Night time drop in blood sugar

Hello! I was wondering where I would post a question about my blood sugar? You see, I have to keep it at 300 before bed or else I will wake up with my bs in the 30s. Did anyone have this experience once? My Endo does not know why it drops so much while I sleep. I take 1:15 insulin for my meals and correction is for every 50 over take one unit. I am thinking I am taking too much here but my bs stays high during the day. Like my insulin works slower when I am active and faster when I am dormant(sleeping). I take 20 units of Lantus as well once a day. Can someone please help me? 300 is very high to be going to sleep with.

Wow, that stinks. Have you considered using a pump to see if that would help? The ability to adjust basal rates and at different periods of the day might help you.

I have considered the pump however, I do not have insurance to cover the cost of one. i hear they are expensive.

You are right, 300 is way too high to be hitting and maintaining on a regular basis. I’m a little surprised your endo is not working with you to change this! My first question would be when you take the Lantus. If you are taking it at night it obviously is too high a dose and it is hitting you before waking and crashing your blood sugar. You want your blood sugar to drop (or rise) no more than around 30 points at night.

My next question would be are you having highs at other times that wouldn’t be related to food spikes (such as bedtime and before meals?) If so, it just confirms what seems pretty clear is that your basal dose is off. If you are taking it at bedtime it is too high a dose and crashing you during the night, then wearing off during the day and leaving you high. Lantus does not last 24 hours and it is better to either split the dose or switch to a split dose of Levemir which is smoother. I would experiment with tweaking the dose by a unit or two and watching the effect for a couple days before tweaking it again. You also can do basal testing by fasting for segments of the day and seeing if your blood sugar stays stable without food. You really don’t want to have to intentionally go to bed at 300 and if your basal is right you shouldn’t need to!

I strongly encourage you to either have your endo work more closely with you at managing numbers (or find one who will!) and/or read Using Insulin by John Walsh which will help you work on your own blood sugar management.

Thank you so much. You provided great information. I will try tweaking the Lantus. I do take it at 7pm. I will ask my Endo if taking ten in am and ten in pm would be ok. I also have gastroparesis if that makes any difference. Its hard to control during the day. Thanks for your help.

Crystal, here’s a discussion on splitting Lantus:

Since that discussion I’ve reverted to a single shot of Lantus, because even a 2-unit dose at night tanked me by morning. Then I moved the morning dose around until settling on what seems to be working (9:00-9:30), which prevents me from tanking early to mid-morning but also from elevating in the late afternoon.

I regret I don’t know all there is to know about experimenting with basal dosing (lots of people on this board who are very well-studied). My decidedly not-as-educated opinion is that 20 units of Lantus seems like a lot with a 1:15 carb ratio; I do 17 units of Lantus, and have an I:C of 1:6.

I wonder, too, if your I:C is correct, particulary with respect to your dinner meal. Is it possible that both your Lantus dose AND your dinner bolus could use adjustment? Either way, always better to tweak one or the other rather than both so that you’ll have a control factor (e.g., which adjustment is doing what?). And, remember to observe one adjustment over a period or four or five days before making another…

Good luck, and post back with results!

Before digging too deeply, let’s take a look at some of the basics (which you may have already looked into, but I don’t know that!):

  1. At what time do you take the Lantus and what time do you go to bed? Perhaps the “peak” of Lantus really affects you strongly, but going from 300 to 30 overnight seems like too steep a drop that splitting the dose would solve it.
  2. When is dinner (or whatever the last meal of the night is)? What are your pre-meal, post-meal, and boluses like? What type of insulin do you use to bolus? That drop seems too steep for a basal-induced one.
  3. You should never mix Lantus with another insulin, nor should you inject the two very close to one another
  4. Is this a recent change or have you been this way for a long time?
  5. Do you exercise before dinner? I used to play ice hockey, and my sugar would still drop pretty rapidly for hours after a game was over.

Depending on your answer to #2, I’d test your blood sugar pretty consistently (hourly while awake, every two hours overnight — set your alarm and prepare for a sleepless night!); it would be interesting to see if your sugar drops gradually or if it has a steep decline and then levels off. That could help you figure out if it’s a basal or bolus issue, and could be a good starting point for the next steps.

