# Night time low alarm going off a lot



## PWinter (Dec 20, 2021)

Hi all
Mother if T1 here, diagnosed when he was 25. He got L2 which he started on Friday but its going off a lot at night as he 'seems' to be running too low. He's getting pretty fed up with it and last night compared by doing some finger prick tests to check. Eg Libre said 3.3 but BG said 4.4...  He wants to keep at it but I am concerned he will get too fed up and go back to BG testing. Also whats a good night time snack to keep BS at a better level? Something like a small yoghurt? 
Hes recently had his first pretty horrible hypo and ended up in hospital and would rather try and help him avoid that again if I can.... Help/advice appreciated.


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## Lucyr (Dec 20, 2021)

I think 4.4 is too low to be asleep with so it’s good the alarms are waking him to increase the BG level. What level is he going to bed at?


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## Thebearcametoo (Dec 20, 2021)

Night time snacks for low but not hypo here are milk or crackers. 2 crackers or 200ml of milk is about 10g carbs. The milk is pretty neutral for teeth so means he doesn’t have to do his teeth again afterwards. 


If he’s getting a lot of lows at night then it suggests the basal isn’t quite right. L2 will give a lot more data than finger pricks so it’s worth looking at the times he drops. I’m presuming he’s on injections not pump. Pump is easier to tweak night time basal. If it is injections then fast acting is out fo the system after 4 hours (give or take) so if he’s dropping before that it may mean he needs less bolus with his last lot of food. If it’s more than 4 hours since he ate then it’s more clear that it’s basal that’s the issue.


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## PWinter (Dec 20, 2021)

Thebearcametoo said:


> Night time snacks for low but not hypo here are milk or crackers. 2 crackers or 200ml of milk is about 10g carbs. The milk is pretty neutral for teeth so means he doesn’t have to do his teeth again afterwards.
> 
> 
> If he’s getting a lot of lows at night then it suggests the basal isn’t quite right. L2 will give a lot more data than finger pricks so it’s worth looking at the times he drops. I’m presuming he’s on injections not pump. Pump is easier to tweak night time basal. If it is injections then fast acting is out fo the system after 4 hours (give or take) so if he’s dropping before that it may mean he needs less bolus with his last lot of food. If it’s more than 4 hours since he ate then it’s more clear that it’s basal that’s the issue.


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## PWinter (Dec 20, 2021)

Hi...  thanks for the snack tip..  I think his levemir (base insulin) might be too high so will get him to tweak that down a few units. 
He was 7.7 before bed but had several dips to 3.5 it so during night so took JBs or glucose to push it back up. But when he finger pricked it was higher than the Libre also.... 
After spending months getting approval for it I dont want him to stop because of this...  Not if its something he needs to tweak in base insulin or a snack... TY


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## helli (Dec 20, 2021)

The level to go to bed depends on how he is treated.
With injections, it is always recommended to go to be higher as our levels may fall overnight.
With a pump, we can run levels a bit tighter overnight as we can set our basal rate to match dips better.

When I was injecting, I would aim for a level in the 6s as I found a high level (above 8) keeps me awake.

With a pump, I am comfortable to go to bed around 5.

Regarding snacks, that should depend on how much you need to raise your levels. I think there is no point is always having a slice of bread, for example, if your levels are already around 7.


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## PWinter (Dec 20, 2021)

Lucyr said:


> I think 4.4 is too low to be asleep with so it’s good the alarms are waking him to increase the BG level. What level is he going to bed at?


He was 7.7 last night. I think his night time basal is too high for him...


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## rebrascora (Dec 20, 2021)

Hi and welcome.

That discrepancy between Libre and finger prick reading is pretty standard for me. As others have said, even 4.4 is lower than he really wants to be at night, so his basal insulin may be too high and the Libre warning him at that level is a good thing, especially if he has had a bad hypo recently. That must have been scary! Did he or his DSN figure out why that happened. 

