How To Minimize The Risk Of Nocturnal Hypoglycemia
Some diabetics set an alarm clock each night to check their blood sugar. Some do this only occasionally, believing that if blood glucose drops excessively during the night, they will wake up anyway. What should you do if you are at risk for nocturnal hypoglycemia? There is no definitive answer. Nocturnal control is most commonly practiced for the youngest diabetics. However, there is no clear guideline on whether it is enough to check sugar once, around the most sensitive hour of 3 a.m. or more often.
How Are Low Blood Sugar Levels Treated
Your diabetes health care team will give you guidelines for treating low blood sugar levels, depending on your symptoms. If you can, try to test your blood sugar levels to make sure that your symptoms are because of hypoglycemia. If you can’t test blood sugar immediately, don’t delay in treating your symptoms you can always check your blood sugar after you’ve taken steps to get your blood sugar back up into the normal range.
When blood sugar levels are low, the goal is to get them back up quickly. To do that, you should take in sugar or sugary foods, which raise the blood sugar level quickly. Your health care team might suggest that you:
- Eat, drink, or take something that contains sugar that can get into the blood quickly. Your doctor may tell you to have really sugary foods or drinks or might give you glucose tablets or gel to take all of these can help to raise your blood sugar level fast, which is what you need to do when it’s low.
- Wait about 10 minutes to let the sugar work.
- Recheck your blood sugar level with a glucose meter to see if blood sugar levels are back to normal.
- Get a glucagon shot , if your symptoms are severe or get worse after you eat, drink, or take glucose.
Sometimes, blood sugar levels can get so low that you may not be awake enough to eat or drink something to get them back up. When this happens, you may need a glucagon shot.
Why Does Blood Sugar Go Up In The Morning What Is The Dawn Phenomenon
There are a few main reasons why your glucose levels may be higher in the morning. One of these is known as the dawn phenomenon.
The dawn phenomenon occurs early in the morning between 3 am and 8 am while you are still asleep. As morning approaches, the body naturally signals your liver to produce glucose, giving your body the energy it needs for the start of the day. Caused by changes in hormonal levels, the dawn phenomenon happens to all people, with or without diabetes. However, for those without diabetes, insulin levels increase and they do not experience hyperglycemia.
Another reason you may experience higher morning glucose levels is because your injected insulin wears off. If your body has insufficient insulin during the night, your glucose levels may start to rise. To combat this, you may consider trying a new basal insulin, adjusting the timing and amount of your basal dose , or changing your nighttime basal rates .
The last reason you may experience higher morning glucose levels is known as the Somogyi effect. This occurs if your glucose levels fall too low during the night, caused by too much insulin or medication. To respond, your liver produces more glucose to try to maintain your glucose levels, which may result in hyperglycemia. The Somogyi effect is not as common as the other reasons described.
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S For Treating A Person With Symptoms Keeping Them From Being Able To Treat Themselves
Dont hesitate to call 911. If someone is unconscious and glucagon is not available or someone does not know how to use it, call 911 immediately.
Do NOT:
- Inject insulin
- Provide food or fluids
Adjust Doses If Necessary
We are often so busy that we forget that many different things can affect both our medication and insulin doses. If you recently lost weight, started exercising, are taking steroids, changed your diet, or have become pregnant, to name a few, you should check in with yourself and your health care team to make sure you are taking the proper amount of medication. Ensuring that you are will no doubt give you better results at all times including the hours of rest.
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Nighttime Low Blood Sugars
Keeping your childs blood sugar higher at bedtime and overnight will help to prevent their blood sugar from dropping while theyre sleeping. The greatest risk for seizures due to a low blood sugar occurs during the night.
Nighttime low blood sugars can occur because of:
- Exercise during the day, which can cause delayed drops in blood sugar
- Insulin doses that are too high
- Not eating enough carbs for the amount of insulin given
- Difficulty detecting symptoms of low blood sugar because your child is asleep
If your child is 5 years or older, they should have a nighttime blood sugar range of 90-150. If they are younger than 5 years old, their blood sugar range at night should be 100-180.
So How Do I Treat Low Blood Sugar At Night
What I do is treat it for what it is, a medical emergency. So I test my blood sugar and immediately eat or drink 8-15 grams of carbs in the form of 2 glucose tablets or 125 ml juice. I then assess whether I need a low glycemic carb as well . The assessment is pretty quick, and for me only involves checking that I didnt bolus within the last 4 hours. If I did, I might have to cover that with a few rice cakes.
