I didn’t have my dysfunctional pancreas still in play - sometimes when my BG is high, it’ll suddenly pump out insulin as a delayed response an hour or two after the high, so I’d be afraid that, combined with any IOB, I would go low while sleeping. It’s probably unlikely that would happen if I just did .5u, but the risk is still there.
Sorry, mostly thinking out loud here! Thanks for all of the input. I just need to get this Dexcom situation straightened out so I don’t have to worry about it.
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I think my response was open for misinterpretation. I apologize for that.
You asked:
So my answer was what I would do. And then I added some things about how if you are going to do it, you need to be careful and get comfortable with it, and blah, blah, safety, blah. But I wasn’t saying you should do it.
But maybe you were asking, “What should I, pianoplayer, do?”
And that is such a big distinction, because what I do and what you do and what everyone else does is always so different.
So I know we all need to phrase our answers in such a way to make it clear, that what I do and what you do may not be the same, etc.
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I understood what you meant, and I was asking what others would do, as I was just curious to hear others opinions and perspectives (and thanks for sharing yours). Everyone is different, their situation and their needs are different, but I have always made decisions by gathering as much information about how others address a particular situation, and then coming up with something that fits my needs, as I don’t always think of all of the particulars that could be involved, so it’s helpful to get reminders of those. Like @Michel pointed out, you’d want to consider the potential IOB before adding more - I don’t always remember to consider that (I know, I know - still working on getting past an early diagnosis flawed mindset that if I went high, it must mean I “used up” all the insulin I took), so that was a good reminder for me.
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You seem to still have a good tendency to return to normal levels from what I’ve read too so your considerations will be different than someone who’s had childhood onset type 1 for 40 some years…
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Right, I do. I’ve had very few instances where I’ve had a stubborn high that took multiple corrections to bring down because it just wasn’t moving on its own. I guess that’s the advantage to still having a semi-functioning pancreas.
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For me, I would consider IOB, BG trend on the CGM (i.e. up or down), and give enough insulin to correct to 90. Usually I have no IOB at bedtime and my food is all digested so I would be giving a full correction.
For my son (who is 2), I would consider IOB and exercise and maybe give a couple grams of carbs if he was 120 and had IOB. He always has IOB at bedtime because of the timing of dinner.
Back when I was on R/NPH, and there was no CGM, 140 was my target BG at bedtime 
I noticed that the answers you got tend to fall into a few buckets based on length of diabetes and whether it is a child or adult who has diabetes and if there is a CGM at play. I definitely am way more aggressive correcting with a CGM because I will get an alarm; however, I do wake up easily with night time lows so I am comfortable with correcting. If I did not wake up for night time lows, I would definitely be less aggressive.
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It would also depend on your hypo sensitivity—I never used to worry about overnight hypos because I would inevitably wake up for them. The only exception was if I had alcohol in my system, since then lows are inherently more dangerous, so I’d err on the side of caution. I think having a CGM and tightening my control (which has included a lot more hypos) has somewhat desensitized me, so I might be more cautious now if I had to go off my CGM for reason. CGM alarms prevent me from testing that hypothesis well though, since it’s hard to tell if I’d still wake up on my own after the alarm would have gone off—sometimes I think I’m already in the process of waking up when it does.
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That’s what worries me about my son (for the future, not now). He does not wake up when hypo 
Of course, he is only 12.
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I’m not sure how much age is a factor… I know I definitely woke up for them starting when I was diagnosed at 10. It was physiological, in that I really just couldn’t sleep when low because my sympathetic nervous system would kick up and wake me up. However, it may depend on what you’re setting low thresholds at—if you’re expecting him to wake up for a 70, for instance, that may be too high to do it, so your CGM may be catching it before his body does. I’d usually wake up in the 50s or 60s, and your son is in tighter control than I was, so his threshold might be more like 40s/50s, who knows. You’d probably need to be willing to sit and wait until he goes that low to see if he wakes up to know if he is actually not roused by them (and then obviously wake and treat with some very fast acting glucose).
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@Pianoplayer7008 I would absolutely leave it alone, unless your meter readings indicate a rapid rise due to unanticipated carb count errors.
Try taking your Bg a few times about 1 1/2 hours before and until bed to try to ascertain a trend. Act on that trend.
Personally, even though I have a CGM I would leave a 140 alone at bedtime. I tend to trend down during the night and don’t want alarms waking everybody up.
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Thanks again. I’m not sure what my hyposensitivity while asleep is, as (to my knowledge anyway), I haven’t reached a point where I’m going low during the night at all (no basal, and try not to go to bed with lots of IOB or while on the lower BG end). I do know when I was pregnant with my first baby, pre-diagnosis, I would often wake around 4am shaky, nauseated, and hungry, and I think it was hypoglycemia, as I would eat a quick snack and go back to bed and be fine. So I’m hoping that means I would wake up now, too.
@docslotnick, I will follow your suggestion next time and make sure to test more often when eating something new before bed. After the kids go to bed is the time for me to enjoy a snack without sharing (lol), but I need to remember to keep treats to naptime so I can watch my BG more closely!
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I’ll adjust if it’s over 130 as in my head that’s the critical cut off I must be below - lower than 120 I don’t bother
I normally take 1 to adjust - I’ve worked out that 1 humalog drops me about 60 when there is nothing else in my system in 3hrs from doing a test in the middle of the night so I can work out the total drop to expect
If I still have post meal effects I’ll normally not do it until they stop unless it’s heading for the 130 and then I take 1 go to bed and hope for the best !
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