Where you inject matters

Until recently, it had heen several years since I last had a night-time hypo, but in February, I had two. On the evening of the 25th, my BG before bed was 14.2 - unusually high for me - so as well as my normal dose of BI, I had one unit of QA. At around 3am I had a bad hypo - requiring assistance from my wife. I could see no reason for this hypo, so I assumed it was 'one of those things'.
A few nights later (on the 27th) my BG before bed was 10.0 - but I did not take any corrective QA. I awoke at 3:45am covered in sweat and when I tested my BG, I was 3.6 and was able to take some corrective carbs.
This was now a real concern. I looked at my BG diary, and noticed that I normally inject in the stomach area before dinner, but on these two occasions I had injected into my thighs. I raised this at the 1-year DAFNE review and was told that insulin injected into the legs takes longer to become active and that this could explain my night-time hypos.
Since then I have injected in the stomach before dinner and have had no further night-time problems.
It seems, that for me, where I inject really does matter. I was not aware of this before. Has anyone else noticed this?

I haven't noticed it to these sort of extremes but I have known for a long time that some areas are slower than others.

From my understanding:
Fastest is arms (often straight to muscle)
Second is tummy
Third is legs (depending on exercise though, if you inject and then run, your insulin works better as typical insulin behaviour to exercise)
Bum cheeks are the slowest.

Sometimes you have to also consider the possibility of lumps you may not be aware of because that can affect the timing of your insulin - or just simply the effect of exercise on the insulin you still had working at the time of exercise.

Do you apply the DAFNE rules regarding exercise or even hypos? Some of your decisions in reference to some of your results (treating a hypo with just 2 CP instead of 2 fast CP and 2 regular CPs for example - and adjusting after a hypo when you shouldn't be) puzzle me so I'm not sure what else to advise.

much as I hate to be a swat the handbook says this . Which is not exactly the same as you seem to have been told regarding hypos. That said I totally agree with everything else you say ;-)

My take Alan is maybe your nighttime BI is too high, you seem to be low most mornings and a fair bit higher the night before. If you don't have any CP's before bed then the BI should keep you roughly the same and you seem to be dropping a lot, especially as most people tend to be higher in the mornings due to the dawn phennomeon. This of course is the view of a fellow DAFNE Grad and not a HCP. I would check with your DAFNE Educators what they think about your readings.

Considering quite a few of the low results are over an hour before a meal, it's fair comment to consider the extra CPs - especially when exercise is involved.

I hypo at work for taking lots of calls on a busy phone line while sitting (eg, no 'exercise' that's noted in the guidebook!) so I know it can be very awkward to work out how much to eat to prevent hypos - it's because of my experiences that I'm able to think out side the box and remember that the DAFNE guide book is JUST A GUIDE. On top of this - once you've had a hypo, this can make you prone to them for the next 24 hours which is probably causing a knock on effect generally for Alan's situation.

With this, your taken opportunity for a bit of nick picking with the hypo stuff came across as a bit condescending with me, just so you know marke.

If the concern is with the overnight stuff, I do recommend setting an alarm and doing a 3am night test considering it should be only your BI working at that point... even more so that your dinner tends to be around 7pm-7.30pm when your insulin probably hasn't finished working before 12midnight (I have to count 5 hours for my QA (humalog)... you should keep in mind what your QA working time is as well)... so when you do your test at 11pm, it's unlikely that you're getting a true picture of your BG.

With that, good luck with your pattern finding Alan. I've been there with the over night stuff myself. You'll work it out.

Just to add, I was told the "Dawn Phenomenon" was a rare thing by my DAFNE nurse - not a 'most people' thing... and that it doesn't tend to be a 'one off' occurrence like this example, either.

Thanks for the feedback - very useful. Regarding the treatment of hypos: I've never found it necessary to have the recommended 2 CPs of medium-acting carbs as well as the 2 fast-acting portions. I used to use hypos as an excuse to 'pig-out' on things ususally forbidden - chocolates etc, but I found that the resuilting BG tests were way too high, so I now keep it to 2CPs - or 3 if it's a bad one. That seems to work for me.
I have to admit that in February I was trying hard to keep my BGs 'withing target'; obviously I was trying too hard and getting lots of 'below 4' tests. I have since (as Marke suggests) reduced my BI by one unit and I've not been so stringent with my QA injections. Consequenlty, my BGs are running a bit on the high side.
I agree with JWo that the DAFNE guidelines are just recommendations - not rules.
Thankfully, the night-time hypos haven't occurred since.

That's cool if it works out better for you instead to do that for your hypos. The highest I seem to go with the 2-2 treatment is about 14 usually... which in turn, I also noticed that I tend to be about the same for when I've hypo'd during the night while I was still working out what my body needed over night.

It certainly is funny how the body works! I have also been very frustrated by the option to not adjust after a hypo for 24 hours because of the discomfort being high can cause - it took me a while to break the age old habit of adjusting at the slightest high... gotta let the BI take it down gradually, not the QA rapidly... -_-;; you're going to be high sometimes but with our BI, all will work out again (as long as other stuff is sorted too of course). One day of being high isn't half as bad as being high for, say, a month - it's the longer periods that do the damage - I hope that helps you feel a bit better about it possibly...

While I think of it, another pointer I picked up on at my last DAFNE from a chap who did regular exercise (football playing mostly though - his BG results were remarkably good but he wasn't long diagnosed which may be an involved factor) - he said that if he had taken too much insulin for a meal, he could tell a hypo was coming before the symptoms hit by testing at the 4th hour of the insulin working - the BG results being lower than what would be considered reasonable. This may be something you could look at as well but I am unsure how reliable it is. I have mostly been applying it when I have doubts about my meal CP which hasn't been too often.

Glad to hear it's working out better for you now anyway... keep up the good work.