Insulin while sleeping

Did anybody else realise insulin stops working or works very very slowly whilst sleeping?

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Yes. I’m on a pump, and I have a higher basal rate for overnight than I do for daytime.

And sometimes I need a larger correction dose at night, too, to manage a high BG.

If I am 10 and want to get in range during the day it will work much faster than if I am sleeping. Whilst sleeping insulin works slow if at all…

My needs of insulin drop once late evening hits and drops again for the night. My lowest basal rate is at night. With some kind of increase at dawn for DP or FOTF for me .

I believe increases in blood sugars while asleep is caused by hormone releases that happen when you are asleep. Probably different hormones, but if you need more insulin starting from when you are asleep because of glucose from the liver, do you still get DP or FOTF which also dump glucose?

I think it’s because we are not moving around during sleep.
Exercise really lowers my need for insulin ever just walking around makes a difference. My night time rates are only slightly higher than daytime, but my pump ramps up to correct predawn spike so I do t even notice it anymore.

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It doesn’t stop working or you would be dead by morning or in dka etc. prolly. However it can vary how much you need and how your body uses it overnight. I need a high basal usually but it also can drop a lot. I went to sleep at 200, after an injection, snack and higher than usual basal I eventually woke up at 35, lol. Juice etc. corrected it. That was after already waking up once not so low. I am on a nocturnal schedule but it follows when I sleep etc. and my thyroid meds taken before sleep make a difference. My inr also dropped a lot, ugh. One thing I have noticed is when my bg is low bp is low but not usually the same for high bg, not high bp.

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I’ve arrived at 0.55-0.64 units / hr during the day (and 1.2 for an hour from 0545 to 0645).

At night my basal is a bit higher 0.72

I only wish my daytime control was as good as my nights!!

I think this is one of those areas where it varies from individual to individual. For me, I definitely use less insulin overnight. I have identified the pattern of increasing/decreasing insulin over 24 hours and have programmed 6 different basal rates into my pump to hold me at a steady rate without bolusing and my insulin requirements start to decrease around 10:30 pm, reach their lowest demand from 3 to 5 pm - less than half the rate at my highest insulin demand - and then starts in increase quickly with the highest demand during late afternoon to early evening. Time changes in Spring and Fall are a real nuisance since I have to fudge the timing to keep my basal background insulin steady while my body adjusts to the new schedules. My insulin sensitivity also increases overnight so if I need to bolus (usually for a snack, etc.) I need less insulin to cover it than I do during the day. So, yes, for me - but I understand it is no for many others.

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My basal rate is lower at night, until it starts going up in the very early morning. Overall, I’m 80% bolus/20% basal with basal testing.

Interesting how different we can be. I am pretty close to 50-50 with basal and bolus insulin.
It was that way, even when I was first diagnosed 35 years back.
Now with a pump that tracks everything I can see it more clearly. I generally take 21 units basal and 20 bolus.
That’s down from 25-25 before I changed my diet.

I know my basal rates are good because when I don’t eat,I draw a seriously flat line on my glucose graph.

For me it’s all about estimating carbs correctly. I try to alter my calculations to deal with activity and fat intake and I’ve never gotten it down perfectly. Sometimes things go whacky for a while and settle back down.
Still I’m in the best control I’ve ever been so I’m happy where I am

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I always think of sleep as restoring the body back to normal. Which also means blood sugars. Which is why i thought the reason that people with high blood sugars always get tired and feel like sleeping, but this could be a different reason why people get tired when their blood sugars are high. Their bodies think or feel as if they are sleeping because their sugars are high. Turns out blood sugars do rise in our sleep, or actually they rise at night time whether one sleeps or not, and is actually considered normal. My sugars more often than not do go up in the middle of the night. What do ya know. Thanks, interesting conversation.

Hi, i just read that no matter what, as part of our natural circadian rhythms blood glucose levels rise at night whether you sleep or not. So with the extra basal that you mentioned I guess you’re compensating for the amount of glucose that the liver is releasing into your bloodstream during the middle of the night. Be careful with the bolus dosages, they can last for up to 4 hours, and if you’re taking extra in the end you dont know how much insulin is in your body you know. Glad you woke up. It’s certainly happened to me.

