How dangerous is a hypo during sleep

[laurayn]

My husband and myself are both type 1 diabetics. Whilst we are both quite well controlled during the day, my husband takes a lot of hypos during the night which he will not wake up from. There are times he has gotten up and acted strange, often aggressive and I know it is a hypo because he always has beads of sweat on him. Other times he spends the whole night thrashing and kicking and soaking with sweat. Last night, as has been the case many times before, he was ice cold (I often worry he is dead!) and the bed sheets were soaking with sweat. He will not wake up and when I try to get him to he gets aggressive then goes back into a deep sleep. I am really worried that his body will shut down one night and my 2 girls will be without a father. I am sick of telling him to eat before his bed etc, to stop this from happening. The thing is when he does get up in the morning, his sugar has went up to about 3 or 4. This happens 2 or 3 times a week at least.

He eats a healthy diet, loves playing football and is generally healthy. I don't know what to do, but I am worried. I have just joined this website in the hope someone can offer me advice or tell me how much damage he is doing to himself. :| I get annoyed with him and often leave him to it as I am diabetic myself and feel if I have to take responsibility for myself then why can't he?

 

[sugarless sue]

He really does need to eat something before bed. Does he test his Bg before going to bed ?

Also, if he plays football in the evening the exercise will have a knock on effect into the night which also can cause a hypo.

 

[sugar2]

That description sounds familiar! The sweats and teh freezing cold thing rings bells with me. Luckily, my husband (not diabetic) has more luck at getting me to take action when I am hypo.

Question.
Do teh hypo nights coincide with football nights? If so, it is either more food of less insulin.

If not, and I am not sure what insulins he is on, but I would suggest perhaps lowering his long acting insulin.

Does it do damage..not sure, I worry that severe night time hypos haeve led to me memory going a bit. He really must eat something if he know he is going low. Just going low overnight is a great way of getting a good HBA1c, but it is not great control.

I really do feel for you!

 

[laurayn]

Thanks for your replies. He plays football more during the day, about 3 or 4 times a week. He used to play at night and I could guarantee those nights he would have one of these awful episodes. Now it just seems to be more random. I am fed up telling him to have something to eat at times. I just wondered if your body can shut down in this way. I get really worried when he is freezing cold to the touch, but drenched in sweat, it is awful.

 

[noblehead]

laurayn,

Frequent night-time hypo's means your husband is injecting too much insulin and this needs to be cut back, what insulin regime is he on?

Nigel

 

[laurayn]

He is on Humilin M3 twice a day. He is quite bad for doing a blood test before his bed and if he thinks it is higher than it should be he gives himself a few extra units of insulin then drinks lucozade! I think it is madness, but cannot tell him. It is so frustrating. The thing is, when he goes to his hospital appointments his average blood sugar is always around 7. But I don't think having all these hypos can be good for him in the long term.

 

[Geoff]

Hi Laurayn, as has been suggested by others, what I believe is the problem with your husband’s frequent night hypos is not food related but insulin related. In order to indulge in frequent exercise such as regular games of football, you need to have very good control of your basal (background) insulin, using a 2x daily regimen such as with Humilin M3, does not work for someone who exercises as much as your husband does.

“Humulin M3 contains a mix of two types of insulin, soluble insulin and isophane insulin. Together, this combination of insulins is called biphasic isophane insulin.
Soluble insulin is known as a short acting insulin. It works rapidly, within 30 to 60 minutes, and its effects last for about eight hours. Isophane insulin is known as an intermediate acting insulin. It takes longer to act, but its duration of action is longer. The pre-mixed combination provides a rapid initial blood glucose lowering effect, followed by a prolonged effect that controls blood glucose throughout the day. It is usually injected under the skin approximately 30 minutes before a meal or snack, and this initially controls the increasing blood glucose levels after eating.”

http://www.netdoctor.co.uk/medicines/100001278.html

This type of insulin is usually given to people who do not indulge in high levels of sport, because their levels of insulin will be too high throughout the day which would induce hypos while playing football, and I am guessing that he probably drinks lucozade during playing, which would mask this problem, but would cause a large swing in his bs which could lead to a problem with night time hypos.

He needs to talk with his GP about changing to a Basal/Bolus system using a long acting insulin such as Lantus or Levimer, splitting the dosage in two and using a rapid insulin such as Nova rapid when he eats.

Sorry for such a long explanation! I hope it helps you with your problem

 

[iHs]

Hi Laurayn

I have been type 1 since the 60's and used biphasic insulin since the 70's upto 2002 when I switched to bolus/basal - biggest mistake of my life.

The reason why your husband is having the hypos in the night is because he is not eating a snack before going to bed or if he is eating, he is not eating enough. I have always eaten a small snack before bed even with bolus/basal, it's too dangerous not to especially if bg is only 7mmol or below.

Bolus/basal takes some getting used to especially with adjusting bolus insulin to the amount of carb that is being eaten and trying to avoid hypos and it also calls for compliance in remembering to inject approx 4-6 times a day. It gives people more flexibility though over being able to eat more carbohydrate than they could using biphasic but it's not everything that's for sure.

 

[Snodger]

I don't know if this would help but - on a couple of occasions when I've gone hypo and gone into that 'no, won't!' phase of refusing to eat, my partner has treated me using golden syrup. You can buy squeezy bottles of it, and a little bit can be rubbed on the hypo-person's gums if you can get their lips open. It tastes a lot nicer than hypostop so is less likely to get spat straight out again. You can do it even if the person is not conscious. And it brings me round astoundingly fast.

Obviously, everything everyone has said above is good advice, but in case he isn't ready to change yet I hope the golden-syrup trick might help when it's the middle of the night and he's scarily cold.

