FUDiabetes

What would you do? Nighttime and low BG

We got a new sensor (YAY!) from a very generous person on the support listserve where I live.
So, I was sick last night. I went to bed and my husband monitored Samson’s blood sugar. I heard the alarms all night but he always told me he was watching.

This morning I woke up and noticed Samson was at a flatline all night between 60 mg/DL and 80 mg/DL. He never went below 60 during the time I was sleeping, and he never topped 80. Mostly he was cruising right around 70. My husband was on top of it and ready to correct if the drop seemed faster, and also openAPS was operating to dial insulin levels up and down, so there were two things, so to speak, that could have created a floor on a low should it have happened.

I know that many on here would consider this a good flatline, but I tend to err on the side of wanting a little buffer – so would be happier if Samson was between 80 and 100 at night. I actually think these are pretty good and healthy numbers for Samson to be at, assuming he did not ever actually dip below 60. But I guess I’m wondering what others would do in this situation – would you take a glucose tab to bump up the numbers just a touch? Or coast in that 60 to 80 range? Would your answer be different if you were a kid versus an adult?

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I personally don’t mind cruising at that number, but I also have a LOT of lows over night. Because of my tendency to drop, if I were awake and aware of those numbers, I probably would have one sugar tab. It’s barely enough to have an effect, and yet it might help you hold.

You should know I’m also corrected on a regular basis around here, so you might want to wait to see what someone who is right might say. :grin:

Hope you are feeling better today!

For my son, I would give him a gram or two of glucose to try to get him above 80 (4.5). and then my guilt would kick in and I would brush his teeth. My son is on MDI so there is really no other option to raise BG.

For me, I would probably do nothing if I was cruising around 70 but I may do a low temp basal to try to bring it up a bit to around 80-90 at night time.

It would depend on how tired I was.

If I thought I might not wake up to an alarm then I would give 1/2 Cup juice and verify a bump up.

If I was rested then I would run with multiple alarms and perhaps set a 3AM to wake up and double check even if no cgm had alerted.

I have seen my T1 cruise between 65 and 70 all night and I assume if that is a “comfortable” place for the BG then let it go.

I would also verify the cgm with a meter just to double check if I was going to let it ride.

We use an iPhone in my T1’s room, the Dex Receiver in my room (against the ajoining wall) and a Tablet (share/follow) next to my bed. The multiple alarms and paths for the signal do add to my comfort level.

I would coast and take comfort in knowing my Dex would alarm if I drop below 55. I’m an adult though and personally suffer the consequences of my own choices, so it’s a bit different.

Given that openAPS would create a floor even if your husband slept through a low, I think it was handled well. I suppose the only concern would be how confident you are in the accuracy of Samson’s cgm. A blood test might be a good idea to ensure he’s not 15 mg/dl lower than 60 which would be a big problem for hours on end.

i think you may have said in the past that the Dex tends to run lower than Samson’s actual bg though, so maybe that isn’t something you need to worry about.

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no I would definitely have tested if it was me. But my husband is less concerned about brief, transient lows in the mid-50s.

I personally think there is nothing damaging with 60.

Reference this.
biochemistry-glucose-and-your-brain

40 seems to be the bad number.

I think the “below 70” idea is overly-cautious advice, perhaps based on the idea that, “If we say ‘below 70’, that might prevent people from being below 50…

The only risk might be if someone spends a lot of time at 60, they would not “feel” it as much, and their built-in personal feelings for a “low warning” would be diminished. I don’t know if that is true, but I have heard that. I still feel lows when I am actually low.

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Personally I don’t like being in the 60’s, I find my thinking is not optimal. Why not adjust your openAPS settings to use a higher low-range value? Then no food correction would be needed - openAPS would presumably keep him at a slightly higher level?

So, his target at night is actually 110 mg/DL. So this is a lot lower than that, meaning openAPS was basically giving him a zero temp basal for at least some of the night. We could weaken some of the other ratios (sensitivity, underlying basal rate) but we usually only do that if he’s running low consistently. This night was a one-off – most nights he’s actually higher and if he ate a carb heavy meal openAPS will struggle all night to get him down.

Yeah, i don’t think I’d ever want Samson to be 60 mg/DL for hours if he was awake. I guess I just wonder if the low-level, basal types of brain processes that are going on during sleep are actually affected by being 60 for some period of time.