I am actually not following that pattern. Also I am nocturnal. My bg goes up if I don’t eat before sleeping most of the time, so I have to. It also does that at other times most of the time.

Unfortunately lows are going to happen, no way for me anyway to avoid them with this disease. It’s never the same for me also there are always differences each day although I do follow some generalized patterns and if I don’t sleep properly my blood sugar usually spikes up from that too.

I’m not sure what you mean by taking extra in the end? I am well aware of how long insulin can last in my system and that varies too. That’s part of the problem with this disease everything varies every second of the day so there’s no way to ever have the same results each time.

I’ve also seen numerous times when I didn’t wake up and my blood sugar just came up by itself assuming that Dexcom was even right because a lot of the time is wrong anyway.

Maybe i misunderstood, but what i meant was you said, you went to sleep at 200, after snack, bolus, and extra basal. Thats what i meant, with taking extra bolus and extra basal before you go to sleep. Yeah I’m aware that no day is really the same, what i try to do although it’s tough sometimes, is i try to eat a certain amount of calories with specific types of food. Like breakfast for me for instance, 2 eggs 3 egg whites, 2 slices whole wheat toast with peanut butter. Then i’ll have a morning snack an ounce of cheese, or maybe a apple. Then lunch, like a chicken caesar salad plus a small whole grain baguette. Then an afternoon snack, some baby carrots. Then dinner, a pork chop, some rice, and some brocolli. And i’ll skip the evening snack. Thats all I’m saying, it depends how you eat, it gets confusing for me always adjusting. I have a doctor who tells me not to adjust for high sugars except at meal time. Thats all i mean or am trying to say. Eating a certain type and certain amount at a certain time may help with changes in blood sugar. So any change in blood sugar is probably a little easier to deal with. If I’m eating ok my count stays in a normal range, if im eating too little during the day, my count will go low at night, or i’ll eat too much before i go to bed and my count will go too high. And if I’m eating too much of course my count will go too high. And if I’m taking extra insulin, then the whole thing kind of changes. It’s difficult for me i say because i have to be eating all the time, like i cant just skip eating or put it off. Had another doctor that said that that’s the way to take care of the diabetes, routine routine routine schedule schedule schedule. It’s the only way to get the body to mimic how it’s supposed to normally act. Adding extra contrdicts that in a sense. Unless of course you need to with the basal, i’m not saying that of course. I was taking 25 u lantus, they dropped it to 10. Ok, didnt work, upped it to 12, then to 14, I’ve settled for 16 at the moment.
In my opinion, the sugar level drops a certain way based on what you eat, the types of foods, in relation to the insulin. I know its complicated. Anyways, thats kind of what i was saying. Thanks

This is what was taught in the old days, before carb counting and insulin pumps.

With newer, faster insulins and pumps and CGMS, many people can eat most foods if they learn their carb ratios and dose mealtime insulin to match what they eat. Some count carbs only, some include protiens and fats to calculate insulin dose.

But if you prefer fixed meals, fixed doses, thats fine too.

If interested check out the website or book, Sugar Surfing by Stephen Ponder, who has T1D and is an endo.

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Your opinion has no bearing on how my body reacts to insulin etc. though. So really you or others, myself included, can give advice only on what we/ you / they do, but that is all it is, an opinion of what you think should be done or what will work.

Personally I don’t think it is a good idea to give advice on how to dose insulin based on that.

I told you what my issues are but you just reiterated if I just did this it would work. But really you have no clue what would happen or work, I find that funny :grinning:

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I’m just quoting what some doctors have told me. Perhaps i should’ve put quotations around some of what i said. And i said a lot. You can generalize it all how you want. I give opinions. To each their own. I’m here looking for advice or experience. I have no idea what your issues are or who you are, but it seems as if you have some, if I’m going to just sound the same as you. Thanks for the compliment of not having any clues, coming from you that means a lot. I can be standoffish too you know. And i listen pretty well thank you very much.

When you wake up in middle of night and you are 8.5…what is right thing to do bolus and back to bed …or do you have to wait around?

If you don’t stay up it dosent work as good

Depends when and what I last ate but at 8.5 mmol/l I would generally bolus between 0.75 and 1.0 unit and go back to sleep