 

[laurayn]

I just recently went onto a basal/bolus regime after being on Human Mixtard twice a day. I have been trying to talk him into changing aswell but he is just not for it. We were both put on the twice a day method when we both first took diabetes. My doctor did say that nowadays, there is no way that anyone as active as us just being diagnosed would be put on the twice a day method. It would definately be the basal/bolus way. I am finding it okay, but still have the odd hypo and am not too sure if I am keen on so many injections, but I am persevering. I keep saying to my husband, that by the time he often gives himself an extra injection at night, he would be aswell being on it. But to no avail.

Thanks for the tip on the syrup. It just annoys me though that I have to take responsibility for myself and think that he should be doing the same. But I will get some and keep it in the house for the future.

 

[copepod]

Main concern I reckon is that lots of night time hypos might lead to loss of hypo awareness.

 

[Paula_type1]

Dear Laura,

I have had hypo's before whilst sleeping, but I usually automatically wake up when have them.

Below you will find the steps I sometimes take when I have a period in which my glucose levels drop while I sleep:
1. I try not to eat after 8 pm, so the carbohydrates I consumed do not influence my glucose levels.
2. I check my glucose levels before I go to sleep. If my glucose level is low or good I sometimes eat a snack or a sandwich. If my level is a bit higher than it should be then I leave it like that, but when it's unacceptable high I inject some insulin.
3. I sometimes set my alarm around 2 or 3 am to check my glucose and act accordantly.

This is only an advise and it does not always work, it is very important indeed to be careful, and it might be a good idea to discus this with a specialised person in hospital.

I hope I could help you a bit and I hope everything will turn out well.

Kind regards,

Paula

 

[Snodger]

It just annoys me though that I have to take responsibility for myself and think that he should be doing the same.

yep, that must be very annoying!

 

[laurayn]

I'm glad you agree with me that it is annoying. Sometimes I ask myself what kind of person I am to be getting annoyed at something like this. But I have a busy life too. Each day I am up putting kids to school, walking the dog, going to work etc and have to cope with my own diabetes, never mind another adult's. And one thing that gets me is sleep deprivation. What a moan I am eh? :roll:

 

[HLW]

You shouldn't feel bad about being annoyed. Like you say, everyone with diabetes has to learn to cope with this stuff, not rely on other people to look after their health for them.

 

[adrian29459]

Hi Laura. You're not a moan. You're very sensible. Night time hypos are very serious and can easily lead to severe hypoglacemia if untreated. I've had many severe hypo's over the past two years and I've been very lucky I've ate before each one or had somebody there to put hypostop in my mouth. Severe hypoglacemia can cause damage to the brain such as memory loss, but then can also lead to coma or even death.

I've had type 1 diabetes for 14 years but only in the last two years these hypos have become an issue. Why?
Exercise!
I've done a lot of jogging in the past two years and not always taken this into account when having supper/testing before bedtime. Its easy to forget what you've done in a day, but now I always try to have diabetes on my mind in the background. Right now I'm currently on an insulin pump and its gave such freedom to my life and my diabetes. Hypos are much less frequent. I know pumps are expensive and tricky to acquire. I'd also suggest he trys the basal bolus regime. It should make life much simpler for him. Perhaps you could make note of the times he has hypos and show this information to the diabetic clinic.

 

[T1RMH1985]

How dangerous is a hypo during sleep? The answer is very dangerous and your man is being very selfish to continue to do nothing about it. Sorry to be so blunt.

 

[janetitherington]

I am a type 1 who does not react when I am hypo whilst asleep, I often wake up with the whole family in my room after one of my dogs had gone for help( my miniature yorkies have saved my life many many times)

I don't know if they are going for help for me or themselves because they are scared but either way it doesn't matter.

Twice this week I have woken to find my mother had given me the Glucagen injection, and I have drank a couple of bottles of lucozade .
Her biggest worry is that she doesn't get to me on time or before I start fitting, it's having a real impact on my family since I ended up on life support June 2009.

I was on an insulin pump and had a hypo whilst asleep, I was in a coma for 3 weeks not expected to survive or be severly brain damaged.

Since then, I have been off the pump- by my choice and my long acting insulin was changed from a 24hr acting lantus to 18hr acting levemir.
I now take it at 10am, it works for 18hrs and stops working at around 2am.
Unless I have been shockingly high during the night a s needed to have extra insulin I am safe until the morning.

 

[iHs]

Hi Jane

Pumps are wonderful but if the basal rate is too high during the night then a hypo will happen. I'm glad that you are ok after what happened to you. Thank goodness you've got your dogs.

Personally, I think both Lantus and Levemir are best injected twice a day instead of once. The control is more even and the likelyhood of going hypo is not so bad. Have you thought about eating some carb before you go to bed to see if that stops the hypos?

 

[g-man]

Personally, I think both Lantus and Levemir are best injected twice a day instead of once. The control is more even and the likelyhood of going hypo is not so bad.

I inject Levemir once a day at around 6-7pm or whenever I take my evening meal. I find it lasts the full 24hrs (everyone is different I guess). Control over this period is fine. I usually check my BG before I go to bed but it's very difficult to know if a high of 10 or 12 will correct itself or not, it will depend on how recently I eat food (having 6 meals a day makes it a bit easier).

The important thing is whether you still have hypo awareness (which thankfully I do) but I do keep glucose tabs and mini mars bars by the bedside in case.

I can totally understand the OP's frustration with getting their partner to have better management of their condition. My father was diagnosed and put on tablets which he believes are a "magic pill" that allows him to eat whatever he wants. He wasn't offered nor wanted a meter and he wouldn't entertain using any of them anyway (this is outside of the UK btw). I guess I can't live his life for him, but it is mighty frustrating!