Late night lows are become sleep deprivation

Medicines Insulin
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So a little about me first. I’m 33, currently on Lantus 20u at 10pm. My Endo has told me the lowest I should go is 18u and I’m probably going to dose that tonight. However, since starting my Dexcom journey I have noticed:

Beginning around 3-4am I drop very low. I have not gone for glucose tablets yet, but I shall try today after work. But chocolate was attempted and only raised me 20 mg/dl before more drops. Handfuls of Skittles raised me about 20-40 mg/dl before more drops. I am hypo-unaware so my fiancé is nudging me whenever my urgent low alarm goes off and both of us are losing too much sleep over this.

@Eric has advised me that 50/50 splitting a lantus dose may not be a good idea, but I am really at my wit’s end with all of this and am open to the suggestion of all of you wonderfully minded diabetics. I will be calling my Endo at some point today to try and discuss this, though he has accepted a share invitation and has access to my numbers, and is probably already aware of this issue.

Any advice will be thoroughly read and taken in. Thank you all in advance for all of the help I’ve received already and know I will continue to receive through experience and shared knowledge.

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Your BG is dropping overnight all by itself. That is direct evidence that you have more basal insulin than you need. Reduce your dose. The basal insulin dose is right when your BG stays more or less level.

Your endo said you could reduce it from 20u to 18u. That’s just a guess. Try it. If your BG continues to drop overnight, then reduce the basal again. Keep going until it stays more or less level. At some point your BG may start to rise overnight rather than falling. At that point you know you have gone too far, so increase the basal again.

In general I wait two or three days between dose adjustments to see how the new dose is working, but in the case of significant hypos I’ll adjust every day until I get to a safer place where I can fine-tune things more gradually.

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Skittles, smarties, glucose tabs, these are all equivalent in my book. In my son they all work the same, but the skittles taste the best of those three. Which is why we don’t keep skittles in the house very often, the non-dia people think they taste too good to leave alone.

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The right amount of insulin is the amount that does what you want.

I don’t know where your endo got 18 units. I mean, unless you have tried it, you don’t really know. It might be 18, it might be 17.

Well, not exactly. What I am saying is that there are advantages and disadvantages, and you need to carefully consider them. Because you will have some areas of lower coverage.

But it might work for you.

So let’s examine this…

The problem with splitting Lantus is that there is an overlap. Suppose it lasts 18 hours. You may be able to split it and have the overlap land at times where you want a little more or a little less.

So splitting Lantus can work, but it’s tricky to do that and needs some analysis and trials to get it right.

Also, you don’t necessarily need to do a 50-50 split! If you are going low at night, maybe doing 60-40 would work better (60 in the morning, 40 at night).

This is an EXTREMELY rough illustration of 1 dose of 18 units at 10pm versus 2 doses evenly split at 10pm and 8am, assuming 18 hours of duration (which may not be exact for you).

In one case you have a drop down to nothing. In the other case, you have no area of zero coverage, but have a few areas less than your normal basal.

Remember - this image is basal, not BG! So the high and low is kind of reversed from the normal thinking of BG graphs! :grinning:

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But notice in that image :arrow_up: how when you split it, you have a little less between 2am and 7am. Yay, right?!?!

Also we can imagine splitting it at something other than 50-50. Maybe 60-40 or 65-35. And we can also think about adjusting your dosage times. You can do all kinds of things with it.

Okay, disclaimer. That graph is super rough. There is a little ramp up and ramp down with Lantus. And we don’t know your exact duration. So that graph is just an illustration of the potential.

One other thing - a slower release carb at night can help you with some nighttime lows. Something like a Kind Bar or Belvita bar right before you go to bed can give you a slower release of carbs that lasts longer through the night.

Anyway, there are a lot of smart people here that can look at these things and give you some suggestions, Read it all, take it all in, analyze it, and come up with a plan you want to try.

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The best way to figure all this out is to strike out on your own and test, test, test. If you test and don’t arrive at the solution then that is narrowing down the possibilities. The best way to know what’s right for you is to just drive in and test all theories. Then tweak and retest.

Unless someone has the magical answers for your use case, the only way to get the answers is through trial and error. Use the scientific method as the premises for your testing and go at it scientifically. State the problem you are trying to solve, form a hypothesis, test that hypothesis, cornfirm the hypothesis or tweak the variables and retest.

That’s how I’ve gone about getting Liam’s numbers dialed in. Every body is different and two people of the same body makeup can have drastically different needs.