The reason why I say 4 hours is because I bolus with Humalog, which stays active in the body for about 4 hours. If it has been more than 4 hours since I took my bolus, I know that just the sugar or juice will get me through the night.
My recommendation is to be honest with yourself, and if you cant go into the kitchen and just have those 15 grams of carbs without emptying the fridge every time, then keep your emergency carbs in the bedroom next to your bed .
I also recommend that you dont treat your hypoglycemia with candy or cake. As I said, its a medical emergency and you need a carb that will hit your bloodstream quickly. Pure sugar or juice is the best for that because the fat in candy or cake will slow down carb absorption. Also, you dont need a treat in the middle of a low blood sugar. Youre not enjoying it anyway, just stuffing your face.
You can read more about the best and quickest ways to treat low in this post: How to Treat Lows as Quickly as Possible
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Overdose Of Diabetes Medication
A common cause of hypoglycaemia is taking too much insulin for your current needs. Insulin is a medication that helps control your blood glucose levels. It’s commonly used to treat type 1 diabetes and is also recommended for some people with type 2 diabetes.
A fall in blood glucose levels can also occur after taking too much oral hypoglycaemia medication, such as sulphonylurea, which causes a release of insulin. This medication is often used to lower blood glucose levels in people with type 2 diabetes.
How To Prevent Low Blood Sugars In The Future
There is probably no way to completely eliminate low blood sugars at night, but I have learned how to limit them quite a bit. What I do is pretty simple I try to learn from my mistakes. If I have a low during the night, Ill go back and see how my bolus and basal patterns were the day before, what I ate, and what I did.
For example, my last low blood sugar was at 4 am a few nights ago, and when I went back and analyzed the data, this is what I found:
Since it was 4 am and my last snack was at 11 pm, the low couldnt be due to my last bolus. I also hadnt changed my basal amount. However, I had moved my workout to later in the evening. So my conclusion was that to limit future nighttime lows, I should take less basal insulin before I go to bed if I work out later in the evening. Thats a pretty easy fix. I reduced my nightly basal and now Im sleeping through the night again and waking up with perfect sugars.
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Severe Low Blood Sugar
As your low blood sugar gets worse, you may experience more serious symptoms, including:
- Feeling weak.
- Having difficulty walking or seeing clearly.
- Acting strange or feeling confused.
- Having seizures.
Severe low blood sugar is below 54 mg/dL. Blood sugar this low may make you faint . Often, youll need someone to help you treat severe low blood sugar.
People with diabetes may experience low blood sugar as often as once or twice a week, even when managing their blood sugar closely. Knowing how to identify and treat it is important for your health. Learn how to treat low blood sugar.
What Should I Do If This Happens
People and their partners or roommates should learn to recognize the signs of nighttime hypoglycemia. Be prepared! Ask your doctor for an emergency glucagon kit. This kit contains a fast-acting medication that can be injected if the person cant be woken up. Store the kit in a bedside drawer for easy access.
DO NOT PUT ANYTHING INTO A PERSON’S MOUTH IF THEY ARE ASLEEP OR CANNOT SIT UP.
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If the person cannot be woken: If there is no emergency glucagon kit, call 911. If the person has a glucagon kit, the partner or roommate should follow the instructions to fill the syringe and inject the medicine. Once fully awake, he/she should eat a meal and check their blood glucose every few hours using a home test kit. After giving the injection, the persons doctor should be notified.
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If the person can be woken up and sit without support: They should be given a fast-acting glucose source. Good options include hard candy, fruit juice or glucose paste or tablets, which can be purchased at most pharmacies. Once the person is fully awake, they should eat a meal and check their blood glucose every few hours using a home test kit.
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Know The Signs Of Low Overnight Blood Sugar
Symptoms of hypoglycemia usually develop when blood sugar levels drop below 70 milligrams per deciliter . They include shakiness, sweating, confusion, erratic behavior, headache, and lightheadedness. With nighttime hypoglycemia, you may wake up with these symptoms or with a higher blood sugar reading that results from the bodys response to an overnight low. However, some people experience whats referred to as hypoglycemia unawareness, which means that they dont feel the symptoms of low blood sugar.
Talk with your doctor about ways to recognize nighttime hypoglycemia, especially if you think you may have difficulty detecting it. Its a dangerous condition because people cant tell when their blood sugar has dropped, since they may not have symptoms, Dr. Rodbard says. The body can get desensitized to it. People with hypoglycemia unawareness are also less likely to wake up as a result of nighttime dips in their blood sugar.
