I have been taking lantus for a few months and have finally reached a level that is keeping my numbers in a good range. The only thing I do not like is 2-3 nights a week, I will find myself waking up needing to eat because I am having a low (generally 70-85). I hate this more than anything. Not only is experiencing a low episode in the middle of the night a somewhat nerve wrecker, but i cant get back to sleep afterwards.
Is this just a side effect of being insulin dependent, am I not eating enough at dinner?
If your BG has been high for a while, normal BG will feel like a low while your body adjusts. 70-85 isn’t low. High 70’s-80’s is perfect! Under 70 is technically considered low.
Lowest BG for normal people is between 2-4 AM. Body processes slow down during resting.
You don’t want to eat enough to raise BG too much before bed. I eat a few nuts (pecans, almonds, walnuts) or a small piece of cheese before bed to have some protein to prevent overnight lows. You don’t want to eat anything with carbs to send you high.
When do you take your Lantus? Is your fasting BG good?
Yes, my numbers have been high for several years. I have just found a dr who figured out the right combo of meds i need. Dinner is normally between 6-7. If i have a snack prior to bed, its normally popcorn or chips & salsa (just a few chips). Lantus is taken between 830-9pm. Fasting BG has been around 120-130 (great, considering what it has been). This morning about 4am I was at 83, and I just about passed out walking through the hall. Do you keep certain foods on hand just for overnight lows? I haven’t experienced them until now, so I just grab what i can get my hands on.
Your Lantus dose isn’t too high since your fasting numbers aren’t low enough yet. What’s BG before you go to bed?
I wouldn’t treat 83 & have my body adjust to normal BG. It’s the only way to reset your reactions back to normal. It doesn’t take long for this to happen. You shouldn’t feel like you’re about to pass out from 70-85.
Popcorn & chips are too high carb for a snack, sorry. Protein is better.
I use Jelly Bellies for lows. They’re cheap & come in great flavors. I can’t stand those nasty glucose tabs. I keep baggies of Jelly Bellies in my nightstand, purse, desk & car, but I’m T1 on insulin so I’ve got to have something handy all the time.
Something new you have to learn is how much 1 gram of glucose raising your BG so you don’t overdo it. Everyone is different, but 1 gram of glucose (1 Jelly Belly) raises my BG 10 pts. You want to let the sugar dissolve slowly in your mouth to correct a low.
This is what i needed! As soon as the article talked about exercising in the evening, thats what it is. The 2-3 nights i have been experience lows is the nights i do my workouts in the evening!
A bedtime reading of 140 is unsafe & too high. BG 140 & above causes damage to nerves–eyes, kidneys, etc. Quite disheartening that Joslin is putting out this kind of info. Unlikely that someone going to bed with 140 will wake up to under 100 fasting BG without taking higher insulin doses.
Ali isn’t experiencing low BG. An 85 is not low, it’s perfect, on-target BG. We should all have numbers like that in the middle of the night & every day!
Good points Gerri- definitely helps bring more depth to the convo.
I’d say this - if BG is at 85 and still falling that could be a problem. So, the trend is important. The #1 risk of “tight glucose control” is hypoglycemia - it’s also the #1 side effect of most D meds.
I’m not a Doctor, but that 140 BG came from Howard Wolpert, who is a MD, Director of the Joslin Insulin Pump program. So, his recommendtion might partly have something to do with pumping and CGM, not sure.
Adding still more depth…, having a one-time BG of 140 isn’t going to immediately cause nerve damage. Rather consistently high blood sugar levels over a long period of time cause nerve damage. I think what Dr. Wolpert is advising is that - if you expect that your blood sugar is going to fall, then get to 140, because as your numbers drop, you’ll be back into “normal” range.
I agree 85 is a good BG, (usually I hear 80-120 as a target); but, for some people, striving to get that low can accidentally lead to severe hypoglycemia.
So, there’s a risk/benefit there. Lower #s are good, but very low #s can be bad
Ali- Do you know what your bedtime reading is on the nights you feel low? You might be able to see a trend. For example… if my blood sugar is 150 or less at bedtime and I take my Lantus, I will wake up with a “low” around 80-85. Since all of us are different, what is low for me is “in range” for others. I get shaky and lightheaded and discombobulated below 85. So I’ve noticed now, that if I’m 150 or less when I take my lantus, I know to eat a light snack or take a glucose tab before I lay down. My morning sugars are right around 100. I have recognizable trends but you may not.
Not all of us have the same symptoms. My “normal range” might not be for everyone else. Please keep that in mind, it can make people feel “defeated” to be told otherwise and I don’t want that! If you didn’t know, when you’ve had high blood sugars for a while, those “lows” may be technically in range, but it is still a very scary feeling to wake up shaking and sick. After a while it will sort out for you, but in the meantime, that low is a REAL low for you and needs to be treated accordingly.
