How slow is an untreated low?

We’re becoming convinced that V is having undetected nightime lows, which is causing his breakfast highs. (The highs are not every or even most days, so we are leaning toward lows rather than DP)

My question is, rather than having him test every hour, can anyone tell me how long the curve of an undetected low is?

Does the bg slowly go down to, say 45 and stay there for 10 minutes? 30 minutes? Then slowly move back up when the liver kicks in?

Or does it all happen quickly?

We eat late, 10:30. and are normally in bed by midnight. He’s always tests at 2:00am, as the typical post meal test; and they are almost always good.

If he tested at 3:30 and again at 5:00 would that be enough to catch the nighttime low? Or does it need to be more often?

He is not pleased with this whole idea of multiple nighttime testings so I’d like to keep it to a minimum… But it has to be done to figure this out. And, anyway, who would be happy with it?

Thanks for any help.

Somogyi effect only takes 2-3 hours to reach full effect following the low, in my experience. The low can take just as long to get low enough to cause the reaction. My body will literally never kick in with a modest low (like the 50’s or 60’s) but seemingly goes into overdrive if I dip under about 45. If this happens overnight and I don’t wake up from the low, I will have a fasting over 250. Regular DP puts me around 200ish.

Can you do a 3 day CGMS? That was critical in “seeing” mine when it was happening… I was going low between 5:30 and 6:30 am which didn’t always wake me up… and then getting up at 8:30 fairly high. I was waking to test at 2-3am and completely missing it. I do have regular DP and it was difficult honestly to tell the difference, but the CGMS told the full story. When that was going on, it was because my pump basal was just a bit too aggressive overnight - my attempts to “fix” the problem only made it worse…

A 3 day— You mean, get one to use for 3 days… That would be wonderful. I wonder if we can.

I just wanted to add that the diary of V can be seen here…

The only way to know is to wake and test. On three different nights (to compensate for any changes in routine, diet, activity levels, hormones, etc.) No fun!

But hey, I need to test overnight myself to check my basal rates. We should arrange to do it on the same day (different time zones) as moral support!

Morning HIGHS have three basic causes

A bounce (ie HIGH) caused by a low (whether a major one or just clinically meets the definition of “just barely” low) he’s had typically in the previous 12 hours whether it got caught by anybody or not.
Dawn Phenomina. The bodies physiology literally turning on all the proverbial switches to start the day.
A gap in your long acting insulin coverage.

Any one of the three can easily do it, assuming he’s not picking up some kind of cold etc., but that would be consistantly high, not merely just in the morning. If you believe there is a low why not experminet by just cutting back a couple units on the last short acting insulin dose (ie bedtime), and see if that removes the AM high, you’ll know it.

If the change in the AM is dramatic immediately you’ll know No middle of the night sillyness required

If that doesn;t do the trick it’ll take 2-3 days, maybe a week, and you cut back (bedtime short acting) by a couple units every day or two. If that produces nothing either, then sounds like a GAP in the long acting’s coverage to me.

Experiment, let us know,

Stuart

Dave yes - the thread is about lows - but Stuart is just trying to explain how V’s high could be happening in the morning. Gotta look at from both angles!!!

I’m trying to remember again Katie what insulins/meds V takes - as that could be contributing to his lows at night. I know for myself when I was using Lantus - a slow acting insulin that is the basal - I was having alot of lows at night - but would always wake up high - I thought it was more to do with the fact that I over did it on getting myself out of the low - gorge like a pig I did. In the end, I split up my Lantus dose to a smaller amount (6 units) before counting sheep time - and then a slightly larger amount (I think it was 10 - this is a year ago for me - when I was injecting). Again, we all differ how much insulin we use - so don’t go and do what I do. It’s just something to nosh over in your head - as you try to figure out this puzzle with the rest of us!!!

I like Kelly’s idea of a few of us checking our basal rates overnight. I’m due to be doing that. Let me - and hopefully I can join in - and make V and you feel less alone as you are semi-awake testing the BG!

Actually, my question is much simpler… I’m trying to find out how long untreated lows last so I can determine at what intervals we need to wake up to test in order to discover the little blighters in the act…so to speak.

Last night we tested at 2am (3 hours after dinner, as usual) and he was 143; and again at 4:30 and he was 180. When he got up at 7:30 he was at 179.

I’m tempted to interpret this to mean that his night basal is okay, as he held steady from 4:30 to 7:30. I don’t know what caused the increase between 2 and 4, unless it’s the wine kicking in a bit late, in which case we could increase the bolus by 1 unit at dinner (from 5 to 6, decreasing all readings by 30 - 40 points) and still be safe.

