Interested in what you consider an appropriate bedtime target BG. And if you snack at bedtime for BG reasons. My CDE says “No snacks!” (obviously if I have a low that’s different) and that “I need to reassess my idea of what’s low.” Before Dexcom I used to always have a small snack (10-12 carbs, 12 protein) before bed if I was below 130 or so. But now she doesn’t want me to have a snack regardless of what my BG is. My BG does tend to increase slightly beginning about midnight through 3am, and then slowly drift down the rest of the night, so often I wake with a low. Love to hear your thoughts on this.
I’m on a pump, so I adjust the basal rates to keep me as flat as possible overnight. My target is anywhere within my target range. If I’m on the lower side and still have active insulin on board or have exercised a lot that day, then I’ll have a small snack.
I think the idea of needing snacks is mostly from the old days when NPH would peak in the middle of the night, and people really did need a snack of carbohydrates and protein to prevent serious lows. When I switched from NPH to Lantus about 15 years ago, I was told snacks were no longer needed unless I was actually low.
We have Basal-IQ and it keeps the BG mostly stable overnight.
Not always. But if not then the Dex alarms.
Most nights it is level at 80. So starting the night in the range 80~100 seems to work well for us.
Absolutely! Thats when my night time snacking habit was ingrained in my routine. Now I snack at bedtime when I want to, not because I have to.
I don’t have specific target of nighttime BG. Before bed, may eat, bolus or do neither depending on cgms trend. Different thinking on days with more exercise/activity based on timing and intensity.
I don’t really target a specific number. I look for flatness and being in-range, or making adjustments so that I can get in-range. So I will eat or bolus to be flat and in-range.
For example, if there is a slow drift downward, I will eat just a small amount so that it will settle in-range.
If I am rising, I might take insulin even if I am still in-range. Like if I am 90 and it is climbing, I don’t wait until it is out-of-range, I will take insulin right then to stop the climb.
So the key for me is both flatness and in-range.
The DIRECTION, not just the number…
I apologize for asking again, because I think we may have already discussed this, but how are you doing your basal insulin? Pump or something else?
This might make sense, depending on what your "idea of what’s low” is. If your CDE is saying that you do not need to always be above 130, I agree with that.
Try to work on the flatness a few hours before bedtime. Rather than only waiting until you are going to bed, look at the direction your BG is moving a few hours before bedtime and take steps to address it then. Small fixes a few hours before bedtime to stop rises and drops.
You have to find an area that you are comfortable with, and also look at the direction.
Another way of saying it - for you maybe a flat 110 is fine, but a rising 110 is not?
Maybe for you a flat 90 is fine, but a dropping 90 is not?
Try to look at it that way - direction AND number.
And if you want specific ideas about basal adjustments, please let me know.
@Eric I use Lantus (and Humalog).
I think that’s stupid. If you’re at 80 at bedtime and you know that 9/10 times that means you’re going to wake up with a low, then I think it’s perfectly justified to eat some snack before going to bed. I would do the same because I have no CGM. With a CGM, I think I’d rather prevent a hypo and sleep uninterrupted than being woken by a CGM alarm.
I suggest reducing your Lantus, to help remove the low when you wake up.
And also taking a very small amount of either R or NPH to help you remove the spike from midnight to 3am. Both R and NPH are available at Walmart with no prescription, and it is only about $20 with no insurance needed.
Just a small amount of R or NPH can eliminate the spike you mentioned, and it will also make up for the reduced Lantus I suggested (to eliminate the low when you wake-up).
Here is a helpful chart of insulin release profiles. These are just general ideas, not exact. I pasted in the common names for all the insulins to make it easier to understand.
But the other consideration, is that if you are only taking one Lantus shot per day, reducing the Lantus can screw up the rest of your day. So if that is the case, instead of reducing the Lantus, perhaps a slow release carb at night can help.
The Extend bars are designed to slowly release carbs over 6-9 hours, so one of those might be something you can use for the morning lows.
I know this is a lot of stuff. Let me know if you have questions, I can walk you through some scenarios.
@Eric - Thanks so much, this is awesome info. I’m going to process this and I will ask more questions, I’m sure.
I’m thinking that the question which underlies the originally asked question is actually “what is your target range”…
I recently was speaking with a young woman who has recently been told by her endocrinologist to go to bed at 200. Because she is drifting down over the course of the night and winding up in the 40s or 50s. I think the advice I’m seeing here (reduce the basal insulin rate) makes the most sense. (She’s using Triseba and Humalog.)
Thank you guys for your posts on this subject – and @Jan for the good question!
@Eric - Maybe this belongs somewhere else, but have you used the Extend bars? How do you carb count the sugar alcohols? I’ll ask in the food section.
@TravelingOn - Yes, you’re right, I really wanted to know what target range people are using for bedtime!
Honestly, I don’t carb count for BG stuff. Only for fueling.
@Eric - Forgive my ignorance, but if you don’t carb count, how do you know how much insulin to take?
Considering only carbs and insulin is a kind of simplistic formula. It’s a fine place to start. But there are so many other factors.
Activity level, total amount already eaten in a given day, stress level, amount of sleep, how well my pump site is working, direction of BG movement, speed of the BG movement, type of food, whether I can be more aggressive with it (am at home, am not trying to cut weight, and can eat carbs for a low later) or less aggressive (away from home so don’t have easy access to food, or don’t want to snack later to be able to drop pounds), whether I have been generally trending to be on the lower side or higher side on a given day, etc. So many factors to consider.
It would be impossible to use all the factors and put them in a formula. So I just have a “feel” for it by now.
I defer to @Eric for best technical and practical advice.
FWIW, when I used Lantus, I always took it at night (9:30PM). It would give me a heck of a low at 2:30AM without any bedtime snack. If I reduced my Lantus to stop that 2:30AM low, then I’d be fighting highs throughout the daytime hours. So I picked dealing with a middle of the night low with good daytime numbers. I’d snack at night to deal with the anticipated low, and then I’d test in the middle of the night and take more carbs as needed.
CDEs and Endos love their world of “shoulds” and “equations”, but those of us living it have to actually make it work!
My experience that I relayed above is just an example. I hope that you find what works for you!
Also, I don’t think Lantus lasts 24 hours.
I know the general recommendation is to take Lantus at night. But I used to take it in the morning, so it would be gone by the next morning, and that would prevent me from having a low that I did not wake up from.
You can consider splitting it into two doses, that might help you address some of these issues too.
Also you could adjust the split amount in whatever way matches your needs. Like maybe 50%-50%, or 60%-40% or 70%-30%, or whatever.
On the question of my target BG at bedtime: a flat 90-100 is where I like to be. Earlier dinner has helped this a bunch for me, as well as not eating as large of a meal at dinner: my digestion process is complete at bedtime so less surprise highs, and dinnertime bolus is out of my system.
Also, as Eric mentioned: split dose basal maybe could help. It has been much much better for me than 1x daily Lantus. I used to get nighttime lows regularly, so switched to split dose Lantus, and now Levemir (which I prefer) dosed at 50% 6AM and 50% 8:30 PM.
This. The real world is much more complex than those rules and equations.
I love hearing about real life experiences over medical formulas. they’re practical and effective.