Overnight low battle - snacks?

One of the things my boyfriend is finding challenging lately is sleeping. He'll go to bed way too high (as an attempted preventative) and wake up low...sometimes he'll go to bed low (after a quick sweet snack to boost his BG) and wake up super-high.

I've been trying to figure out ways to prevent this, or help him manage that part of the day better, since it seems to be the hardest part for him, but without concrete suggestions/products it's tough.

So, I guess I'm asking what sort of snacks you guys have before bed to help keep you in the safe zone over night. What are you looking for in a snack if you're high? Low? is there certain grams of carbs/protein that I should be looking for?

*note* I'm still trying to get him to join...it's a work in progress. If I can get him on here I will, but in the interim I still need to find ways to help him deal with this. His current issues dealing with his BGs are having a pretty obvious effect on his motivation...as in he seems to have little to none currently (at least when it comes to learning/trying new things). I'm hoping If we can get him a bit more stable then his frustration level will go down and he'll be more receptive to trying new things.

I usually try to go to bed at or around 100. The CDE and Doc say get it over 100 but I'm ok with it being a bit lower. As for snacks if I am low I will have a cereal bar or some peanut butter crackers or cheese and crackers another option is a small glass of milk. Basically what you are looking for is a slow digesting carb. Depending on how low, 15 grams of carbs usually will correct it for me. If I am high, obviously I would not eat, but depending upon how high I was, I would correct with the appropriate amount of fast acting insulin. I understand your boyfriends' frustration there are some diabetics who get Dawn Phenomenon or people here just refer to it as DP. This is an early morning high blood sugar. It's probably hormonal, probably not something you can really do a lot about but it can be really frustrating to think that you are doing everything right and still end up high. For most of us, diabetes is a "work in progress", just so long as you can see progress, regardless of how small, it's a victory.

Thanks Clare, I have a question for you though. You said you go to bed around 100...if I'm converting that right that would be about 5.5? I know that Scott tries to go to bed quite a bit higher than that. I think he prefers to be as high as 8-9 (144-162)? Is my conversion off? I know he's been right around 5-6 and he doesn't feel comfortable going to bed with his BG there.

It's very possible that you're just more stable than he is, and that could cause the different attitude. I'm just trying to 'get' as much of this info as possible :)

I don't worry about being safe as I sort of have things set to be "flat" most of the time? It's a constant chore, keeping an eye on it and adjusting for drifting of the numbers and all of that. I have a pump and a CGM which I find makes it easier.

If a number that I haven't consumed messed up carbs near is off for a few days, I fix things to put it more where I want it? In many cases, if a number gets out of whack, a very small adjustment (easier to do with a pump...) will get it back where I want it fairly quickly. If his BG is dropping regularly at night, with little food, or even some food "on board", perhps cutting the basal back would help? Depending on how many units, even a small adjustment, maybe 5-10% will stop the nosediving? If I eat before bed, I bolus because I don't want it to run up but, if he's eating to "cover" excess basal insulin, it might be problematic to cut it out.

Protein is good to have too and I like milk like Clare since it's supposed to make you sleepy! Then again, I like beer for the same reason. I try to keep different varieties of beer (low carb, medium carb, high carb...) around for nighttime snacks? I've laid off that for a while to see if it might be a shortcut to getting studlier but I haven't decided if it works or not yet?

A goal of tight control is to wake with a reading that is 10-20 mg/dl of your reading of when you go to bed. While it may not seem a concern to bed high and waking low and vice versa, the nightmare is to go to bed low and wake really, really low.

A goal in managing your blood sugar is to maintain good normal numbers, but in many situations, it is just as important to keep your variations limited and predicatble.

Absolutely that is entirely possible. I have been doing this a lot longer than Scott. But your math is correct, I'm sorry I don't do metric, except at work where I do chemistry. At home everything is set American style, no metric involved. But as we have said before, everyone is different. Since I have been doing this for 37+ years I can be fairly sure if I go to bed at 100 or so I will wake up at 100 or so. Scott has no idea yet what will happen if he goes to bed at 100, and I am sure that has to be very scary for him. If he feels more comfortable at 8-9 and his doctors or CDE are ok with it then that's the target you work toward. At least that is the target for now while he's still hopefully learning. Then you move toward a more normal blood sugar. The problem though with a trial and error approach to blood sugars is the error part can kill you.

Way to put a wrench in the works there AR. I like beer for the same reason, but I only have the low carb around so I don't use it for a long acting carb before bed. There are no shortcuts to studlieness, you either are or you aren't.

I see a couple issues to resolve there. First of all, he shouldn't go too bed way too high. He should learn what his ISF is (how much one unit of insulin lowers his blood sugar) and then correct before bedtime (being conservative until he is certain of the ISF).

Second " a quick sweet snack" is not the best way to treat a low. If nothing else, being low makes some people super hungry and it's hard not to overdo. Better to use glucose tablets which he should have always with him. He will find out how many he needs to accurately correct a low without then going high. That roller coaster is really bad for us. For me I use 2 tablets if I'm in the 50s (8 grams) and 3 if I'm lower but he is probably larger and needs a bit more.

