Patient's Query
Hello doctor,
I am a 19-year-old male college student taking twelve units of Lantus at 9 PM and using Humalog with a 1:8 ratio for meals. My CGM data is showing consistent lows between 2 to 4 AM (dropping to 65 mg/dL and sometimes to 55 mg/dL). I often study late and eat a small snack (usually around 15g carbs) at midnight. Last week I had two episodes where I woke up sweating and shaking.
My morning readings are good (around 100-120 mg/dL) but afternoon readings climb to 200 mg/dL. Should I reduce my nighttime Lantus dose or split it into two doses? Would changing the timing of my bedtime snack help prevent these lows? Could the stress from upcoming exams be contributing to these fluctuations?
Please help.
Hello,
Welcome to icliniq.com.
I understand your concern.
Your situation is very common for people managing insulin and balancing activities like studying late.
It sounds like the twelve unit dose of Insulin glargine at night might be leading to overnight lows. Since Insulin glargine is long-acting and has a relatively steady release, reducing the dose slightly (perhaps trying 10 or 11 units) or splitting it into a morning and evening dose could help smooth out glucose levels. Splitting the dose can allow for better control during the day, potentially improving the balance between nighttime lows and daytime highs.
Since you study late and have a snack around midnight, you might try adjusting the carb amount slightly or pairing it with a bit more protein or fat to sustain glucose levels longer through the night.This might help avoid the steep drop during those early morning hours. For example, you could try a snack with around 20 grams of carbohydrates and a bit more protein or healthy fat (like Greek yogurt with nuts).
Exam stress can definitely impact blood glucose. Stress hormones like cortisol can elevate blood sugar, especially during the day, contributing to those afternoon highs. To manage this, keeping up with stress-relieving techniques such as short breaks during studying, meditation, or deep breathing can make a difference. Exercise might also help if you can fit it into your routine, as it has both immediate and long-term benefits for glucose regulation.
Since you are already tracking trends well, it could be helpful to make one adjustment at a time to see what works best. For instance, first try reducing the Lantus by two units, monitor, and see if the morning lows improve without significantly impacting your daytime levels. If you still experience lows, splitting the dose could be the next approach.
Talking with your endocrinologist before making any changes would be ideal, as they can help refine the approach based on your overall insulin regimen and individual needs. If adjustments alone do not smooth things out, they may also explore a different basal insulin or a CGM (continuous glucose monitoring) alarm for early-morning lows as additional safeguards.
I hope this has helped you. Please feel free to reach me again, in case of further queries.
Thank you.
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Answered byDr. Raveendran. S. R
Medically reviewed byiCliniq medical review team
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