You’re right. Having a one-time high of 140 or higher isn’t going to cause damage, but striving for this as nightly target isn’t helpful advice. We don’t have one-time highs & the damage is cumulative. People read Joslin says my BG should be 140 before bed without any explanation or understanding behind it. Better advice would be not to good to bed soon after bolusing for dinner so you’ll know that your insulin is pretty much gone. And another reason for not eating too close to bed, if you’re on an insulin regiment.
Good to wait & test again to see if BG is plummeting further before treating a low that isn’t really a low to know what’s happening.
If coming down from an immediate high BG, a low that’s not terribly low can feel devastatingly low. Doubt that’s Ali case since she’s only on Lantus & not rapid acting insulin.
People on pumps have more control of insulin delivery & CGMs alert people to lows with an alarm.
The goal, of course, isn’t have many lows. Doctors assume that people can’t have tight control without having frequent lows. This isn’t necessarily true at all. Most can’t take the time to teach patients the nuances of timing & doses to help prevent many lows. Some can’t be helped because stuff happens, but mostly they’re due to people taking large doses to cover high carb meals.
People should be given the facts to make informed decisions on their own. Sad how this rarely happens for us.
hmm… apparently I’m the only person who HAS to eat 45+ carbs at night. If I don’t I WILL be 50- in the morning. And if I lower my lantus, my humalog needs will skyrocket.
but I will agree with everyone else on one thing, 85 isn’t low and it shouldn’t be corrected unless you know its dropping
Just to clarify Alan- are you saying, if you are in normal range, 140 is madness or are you saying if you are in the 250-380 range a goal of 140 is madness?
Your Lantus & Humalog doses must be way off for this to be happening. Lantus shouldn’t be effecting post meal numbers. Basal’s just background to help level BG between meals & overnight. A functioning pancreas sends out small amounts of insulin to do this & then large bursts for food. So not exact, of course, but it’s what we attempt to imitate with basal/bolus injections.
You must be taking huge amounts of Lantus for it to be effecting you this way. What’s wrong with taking more Humalog to cover your meals? You need what you need. This is more exact, more predictable & easier to control than Lantus.
You could discuss your doses with your doctor & also talk to him/her about taking split doses to prevent overnight lows. They all say that Lantus lasts 20-24 hours, but it doesn’t. Many have greater success by taking two separate doses. The trials done on Lantus used humungous doses, so the trials showed it lasted 20-24 hours, but this wasn’t the dose range most people us.
I had a horrible time with Lantus causing lows. The dose didn’t seem to make much difference. I had terrible lows every afternoon. I switched to Levemir (at the same dose) & things leveled out. Lantus had obvious peaks & valleys despite claims that it shouldn’t. Many discussions here from others who’ve experienced the same. I also like Levemir because it doesn’t sting.
It definitely lasts a full 24 hours (and maybe then some), but for me, it has a spike. and 27 units isn’t exactly a “huge” amount either. and this is working, why should I start taking 15+ units of humalog at a time? I would rather not start using 1:5 I:C again like when I was going through growth spurts. Wouldn’t smaller doses of humalog be more like a normal pancreas? Its definitely easier to manage…
Hi! I have been back on Lantus since October 2009. I have thought that I was at the right dose several times. When I sat down with my BS readings, I realized that the dose was too high. I like to keep my BS lower than most are comfortable with. The last month the readings have been getting lower and lower. I have some hypo unawareness and do not have any low symptoms until I am below 40. I have just lowered my dose by 10 units in hopes that I can keep my FBS under 85 and pre-meal about the same. I have found out that if I keep my BS at 100 at bedtime then I usually sleep the whole night through. I am another one that once I wake up in the middle of the night, I have a terrible time falling back asleep. If you can keep your BS at 100 or higher at bedtime, you probably won’t go low during the night, if you are still going low, you may need to decrease your daily dose of Lantus.
Paul, You make some great points and many who have commented should read the book,TLAP, to better understand how managing T1D with insulin works.
The reality is, if your are raising your bg to overcome potential hypos at night or during the day, or before bed, or before taking an injection, there is an issue with how you are managing T1D with insulin.
For those that are, it may be time to get some help or learn more about managing your diabete.
The blanket advice given by the MD at Joslin is WRONG and may mask other insulin/T1D issues that, until resolved, may cause a T1D to never be able to effectively manage their T1D successfully to achieve normal BGs.
27 units of Lantus isn’t that much, but it’s too much if you have 45 carbs at bedtime to prevent going to 50 overnight. I’d question how well it’s working keeping your postprandial numbers within a good range with an A1c of 6.8.
The idea is dosing insulin to food, not food to insulin, not eating to match insulin.
Since Lantus works slowly, how do you calculate Humalog dose for meals? How are your numbers after meals?
Your I:C ratio may be different now then when you had growth spurts. My feeling is that however much we insulin we need to keep BG as close to normal is the goal. A lot or little, it doesn’t matter. Good numbers matter.
Nope, smaller doses of Humalog aren’t more like a normal pancreas. Larger amounts are produced for meals depending on how much is needed. Small doses of “basal” are secreted throughout the day & as needed.
If your target is less insulin, the way to do this is with less carbs & more exercise, not taking more Lantus than you really need.