I don't eat a snack to "keep me in the safe zone" overnight. what I do is have my basals set correctly so that I stay relatively stable. It's easier to do on a pump than on MDI, but still he can play with his dose until he achieves relative stability. Some advice: levemir is smoother than lantus for many of us and a split dose is better than a single dose. He can also do basal testing to see if his doses are right.

I understand that he (and you) are nervous about going low at night. I live alone so it's even more dangerous for me. But once he knows his ISF and has an accurate and stable basal dose he will feel more comfortable going to bed at a reasonable level.

Maybe not a shortcut as people think of shortcuts but for me anyway, cutting out the couple beers before bed has dropped the pant size undoubtedly. Regular beer = 150 kcal x 2 is a good 300 kcal a night (on a good night- who just drinks 2 eh?). Cut that out without eating extra food and well you get the picture.

"Studlier", huh? I would think that would be something more appropriate to AR than to Clare! (Sorry, the wordsmith in me couldn't resist!)

I think I'm getting the jist of what you're saying...but I'm not sure. This is the part that is confusing me "A goal of tight control is to wake with a reading that is 10-20 mg/dl of your reading of when you go to bed." Would you mind explaining the '10-20 mg/dl' part a bit more in depth?

He's very worried about going to bed low and waking up really, really low...so am I! However on the othr hand he's trying to get his overall BG (forgotten what it's called...sorry) to be lower as well as trying to prevent himself from going as high as he has been.

I finally got in touch with a useful group yesterday, so we'll be getting a refresher on a lot of thing pretty soon I hope. But in the meantime I'm trying to cram as much info as possible into my brain all at once so I can help him figure out why he's on this BG rollercoaster.

Overnight is the toughest part. If my blood sugar is high I won't sleep good at all. Then I'll be tired the following day and that makes things harder to control. Maybe if we could do and eat the exact same things everyday we could manage this better. I've been dealing with this for about 30 years and I still have problems. Your boyfriend should check out CGMs. Personally I recommend the Dexcom based on reviews and personal experience. I just re-ordered sensors for mine.

That's what we're worried about right now, trying to get his BG to level out. I think part of the problem is that the more weird his levels are the more frustrated and stressed out he's getting...which makes his BG harder to control (so I've heard...).

We're hoping to get some help with this pretty soon, but in the meantime...*shrug*

I will just add here that when I was taking Lantus or Levemir (I tried both and indeed did have more luck with Levemir) I could NEVER get my overnights right. Didn't matter splitting or what have you it just never worked. I need so little insulin when I go to bed and then so much when DP kicks in I just couldn't do it without a pump. I HAD to use food as my basal was so high to match DP so I would have to eat a small amount not to go low shortly after bed.

The idea is that if the basal is correct if he goes to bed at 100 mg/dl (sorry no metric here) he would wake up 80-120 (no more than 10-20 mg/dl away from the 100 mg/dl he went to bed with).
Also, once you get the roller coaster a little more flat ALL of this becomes more predictable and easier to manage. For me anyway.

Well, you'd have to convert and 18-1 would only give you +/- .1 but I agree with BSC both on wanting to be flat and also not to go changing all over the place. I usually try a new thing for about 3 days (I'm in the middle of reducing basal a smidge now...) but, if it works, then I just go with it. IT's hard to guesstimate what to do but I'd stand by if your bg is going down @ night, your basal is too high.

Another thing that might help with that would be to spread the basal out into two shots, a lot of people do that to smooth out the small peaks that can throw them off.

LOL, the ultra light ones are like 60 calories but I like the thicker ones that are probably more like 300?

I mean exactly what I said, that you go to bet with a "good" blood sugar reading and you wake very close to the number you go to bet with. And there are a bunch of things that you should do to make that possible, such as not eating or correcting before bed. And I work really hard to "be regular." I work to go to bed consistently, manage stress and sleep well.

Have you got the book Using Insulin by John Walsh? Having that book as a reference will really help with your info cramming!

What does ISF stand for? (the word-nerd in me needs to know :) ) Also, how does he go about figuring that out? 1 unit seems to do different things depending on when he takes it and what he's doing. Is there a certain method to figuring it out, or is it sort of 'by feel'?

I've looked into glucose tabs...TBH they're pretty expensive and the one's we've tried were all pretty gross. Is there a certain brand we can get (in Canada) that are less awful? Or are there other options? I think he's overcorrecting a lot of the time, so I'm very interested in figuring out how to prevent that.

When we get to talk to an endo/CDE I'll bring up levemir. I think part of the problem is that the lantus IS peaking and causing his BG to drop more than it used to (if that's possible???). He already does adjust his basal (that's long acting I'm pretty sure, right?) a little bit, and he talked to the endo about splitting the dose but neither of us knows very much about this and he's worried about morning lows and daytime yoyos if he tries it.

Thanks for the info! You guys are all helping a lot :)