Which basal insulin is he using? If this is a regular occurrence during the night and his basal insulin is holding him steady during the day then he may benefit from a change of basal insulin, as some have quite different profiles of action. It sounds complicated but the basal insulin is used to deal with the glucose the liver trickles out day and night to keep vital organs supplied when there is no food being digested. This varys from person to person but also varies at different times of the day, so a basal insulin like Tresiba which releases a very even amount of insulin throughout the day and night would not be any good for someone like me who needs much less insulin at night than I do during the day. I use a shorter acting basal insulin, Levemir which means I need to injections, one in the morning and one at night. My morning injection is currently 26 units but my night time one is anywhere from 0 to 7units depending upon how active I have been during the previous few days and I can adjust it every night if necessary to balance my needs. It enables me to balance my basal insulin needs to suit my lifestyle much more closely. 

It is worth mentioning that Libre should always be double checked with a finger prick if it shows you are hypo or hyper ideally before taking action unless you are very clearly feeling hypo as there are circumstances where it can be wrong. One such situation is if your son was to lie on the arm with the sensor as this can cause what is known as a "compression low" and your BG levels could actually be well within the normal range and eating fast acting carbs would push levels too high. Similarly, Libre can sometimes show high readings as being significantly higher than they are and if you base a correction on that reading you could end up hypo because you used too much.
Libre is a brilliant bit of kit but you have to understand it's limitations and know when to double check it before taking action.


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## PWinter (Dec 20, 2021)

helli said:


> The level to go to bed depends on how he is treated.
> With injections, it is always recommended to go to be higher as our levels may fall overnight.
> With a pump, we can run levels a bit tighter overnight as we can set our basal rate to match dips better.
> 
> ...


So... he was 7.7 before bed last night but dipped several times to 3.4, 3.5...  The lower alarm on the libre is 3.7... Whats the average night time insulin you would think as an idea? Hes taking 23 units which I think is the problem or part if it....


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## rebrascora (Dec 20, 2021)

I see you posted whilst I was typing and that he is on Levemir which is great but can you clarify if he takes it as one dose or two... one morning and one evening?


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## Inka (Dec 20, 2021)

PWinter said:


> Hi...  thanks for the snack tip..  I think his levemir (base insulin) might be too high so will get him to tweak that down a few units.
> He was 7.7 before bed but had several dips to 3.5 it so during night so took JBs or glucose to push it back up. But when he finger pricked it was higher than the Libre also....
> After spending months getting approval for it I dont want him to stop because of this...  Not if its something he needs to tweak in base insulin or a snack... TY



What times is he taking his Levemir? Sometimes that can be an issue too. As said above, 4.4 is really too low for nighttime so the Libre waking him is good, even though it thought he was lower than he was. Nocturnal hypos are best avoided at all costs.


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## rebrascora (Dec 20, 2021)

I would say that his Libre alarm is too low at 3.7. The whole purpose of it is to warn you before you get hypo not afterwards.

It is looking like he may be taking all his Levemir at night in which case that is almost certainly the problem.


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## helli (Dec 20, 2021)

T


PWinter said:


> So... he was 7.7 before bed last night but dipped several times to 3.4, 3.5...  The lower alarm on the libre is 3.7... Whats the average night time insulin you would think as an idea? Hes taking 23 units which I think is the problem or part if it....


The correct amount of insulin is the amount you need. We are all different.
Ideally, the basal should keep levels stable. The dose may vary depending whether he has done exercise or drunk alcohol or whether he is I'll or stressed.
So people find they can have the same dose each day. Other people are more susceptible to daily variations.

3.7 is lower than I would have for my alarm. He is already hypo at that level. I set my lower alarm level at 4.5 so I can react before I go hypo.


