Night hypo and Morning BG

I had a hypo in the night at 4am and I was 2.3! I woke up and treated the hypo with 5 dextrose and 3cp,s.
I woke as normal at 8am and I was 22.2!
I understand that through the dafne principals that I should not adjust my insulin, but at 22.2 I was worried that I was going to be high throughout the day. I was. I didn't go below 13 the whole day even though I adjusted my dose at lunch when I was 13.8.
It wasn't until next morning that I was back to single figures.
Is that normal? Did I do the right thing or should I have adjusted it earlier on??
Thank you

Hey fifi,

I am just a graduate but like to give my opinion.....

When you woke up low, the correct action to take is 2CPs of quick acting, then test again if you still feel low. If you need more, take another 2.

How many CPs is 5 dextrose tablets and then a further 3 CPs?....... (that may be slow releasing/high GI)

That might be why you were high, maybe together with your bodily response of releasing glucose post hypo and an increased resistance to insulin in the morning.

Is your background right?

I ask this firstly as you went low in the early hours and secondly stayed high after lunch even after correction.

Assuming its a slpit dose you might need to adjust your am and pm doses. Less at night, more in the morning.

If it was me I would have corrected in the morning and just been vigilant in detecting a hypo, but thats just me.

Its all speculation remember, and HCP should give you there opinion.

Yes I agree I think you over treated your hypo. At 4.00 am you could also be hitting the time when the insulin is more resistent. For a 2.3 hypo I would have just taken the 5 tablets or a carton of fruit juice and perhaps one biscuit and that usually would have brought you up by about 6 and the extra 2 biscuits about another 6 so in all about 12. If you don't know what caused you night hypo I would reduce you BI insulin by 20% unless you know for sure it was due to exercise which might have caught up with you.

I'm with novarapidboi26, to a degree. I suspect you over did the CP's to recover from the hypo. One of the key things they teach on DAFNE is we generally over do Hypo treatment which causes a see-saw effect in blood sugars. I would not change any insulin doses immediately though, if this was a one off then treat it as such. Especially if there were mitigating circumstances. Its fine to adjust doses to treat a pattern but look back and try to find a pattern otherwise its change for change sake rather than being backed up by logic.
Also remember if you are over 'about' 12 then doses and correction doses may have less of an effect than normal. This will vary from person to person so unfortunately the only way to find out is trial and error. If it helps I have the same issue in that if I start the day high I tend to struggle all day, whereas if I start in range I tend to stay in range.

You don't need a pattern for a night time Hypo - from the handbook.

Continue to monitor for 48 hours to see if there is a pattern (exception is a night-time hypo, in which case BI should be reduced the following evening).

bravo, someone else apart from me reads the handbook :-) A very good point. However personally I would still not change my BI without a pattern, my personal experience is I can occasionally get variations in my insulin requirements that go 'back to normal' after a day or so and thus I prefer to be 100% sure I need to change it before I do. Its a personnal choice and I take the point that I am NOT following the official handbook.

Karl, where did you get that quote from the handbook i.e. what section/page ? I can't find it in the online handbook and so am slightly concerned that there is a 'newer' version being given to graduates that is not online. ( Of course I could just be missing it in the handbook :-) )

http://www.dafneonline.co.uk/hbook_topics/36

In black and white, but obviously all other reasons for lows must be excluded and the possibility its just a fluke..

If it happens again you can be sure the BI needs tweaked......

Karl, thanks for the link. I had never noticed this statement before on the diagram and it is NOT mentioned in the section on Hypo's. i have therefore raised it with DAFNE Central and they will come back to me ( and I will pass it on here) with a clarification on this subject. The handbook is due to be revised soon as it happens so its an ideal time to clarify this. If the statement is considered correct then it should be included in the Hypo section as well to ensure consistency and ensure that people ( like me) don't miss it.
I will let you know as soon as I get feedback.