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For the 3 AM lows (which I still occasionally have to deal with despite years of fine tuning basal) I have had success with a two-step late night snack: first some fast carbs to treat the low, as you are doing. Once the BG curve starts to trend up again or at least flattens out, something filling but not as fast as candy, such as graham crackers, clif bar, fruit etc with a bolus. The benefit of a bolus-covered snack to supplement the candy is covering the excessive basal and hopefully avoiding a repeat alarm an hour or two after the candy. Unfortunately this requires being awake for about a half hour at 3AM so it’s not always feasible…you might have to grab your things and go to another room. If I skip the bolus and just snarf it all down and go back to sleep, invariably my BG will skyrocket later on. The other thing that works for me is about a half cup of fatty (Haagen Dasz) ice cream before bed if my gut feel says I am trending low. Not 100% reliable but that has prevented a few 3 AM lows.

I went through some similar troubles with Lantus a few years ago. Things improved with lowering the total daily Lantus dose combined with splitting the dose evening and morning. I never became totally satisfied with Lantus and ended up using a different basal on MDI and eventually (years later) switching to Omnipod pumping. But to wrap up the basal story, I went back to Lantus for about a week recently and it was fantastic! So basal can be a moving target requiring adjustments and trial/error, especially with MDI, because there are so many variables that can mess up your late night BG.

That was my long winded way of recommending fine tuning with Lantus to the best of your ability…which might take a few weeks or more of trial and error. Than give that a try for a while before trying something totally new, such as a pump or a different basal insulin. You will gain knowledge about your basal needs with the Lantus trial and error that can be used if/when you try something different.

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@Eric introduced us to these. Liam has 1/2 or a full one each night and they do wonders for keeping his bgs smooth and level during the night.

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I picked up the blueberry breakfast biscuits and threw one pack in my purse for tomorrow. Keeping the rest in my lows snacking station. Pumped 18u of lantus about 30 mins ago. Had a bigger dinner tonight, Dexcom is saying I’m at 186 right now smh. At least I’m giving the basal something to taper tonight. Ty everyone for the advice! I really appreciate the push you’ve given me to try working it out myself. I will post an update tomorrow and let you guys know how it went.

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Thank you for sharing your experiences, John. It’s nice to know I’m not alone here lol. Unfortunately I was all over the place between last night and this morning.

Thankfully I didn’t start to drop lowish until I was about to get my breakfast, but still dropped to about 55 mg/dl from a high 207 at bedtime. Pretty sure this is due to hormonal changes in my body that will eventually even themselves out.

However, what I have noticed is this: lowering my basal dosage has only aided in tapering off earlier and only postpones my lows, which is still in inconclusive due to the 200 reading. It could’ve just taken longer for the basal to knock that down while I slept. I may have to split up the dose. Seems going lower only puts me at risk for higher nighttime readings post-dinner.

Still tweaking, still learning how my body works haha.

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Get the basal right so that your BG stays more or less steady, especially overnight. If you see that you’re ending up high after dinner, take a larger meal bolus for dinner: you have good evidence that the basal dose is still too large overnight.

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Still haven’t bolused yet, but today might be the day I start.

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Keep some quick carbs handy!

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From what you are describing, it seems like 9 units at 10pm, and 9 units at 8am might be worth trying out.

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… is wine a quick carb? :laughing: I miss wine.

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It’s an easy thing to try out.

The first time you do it, you start by doing it at night, not during the day (since you still have some basal leftover from the previous night’s 10pm dose).

So when you are ready to try it for the first time, wait until 10pm, and just split it into 9 units. The first night you will have a little bit less insulin, since you did not take it at 8am yet. Then the next morning, after you take it at 8am, your will be caught up and on the new basal profile.

You are not increasing your insulin amount at all, so it’s not a risky thing. Just remember to load 9 units instead of the 18 you are used to.

Give it a few days and see how it works.

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I’ll give it a try! Ty Eric. :smiley:

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The response can vary depending on the individual. For me, a dry red wine has no effect on BG. But alcohol can suppress the liver’s release of glucagon, which can impair the body’s ability to counteract a low. A sweet wine does contain sugar, and can raise BG. I bolus for port.

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My favorite wine is white zinfandel, being diagnosed diabetic I was heartbroken when my Dr told me no more wine!

I could honestly try and rationalize that I just got an idea to see if I, too, have no BG reaction to dry red
… but I’ve had so much nonsense going on in my body lately that it’s probably best to leave it alone for now :laughing:

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Unless there are special circumstances in your case, I don’t understand why your doctor said that. You may wish to seek a second opinion.

My physicians have told me that moderate alcohol consumption is fine and not generally contraindicated for persons with diabetes. But that’s here in the US, where the general thinking is that in moderation, wine’s benefits and harms pretty much cancel out. The British medical society says any amount of alcohol is harmful and so should be avoided if possible.

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I think I will now! I really do miss wine. :sob: :laughing:

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