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## PWinter (Dec 20, 2021)

rebrascora said:


> Hi and welcome.
> 
> That discrepancy between Libre and finger prick reading is pretty standard for me. As others have said, even 4.4 is lower than he really wants to be at night, so his basal insulin may be too high and the Libre warning him at that level is a good thing, especially if he has had a bad hypo recently. That must have been scary! Did he or his DSN figure out why that happened.
> 
> ...


Thanks Barbara...  Hes on Levimir and about same as you in morning but wayyyy higher at night so that might be the issue... hes been taking 23 which is what the DSN said to do...  but I think that's way too high..  Really interesting to hear your personal knowledge/use of it... 
Yes.... that was the hypo that was!! I have never seen one before let alone see and deal with my son in a full blown one. After 2.5 hours I had to get the ambulance and the 1st responder sorted him but because he was also sick the day before he was taken to A& E to check him out. It was very upsetting.... but he doesn't remember of course... Hence my concerns if he's dipping so low at night time...


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## PWinter (Dec 20, 2021)

Inka said:


> What times is he taking his Levemir? Sometimes that can be an issue too. As said above, 4.4 is really too low for nighttime so the Libre waking him is good, even though it thought he was lower than he was. Nocturnal hypos are best avoided at all costs.


That varies as he is a bit of a gamer so tends to stay up late.....but usually about 11 or 12... Maybe he should take it earlier? Its interesting as maybe with using the Libre now it will flag up some of the changes he may need to take to get things to settle down again.


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## Inka (Dec 20, 2021)

If he’s dropping like that it does sound like his nighttime Levemir is too high. What time he takes it is important too because it has a slight peak and if that peak happens at the time during the night when his insulin needs are lower, then that’s a hypo risk.

After a serious hypo like that, I think it’s best to slightly reduce all insulin. One hypo can cause subsequent hypos, and that awful feeling afterwards isn’t improved by teetering on the brink of another hypo.

He could try moving his Levemir earlier. It depends what time his hypo was. Levemir doesn’t have to be taken at bedtime or exactly 12 hours apart if something else works better. For now, if it was me, I’d reduce his nighttime Levemir.


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## PWinter (Dec 20, 2021)

rebrascora said:


> I see you posted whilst I was typing and that he is on Levemir which is great but can you clarify if he takes it as one dose or two... one morning and one evening?


Two.... morning and evening.... Usually 26 in morning and 23 at night now....


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## PWinter (Dec 20, 2021)

Inka said:


> If he’s dropping like that it does sound like his nighttime Levemir is too high. What time he takes it is important too because it has a slight peak and if that peak happens at the time during the night when his insulin needs are lower, then that’s a hypo risk.
> 
> After a serious hypo like that, I think it’s best to slightly reduce all insulin. One hypo can cause subsequent hypos, and that awful feeling afterwards isn’t improved by teetering on the brink of another hypo.
> 
> He could try moving his Levemir earlier. It depends what time his hypo was. Levemir doesn’t have to be taken at bedtime or exactly 12 hours apart if something else works better. For now, if it was me, I’d reduce his nighttime Levemir.


Hypo was in afternoon but it was the day after he had a tummy bug so he had to handle a sick day the day before. The docs think he got Norovirus as it was pretty intense vomiting but I have been fine so its very odd.  I think he took too much insulin with a lunch meal the day after the sick day as he still had a touch of the runs so used calculations for a sick day.... then went into full blown hypo... Pretty stressful and difficult few days... So hes pretty irritable with this on top of all that as am sure you can understand...


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## Inka (Dec 20, 2021)

I never use the Sick Day rules unless I’m running high. Sometimes sickness (if it was sickness) can cause low sugar not high, and often it can cause very erratic sugars - stubbornly high, then plunging down for no reason. So, I tend to stick to normal doses then correct if needed.

What time is he going low during the night?


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## PWinter (Dec 20, 2021)

Inka said:


> I never use the Sick Day rules unless I’m running high. Sometimes sickness (if it was sickness) can cause low sugar not high, and often it can cause very erratic sugars - stubbornly high, then plunging down for no reason. So, I tend to stick to normal doses then correct if needed.
> 
> What time is he going low during the night?


