My first endo scared me witless about overnight lows causing death & insisted that BG should be over 120 at bed. After many sleepless nights, testing in the middle of the night, I disregarded his advice about eating before bed & going to sleep higher than I want to be. I got overnight hypo fears. Myabe it was from sleep deprivation:) Exercise in the evening causes lows for me, so I don’t do that.
If I’m a bit low before bedtime, I eat a small amount of protein & no carbs. Going to bed at more normal BG & tweaking basal has helped me. I can’t help but think that recommendations to go to bed high & eating before sleep is a hold over from the days of NPH, as well as doctors possibly being held liable for dangerous lows. Current insulin is more predictable than NPH.
I used to get the don’t-go-to-bed-under-120 speech as well with my first endo… was on NPH at the time too.
I didn’t get a fear of nighttime lows until I had my first seizure in the middle of the night (was on Lantus–blah). For a few weeks at least after one of these, I would be cautious and go to bed higher.
Now with my pump and CGM, I’m more confident that I’ll be okay through the night so long as something hasn’t changed significantly in my daily routine, in which case, I would likely not go to sleep under 90 and possibly set a lower basal that night. But I wouldn’t go to bed higher (140+). —Of course, this confidence doesn’t take into account being stupid. I’ve had one hypo seizure in the middle of the night on my pump + CGM because of my own forgetfulness.
I, and my SO, are much too heavy of sleepers to ever hear that pitiful Minimed CGM alarm.
You know more about diabetes than most doctors & you’re knowledgeable about your doses. Alan had a doctor who told him to take his NPH dose at night, to give you an example. Of course, you can not exercise in the evenings since the effects aren’t predictable.
I am of course just kidding with you. I am struggling with the whole exercise thing. Dr. B says not to exercise in the morning, I work during the day and am left with evenings. I may need to just bite the bullet as you note and move my exercise time.
Really limits time for exercise. I think the precaution about morning work-outs is geared towards T1, but if you have the joy of dawn phenomenon it would apply to any type. Wish I could remember where I read it, but I saw an article suggesting overnight lows could be the result of evening exercise. What other time do most people have?
Thanks for all the comments. I used to run higher befroe bed but since the pump and peak-less insulins, the patterns are way more predictable, so I don’t usually fear the lows anymore. The vice for me are the intense evening work-outs, and delayed response. It is still hard to predict, so I increase my CHO and have a snack with no bolus. Cheers!
It may not necessarily be where your exercise goes with weights but w/ stray NPH floating around? I’ve mentioned this during our other talks on the subject but when I got my pump (straight from NPH…) they mentioned that it only had a 53% chance of peaking when it was supposed to (8-10 hours maybe?) so it can peak early or later but, in retrospect, I think that exercise might crank it up too, although I have not seen, nor have I looked for, since I’m not taking it any more, any studies about it? It sort of sounds like a theory that could be cooked out of your experience? I was always tweaking stuff, eating small snacks and stuff to try to keep on the rails but I think that as a drug it has some severe limitations.
Another way to look at it and if were an under the counter drug that made you feel “really drunk” [or whatever…] but you wouldn’t be sure if it would hit in 4-6 hours or 8-10 hours or 14-16 hours, but it would hit a little bit all the time, hardly anyone would buy it to get wasted on, no matter how tasty the buzz was? Unfortunately, for OTC basal, that’s about all she wrote.
I know you cautioned me about the NPH, but so far the only issues I have had are related to taking a bolus with after workout meals. So far, if I just decline to bolus, and ignore my blood sugar I have not had a problem. As far as NPH, everything you say basically suggests it totally s*cks, which simply confirms everything everyone else says.
But in the end, I would rather feel like I could have after workout nutrition with an appropriate bolus and feel like I could have comfort that I would have an controlled blood sugar rather than a potential rollercoaster.