How To Prevent Nocturnal Hypoglycemia
Start by talking to your doctor about a bedtime blood sugar target. Ask about your risk for hypoglycemia and if you should get a glucagon kit. Dont miss dinner, exercise before bedtime, or drink alcohol at night. Have a sugar and protein snack before bedtime, like a wheat cracker with cheese.
If you have had symptoms of nocturnal hypoglycemia, work with your doctor on a prevention plan. This may include switching to a longer acting insulin that does not peak during sleep, or changing your insulin dose. You might be asked to set an alarm and check your blood sugar in the early morning for a while. For people at high risk for nocturnal hypoglycemia, a continuous glucose monitor may be the best solution. A CGM can check your blood sugar every 5 minutes and can set off an alarm if your sugar gets too high or too low.
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How Common Is Low Blood Glucose
Low blood glucose is common among people with type 1 diabetes and among people with type 2 diabetes who take insulin or some other diabetes medicines. In a large global study of people with diabetes who take insulin, 4 in 5 people with type 1 diabetes and nearly half of those with type 2 diabetes reported a low blood sugar event at least once over a 4-week period.2
Severely low blood glucose, defined as when your blood glucose level drops so low you cant treat it yourself, is less common. Among U.S. adults with diabetes who take insulin or some diabetes medicines that help the pancreas release insulin into the blood, 2 in 100 may develop severely low blood glucose each year.3
How Is It Determined If The Dawn Phenomenon Or Somogyi Effect Is Causing The High Blood Sugar Levels
Your doctor will likely ask you to check your blood sugar levels between 2 a.m. and 3 a.m. for several nights in a row. If your blood sugar is consistently low during this time, the Somogyi effect is suspected. If the blood sugar is normal during this time period, the dawn phenomenon is more likely to be the cause.
Some additional clues that the Somogyi effect may be the cause include nightmares, restless sleep and overnight sweating as these are all signs of low blood sugar levels.
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Recommended Steps To Stabilize Blood Sugar Overnight
One easy way to take advantage of your bodys metabolism is to eat a healthy snack as part of your nighttime routine. Dieticians recommend foods that are high in protein, contain healthy fats and are low in carbohydrates. Some foods that are great as a bedtime snack to lower blood sugar include:
- Celery or apple slices with peanut butter
- Whole wheat crackers with low-fat cheese
- A handful of seeds and nuts
- Fresh vegetables, like baby tomatoes, cucumber slices, celery sticks or baby carrots
- Avocado toast
Of course, it is important to pay attention to portion sizes and avoid foods that are high in empty calories as part of maintaining a healthy diet.
To have a better understanding of your ideal blood sugar range, talk to your doctor about your health targets. If you are diabetic, it is important to discuss a treatment plan with a healthcare professional, as targets differ for diabetic and non-diabetic patients.
The first step towards stabilizing your blood sugar overnight is to check your blood sugar level often. This is especially important before getting ready for bed.
Medical professionals recommend a range of between 90 to 150 milligrams per deciliter as a nighttime blood sugar level before bedtime.
Many things can prevent even the healthiest person from getting a restful nights sleep.
Why does this happen?
Alcohol And Nighttime Hypoglycemia
From the bodys point of view, alcohol is a poison. The liver is responsible for cleansing the blood of this toxin. When the liver is busy metabolizing alcohol, its primary function of producing and secreting glycogen, the reserved sugar that protects us from excessive sugar drops at night, is blocked.
After consuming alcohol, especially if it was more than a glass of red wine, it is easy to have severe hypoglycemia with loss of consciousness. Worse, if it happens, we are likely to need glucose given intravenously. Glucagon injection may not be enough the liver, occupied with alcohol, will not respond to glucagon and will not release glucose into the blood.
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Treating Night Time Hypos
The treatment for night time hypos is the same as the general advice for treating hypos
That is to take 10 to 15g of a quick acting sugary food and some slower acting carbohydrate such as a slice of bread to prevent a further hypo taking place.
Have some quick acting carbohydrate next to your bed so that if a hypo occurs, you can treat it as quickly as possible.
Exercise In The Afternoon
Exercise lowers blood sugar by increasing insulin sensitivity, which allows the body to use insulin and glucose more effectively, increasing glucose movement during and after exercise. Studies have shown that exercise will lead to optimal insulin regulation. Exercise after dinner will set you up for steady glucose levels through the morning.
Research has also shown that moderate-intensity aerobic exercise before breakfast reduced the morning rise of blood glucose in type 2 diabetes patients, partially counteracting the dawn phenomenon. The same study also found that exercise significantly reduced blood glucose fluctuations and improved blood glucose control throughout the day.
Some of the best exercises for avoiding morning blood sugar spikes include:
- A walk
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