Thats good to know... Hes not been sick since he was diagnosed and only had one ting hypo before so he was hit from both sides the other week. He had ketones of 2.1 at one point hence the sick day rules. 
Hes literally going low from about anytime between 1 and 6... Hes got a glucose drink or JBs to give him a boost and then a malted biscuit to try and help maintain it but he still drops again... Hence my thinking its the night time Levemir...


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## rebrascora (Dec 20, 2021)

It certainly sounds like an evening basal reduction is needed if they are persistent lows at night like that, but do encourage him to double check all night time lows with a finger prick. My night time basal needs change far more often than my daytime ones, so my night time Levemir dose often needs tweaking. Usually 2-3 times a week.


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## PWinter (Dec 20, 2021)

Thats really helpful Barbara so thank you very much for taking the time to respond. Going to have him tweak his basal tonight now and see how we get on. Will let you know.


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## Inka (Dec 20, 2021)

That’s a broad time range that he’s going low during the night, which suggests his Levemir is too high. I agree with you and would reduce my nighttime Levemir if it was me. At least he’ll be able to sleep then without the fear of a hypo. 

I didn’t answer your question about a bedtime snack. I have a small bowl of puffed wheat plus milk. Approx 15g carbs. Oatcakes and peanut butter are good too, as area digestive biscuit or two.


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## Inka (Dec 20, 2021)

The malted milk biscuit might not be enough carbs. They’re usually around 6g carbs if they’re plain. I have a digestive or a plain Hobnob or two, depending on need.


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## everydayupsanddowns (Dec 20, 2021)

PWinter said:


> He was 7.7 last night. I think his night time basal is too high for him...



Yes I would think that if those were my results a couple of days running. Dropping 7.7 to 4.4 is quite a lot. Ideally he would keep within +/-2 or less from his bedtime reading (so 9.7 - 5.7).

When sensors are misbehaving for me the first thing I try to think about (apart from compression overnight) is hydration. I really have to stay well hydrated to keep my interstitial fluid levels up and help the glucose to circulate. If I’m not drinking enough water, it really notices.


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## PWinter (Dec 20, 2021)

everydayupsanddowns said:


> Yes I would think that if those were my results a couple of days running. Dropping 7.7 to 4.4 is quite a lot. Ideally he would keep within +/-2 or less from his bedtime reading (so 9.7 - 5.7).
> 
> When sensors are misbehaving for me the first thing I try to think about (apart from compression overnight) is hydration. I really have to stay well hydrated to keep my interstitial fluid levels up and help the glucose to circulate. If I’m not drinking enough water, it really notices.


Thank you... noted the comment on water intake  also.


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## Pumper_Sue (Dec 20, 2021)

PWinter said:


> Hi all
> Mother if T1 here, diagnosed when he was 25. He got L2 which he started on Friday but its going off a lot at night as he 'seems' to be running too low. He's getting pretty fed up with it and last night compared by doing some finger prick tests to check. Eg Libre said 3.3 but BG said 4.4...  He wants to keep at it but I am concerned he will get too fed up and go back to BG testing. Also whats a good night time snack to keep BS at a better level? Something like a small yoghurt?
> Hes recently had his first pretty horrible hypo and ended up in hospital and would rather try and help him avoid that again if I can.... Help/advice appreciated.


Simple solution is reduce his insulin. I I have low alarms 2 nights running then it's a good indicator basal needs dropping.


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## PWinter (Dec 21, 2021)

Pumper_Sue said:


> Simple solution is reduce his insulin. I I have low alarms 2 nights running then it's a good indicator basal needs dropping.


Thank you. His DN called yesterday as I guess because he's new to it and she suggested same so we took it down by a few units. No alarms and he didn't wake until about 4.30 when it started to drop so he caught it in time. He had a good night's sleep so not so cranky today.


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