I also wore a CGM for a few days at different points and found I spent significant time in the 60s. I did feel a little more tired at that level and wouldn’t have wanted to do exercise at that level, but I didn’t feel sick or unwell, if that makes sense.

Another point I just realized is we are looking backwards at entire night.

This makes it easy. Sure - let it ride.

But the real question at 11PM is (when all you see is data up to 11PM) — What is the rest of the night going to look like?

It might go straight. It might have a 3AM rise. It might have a 3AM drop. We get it all. So often the concept of the buffer to handle a 40 point potential swing in any direction is helpful.

But looking backwards at all the data makes the decision too easy. lol.

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yep, I mean that’s why if he was below 80 I’d just give him the glucose tab, so I could go to bed and not be woken up by alarms all night and continually checking. My husband however is willing to do that and also doesn’t think a transient dip into the 50s is a harmful thing, so he’s fine with it just cruising and then dropping, as long as he corrects it. Personally I would rather not have the dip into the 50s at all. They happen sometimes but I really try to completely prevent.
that’s for a separate post though.

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Interesting that you as a non-D spent significant time in the 60’s. The symptoms I feel in the 70’s is simply being somewhat hungry. The symptoms I feel in the 60’s are more pronounced - I am hungry, I am tired, I am more apt to be overwhelmed. Tasks that normally seem reasonable seem larger and more difficult. Bumping with a small amount of glucose puts my mind back to normal very quickly. I don’t have a pump or CGM so don’t have all the knobs to adjust (e.g. I can’t just turn down the basal).

Of course symptoms below that are even more pronounced, but I don’t think we should minimize the symptoms that occur in the 60’s - I do believe they are real and that we should avoid them to the extent possible.

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Personally, I’m fine the next day if I sleep in the 60s to 80s all night. in fact, my sleep is really restful. Once I dip into the 50s though, I tend to be more tired the next day. 40s are a recipe for being really tired.

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yes, I think the difference you are pointing to (between your experience and @jag1’s experience) makes me feel we should be bumping Samson up just a touch. Because he’s still little, he is super articulate but he can’t necessarily put into words when he’s just feeling a little bit tired or not “tip top” – and I’d hate for my husband to run him low thinking he’s “fine” when maybe he’s just at 80 percent – and he could so easily be at 100.

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I think this may be a YDMV thing. I am with @jag1 in that below 70 I am not mentally on top of my game. I like to be above 70 to keep mentally sharp.

But if I am doing yard work, or exercise, or am just in the 60s briefly I do not worry too much and it does not bother me greatly.

One concern I do have is CGM error, so if the CGM is showing a 60 flat line it could really be 50 flat line which is a problem for me.

I know T1s who live in the 60’s without problems. So I give it up to YDMV

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If you want to bump Samson up a notch without waking him to eat, can you do a temp basal for half an hour or an hour? When I’m hovering around 60 at night and don’t want to (a) deal with alarms all night or (b) eat glucose tabs all night, I’ll often just reduce basal by 90% for 30 minutes. It’s not an immediate effect, but I go up into a safe range and stay there – and better yet, sleep through it.

we use openAPS so we can’t really do temp basals (which are canceled and reissued every few minutes by teh algorithm), but we can set a higher temp target – so targeting 150 for an hour or two, for instance. That would have been the easiest way to do it, probably.

I guess ultimately the question I’m sort of dancing around is not so much what I should do in this case – I pretty much always prefer him over 80 at night. It’s more like my husband is doing this, and generally does this differently than me. He’s just less concerned than numbers in the 60 to 80 range than me. And sometimes, like when I’m sick, I’d really love to sleep and let him handle the numbers.

I don’t think my son is unsafe at all, but should I be somehow trying to convince my husband to change this overnight practice? Or is this the kind of thing that qualifies not just as YDMV but also as YDMV as in “your diabetes management may vary”?

I think that his being less concerned than you is normal and probably healthy. If you feel that your husband would have reacted properly when his bg hit 40, then I personally wouldn’t try and reconcile your two approaches.

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yeah that’s my feeling too. (Plus I want to sleep, so micromanaging is not the way to get that, haha!)

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