Replies to This Discussion

Permalink Reply by Gerri on April 9, 2010 at 11:18am

Hi Ali,

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?

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Permalink Reply by ali on April 9, 2010 at 11:25am

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.

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Permalink Reply by Gerri on April 9, 2010 at 11:49am

Wonderful to have a great doctor!

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.

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Permalink Reply by ODESSA BROWN on April 10, 2010 at 3:30pm

hello ali
i have been diabetic for 30yrs now,and @ nite time i always put a snack pack of 4peanut butter crackers or glucose tabs,and a bottle of water at my bedside.this work for me.try to find something with about 15gms of carbs.
odessa

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Permalink Reply by Jonathan_STL on April 9, 2010 at 12:25pm

Hi Ali-

Overnight low blood sugar is a common problem for many people with diabetes, both T1 and T2.

You might actually benefit from a snack before bedtime. Here's a link to an article from Joslin Diabetes Center, all about preventing overnight lows.

http://www.joslin.org/info/avoiding_nighttime_lows.html

~Jonathan

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Permalink Reply by ali on April 9, 2010 at 12:30pm

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!

Thank you both for your responses.

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Permalink Reply by Jonathan_STL on April 9, 2010 at 12:40pm

No problem! Best of luck preventing the lows!

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Permalink Reply by Gerri on April 9, 2010 at 12:50pm

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!

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Permalink Reply by Jonathan_STL on April 9, 2010 at 1:01pm

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 :)

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Permalink Reply by Gerri on April 9, 2010 at 1:42pm

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.

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Permalink Reply by Devon on April 9, 2010 at 1:05pm

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.

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Permalink Reply by Devon on April 9, 2010 at 4:07pm

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?

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