But you’re right, 300 is too high to go to sleep with, and 30 is dangerously low to wake up with. When you say you run “high” during the day, do you mean “in the 300s”? I’m wondering if a correction-factor at dinner may be causing the steep drop.

I don’t know too much about gastroparesis, just that it does, indeed make it harder to manage D. You might try posting your questions also on the Gastroparesis board. It does sound like you have a basal problem, but you might get some help as well with your daytime management.

In addition to the basal kicking in during the night I also was wondering if the lows you woke up with when you corrected at bedtime might have to do with the correction. Correcting from very high numbers can be tricky and it’s better to do so conservatively before bedtime. You might test your Correction Factor more during the day, both when you are still digesting carbs and when you are on empty, to make sure it is correct before using it to correct severe highs at bedtime. That might be contributing to your overnight crashes.

Also, you might want to check with the Pump companies about payment subsidies if you are low income. I do have good insurance but based on my income Animas wrote off my 20% share. I don’t know if they do that for people without insurance. I see you are a student. I know they extended the law about what age you can still qualify under your parent’s insurance. You might, over time, look into that or into getting insurance when you can and then check out a pump. It makes it all so much easier to manage!

I was having problems with night time lows and basically solved the problem with some tweaking of my lantus dose and switching the timing from at night to the morning.

Im sorry let me clear something up, Scott. I have to keep my sugar around 300 because if I go to bed with it where it should be (125) then i get the 30 lows. If I keep it at 300 I will wake up to it being around 130-150.
When I take my meal shots I count the carbs and take the units required however, my bs does not go under 180 in a 2 hour time frame. I take the Lantus at 7pm and go to bed at 10pm. I eat my dinner at 630pm. I use Humalog Lispro for my bolus.
This change has been going on since maybe 6 months ago. Ive taken my lantus shot at the same time for 2 years now. Also I was taking 30 units for Lantus and the doc changed it to 20 because Im not using as much humalog as I used to and she said the Lantus units have to match with what my humalog units are in a day. I called my doc today and asked her about splitting the Lantus dose. she said I could test it over the weekend and call her on tues. Take 10 units at 7pm and then 10 units at 7am.

Oh, that makes sense. I guess I didn’t read closely enough! I don’t quite believe in the “lower-the-Lantus-because-the Humalog-went-down” theory though. Most people take about the same amount of bolus as basal, but some are different. I take about twice as much basal as bolus (I eat a lot of carbs, too) and it works just fine for me.

I’m still curious to see what happens overnight. You could always “test it” by not having dinner and not taking Humalog one night, but that’s not easy to do!

If you need 300 to get out with normal numbers in the morning then Lantus is NOT the right insulin for you. A basal insulin should keep you at normal numbers when fasting - even when you are fasting for 24 hours. Your current sensitivity clearly shows that you should try another basal insulin like Levemir (2 shots per day) - even the crappy NPH will act better then that (also two shots per day). Lantus is supposed to bind to the fatty tissue to be absorbed slowly. In your case this binding might not happen as effective or long as it is supposed to. This might be the reason why the main mechanism to slow the insulin down is failing. You are not alone with this rapid onset - many others have reported this problem with Lantus too.

Can your doctor get you connected to a CGMS like Dexcom for 7 days (or more) - that may give you a good feel for what is happening overnight, if your sugars peak even higher before dropping, how rapid is the drop, etc.
I would also suggest you contact the pump companies and talk to them about getting a pump - never know if a solution is hiding if you don’t ask questions!

I was thinking along the same lines Holger. Some insulins work for you some don’t. I have heard many things about Lantus and tried it one time but it didn’t help me at all.

I spoke with my doc. She agrees that I should split the Lantus dose. I have been doing this since Friday. It seems to be working. My Bs improved during the day as well. I keep my bs at 150 before bed now. Lets see if this keeps up! Thanks to everyone for all your help and suggestions.

Yeah, I know that problem real well. Had EMS take me to the ER last month because even with the D50 I would not wake up.

I am on Lantus and novalog. I had to lower and split the dose of lantus to stop that. Would go to sleep with BS at 175 and would wake up with it at 45 and going up. You may ask your ENDO about splitting the dose or switching to Levimer. That one is taken in 2 doses so if you need more for a while you would increase it and lower it for the other times. Or you can do what I am and that is going back to the pump. That way I can set the basel rate for different times.

Glad things are improving for you, Crystal!