Recently I have been dealing with my sugar levels dropping in the middle of the night. I have a CGM (Dexcom; so I’m alerted. I even made sure my bg level is over 125 before I sleep and it doesn’t matter, it will still drop several time during the night. Any suggestions?
LAB, it sounds as if your basal is too high. Are you on MDI or a pump? If on MDI, the timing of the Lantus if given in the evening could cause such a drop. That would mean giving your larger dose of long acting insulin in the morning and a very small dose at bedtime so that it is timed to just tamp down Dawn Phenomenon and not cause a drop like you're speaking of. I usually figure than Lantus peaks at 5-8 hours after injection.
are the lows actually confirmed with a fingerstick ? I noticed the Dexcom can give false readings sometime if you are sleeping on the sensor.
If they are confirmed, then I agree with Leo2 - sounds like basal is too high for that time of night.
Have you tried tweaking your basals two hours before the time when the lows are occurring? If your basal is correct, your blood sugar shouldn't drop. Assuming of course your CGM is correct; did you check with your meter?
Like Zoe I would suggest tweaking the basal profile of the pump. At the same time I know that this will not be enough:
-a day with higher physical activity will deplete the stores of the muscles. For me they will start to consume glucose late at night (3 to 4 am, the more trained the later). Since I am on MDI I can not adjust my basal. Thus I will eat chocolate that is digested slowly. This way I will have a constant stream of carbs from the chocolate that will be consumed by the muscles. Alternatively you could experience with a lower temporary basal rate for these days.
-for me something happens in the deep sleep phase that will consume carbs. I have experienced the dropping of my bg at different times. What ever happens in this phase it can concume 50 mg/dl in one hour. Maybe it is the rearrangement happening in the brain of all the input of the day. This can be reproduced with Levemir and Lantus so I do not think it is caused by a peak of the basal itself. To be on the safe side I will always eat something before going to sleep. Very reliable are one or two slices of Wasa Original for me. The little carbs from the Wasa will also keep the Dawn Phenomenon at bay. This works by elevating the glucose level over the threshold of the liver for dawn release.