We do have a different schedule than most of you, it comes from living in Andorra (Spanish border), Our meals are at 8:00, 1:00 (for V, 3:00 for me), snack at 7:30 and dinner at 10:30. Don’t bother to lecture about the inappropriateness of our eating habits; they work just fine for a lot of people in the world besides us. We’re determined to work with them as we rather like our life. We understand that we will doing the post-dinner test in, what you would call, the middle of the night. That’s why I didn’t ask what time we should test, but how long the lows last so we can figure out when they might happen in our schedule.

But, we’ll get there, eventually. Maybe sooner if I stop trying to find a cause/solution to every little blip… We’ll keep testing.

We try… and thanks for any and all help.

BTW, his lows are normally mid 50’s or higher. He’s had 3 in the 40’s, one during the night - at 2:am (we know the cause - not figuring the bolus properly for fresh sweet corn from our garden ) and two an hour after breakfast - which is what started us on this path of adjusting, testing and searching in the first place…

The 142 at 2am would be ok for me. But I am very sensitive to insulin and I have to eat long acting carbs before bedtime that will kick in at 2am to work against going low. In your case it seems to climb constantly.

This could be the dawn effect (the body is releasing glucose to prepare for the day) or the Lantus dosage is still not right. Let us assume you inject more Lantus for the night and the 2am value would be then 110. The value at 4:30 and later would then be around 147. This would look much better. So I would suggest to increase the Lantus dosage and to retest at 2am. If you do this repeatingly you will find out if 100-110 can be reached at 2am and how this milestone affects the following values. Please take into account that food before bedtime will make it harder to differentiate the effects of the different insulins.

I think you may be right about the Lantus. In looking at the history I think it is more likely the Lantus than the dawn effect.
Today we increased the morning Lantus to see if we can’t get the days back under control. I think we should wait 2 days, then try the night Lantus increase. We’re learning to only change one thing at a time, then wait to see what happens.
I may look into adding some long-acting carbs at dinner, as well.
Thanks for the input.

I apologize if you’ve covered this already, but did want to jump in to suggest adding some fat to dinner. Before I saw my nutritionist after my diabetes diagnosis, I had years of Weight Watchers under my belt and I avoided fat. My nutritionist suggested adding in some “healthier” fats to help level out my BGs – and she was right. Fat slows digestion so I don’t get spikes as high as I used to. I feel full faster, too, which is a good thing. :slight_smile:

He usually has half an avocado at lunch… but not much at dinner and none at breakfast.
Maqybe that’s why his afternoons seem to be fairly level.
How much do you add? 1 tbs olive oil? 2 tbs?
I can’t believe how many factors there are to consider… and increasing all the time

Thanks for your suggestion ;-))

My niece has the cgms. Lows differ in speed. A quick drop will have one arrow down, meaning she is dropping 1 to 2 points per minute; double arrow will mean 3 to 5 points a minute. Not sure of the duration or length of drop as we treat it immediately. Most of the double arrow quick drops are caused by bolus or correction insulin. We have slept through the low alarms, but, on looking at the cgms graphs, will usually find it will be within the one hour graph. Since we check every three hours, we catch a lot of lows and highs anyway. I have not noticed her blood sugar kicking back up after a low, even a low in the fifties, however. So I don’t know how low she would have to go before her liver kicks in glucose and, since rebounds are so rare with her, let’s hope her liver even does! A rebound blood sugar would be high, according to our old endo, and resistant to insulin as the liver keeps kicking in glucose for a while. I have seen somewhere a formula for how high a rebound is, based on the original blood sugar, but I don’t know if it is correct. Endo told us a high blood sugar from a rebound would be very high. We have caught a lot of lows at 4am, which is a time we had not ever tested before cgms. Normally we do a 2:30am, 3am or 3:30am test then go to bed for a few hours. I always get a test at 5am on the days I work; Sis will get a 7:30 or 8am test on non-school days; school days, 6am test. 3:30am or 4am would be a good time to vary your checks. Most lows for us do occur around 2:30ish, though. She has always slept through the testing I hope your son gets used to it and can sleep through it also.

I’m glad someone else understood my post. Pssst Dave, Anna is quite correct, but thanks for pointing it out anyway. (amused sigh)

Isn’t it nice when something soooo “simple”, is so insanely complex, so many possible factors that might factor in. Ugggggh.

Soooo, how’s the increased Lantus working out? The insulin is always the first thing most of us change I’d bet rather than micromanaging the food, the activity, any of the harder slightly “intangible” factors. But hey duuuuuh if we cut back on insulin and we quit being handed our own teeth, head, etc. right? That choice is easy…

Yeah, waiting 2 days, 3 days is tough to be ~certain~ there’s a “pattern” and its not just some kind of freak accidental reading. You want to crush the problem instantly NOW NOW NOW… DOWN DOWN DOWN kind of a… diabetic Daffy Duck sketch in ways (ref a Bugs Bunny episode)

How’d things turn out?