How dangerous is a hypo during sleep

[Margi]

My husband discovered the honey trick many years ago. He uses honey rather than syrup because it is easier to control and doesn't end up all over the sheets like syrup does.

When I was on the older insulins I used to get bad night time hypos just like the ones you describe: I didn't wake up and my husband had to rescue me many times. Since I have changed to Lantus and Humalog, those severe hypos have stopped. My blood sugar sometimes goes as low as it used to, but it doesn't have that nightmare effect on the body and brain. I wake up and can deal with it myself - I keep orange juice cartons everywhere, including by the bed so I can just reach out and grab one in the dark.

I'd be inclined to try and get your husband to read this thread so he sees how you feel and the responses to it. He's got two choices though: he either has to eat a snack at night, or he has to cut down his insulin, and on days when he has exercised a lot, maybe both.

Don't these hypos leave him exhausted and with a crashing headache, and wouldn't he like to not feel that way? Hypo hangover, I call it.

The best thing I ever did was to go on a DAFNE course. I learnt more in that five days than I had managed to learn in over thirty years of experimenting by myself with no advice from the medics, and now I don't live in fear of hypos all the time, because I have learnt how to balance insulin and carbs. Mostly it works. Is there any chance your hubby might agree to give one of those a try?

 

[Margi]

I just found this thread: http://www.diabetes.co.uk/diabetes-forum/viewtopic.php?f=19&t=12551

Maybe thrust your husband's nose into that. Sorry, getting annoyed with him now, and I want to... I'd better not tell you what I'd like to do, it might get censored. :x

 

[ddrgelliott]

Hi All,
I'm new to DUK. Been T2 for a few years and on insulin for past year. Levemir didn't work well - on 250 units a day and hb1ac still 12-13. Had to stop all tablets inc metformin due to kidney problems and now inject Humulin m3 60 morning, 45 lunch, and 60 evening. b glucose levels now quite good but sometimes get hypo teatime and night/early morning despite midnight(ish) reading of up to 13. Due to work issues my eating/injection times vary quite a bit, especially early evening meal. Have to remember to eat at bedtime but sometimes fall asleep without. I live alone so this thread of great interest. No -one has really answered the question posed. If I go hypo overnight no-one would know for a day or more. What would happen? Also tried byettea (lower blood sugar enough) and victoza (didn't lower b sugar enough and made me nauseus/ill -- but I lost 10kg in three weeks!) Hospital consultant recommended Vicyoza and insulin but my GPs wont do that so now on insulin alone and put on 20 kg - full of aches and pains, joints,muscles and back, and numb/tingly fingers. Feet good though!!! - apart from swelling. Feel totally fed up and just about had enough., Any suggestions welcome.

 

[Malcolm.Smith]

I'm a type 1 diabetic and I used to suffer badly from night hypos. Luckily my wife knows what shes doing and brought me out of them quickly. In the morning I would feel awful, I mean a hangover times 100! I would often bite my tongue and would feel nauseous all the next day.
I was on humilin s and glargine long acting I was taking at night before bed.

My doctor was fantastic and she swapped my fast acting to novo rapid and told me to take my glargine in the morning instead. Its been almost a year now since I started doing this and my night hypos have fallen from once or twice a month to... well one mild one this year so far fingers crossed!. The novo rapid is fantastic stuff and its easier to control my bs as it works so fast and does exactly what i want it to do instead of taking hours to take full effect. Its especially good on my long bike rides.

My only slight problem is now my bs goes up during the night! but i counter this by setting my alarm to go off 3 hours after i go to bed to do a blood test and make any adjustments that need done. I know its a pain but i've gotten so used to it now I don't mind

 

[copepod]

I used to wake up with occasional low blood sugar levels, always around 4am to 5am. When I mentioned this to DSN, he suggested splitting my Humalin I dose into morning & bedtime, and I've never had the problem since.

 

[KPTHEMENTALIST]

Hi Lauren, so sorry to hear about the problems you and your husband are having to deal with.

Your husband needs to wake up to the responsibility he has to you and your daughters. It sounds as if he is in denial.

If you care to look at our website link removed, fill in the contact details we will be able to help you both.

Kind regards,

Kris Perkins (Type 1 diabetic for over 50 years, with complications now) and Gail my long suffering wife who is no stranger to nightime hypos!

 

[Margi]

The other thing I did to help sort the night time hypos was to split my Lantus into two doses twelve hours apart. Tried morning, tried evening, and had spikes of BG rise before 24 hours was up, so I split it and it worked. It seems that Lantus does not stay completely level for the full 24 hours as they first thought. The doctors I have spoken to about it agree that is the case and endorse the two injections.

 

[tekcom]

Margi, the dual injections seems to work for a lot of people, I'm not sure why this isn't being advised by more PCT's.

I'm also prone to a hypos in the night, mine tend to hit me around 3am.
I guess I'm lucky in the fact that mine always wake me up, and my BM's never plummet below 3.

I used to keep a small bottle (500ml) of Luczade downstairs for when things go a bit low. Although I've found navigating the stairs when you've just woken up, and with low BM's can be a bit frightening. So I've now resulted to keeping the bottle next to the bed.

I'm a bit worried about the the person who needs "a couple of bottles of lucazade". Generally, luczade is about 52% sugar, so needing a couple of bottles is horrendous.

The majority of the stuff I've read suggests that you shoud only need aroun 10-15 grams of glucose to pull you out of a hypo. You then need to suppliment it with long lasting cabs.

Personally speaking, after I've had my lucazade in the night, and sat still for 10 minutes, I then trot downstairs to get some dry toast. That will usually be more than enough to get me through until morning.

If you have too much glucose in the night, your BM's will spike significantly. Which is why some of you are getting the "hangover" feeling in the morning.

I know how bad hypos can make you feel, and it's not a nice feeling at all - but please resist the temptation to keep stuffing in chocolate/full sugar drinks/hypo stop until you feel better. Don't forget that glucose can take around 10-15 minutes to be absorbed by your body.

Good Luck !!

 

[Margi]

Thanks, Tekcom,

I find that about 20g CH works well for me and then the rest as you say. I keep the biscuits by the bed too then I don't have to trot down at all!

For me the hangover effect happens if I have had a gentle hypo, say between about 3.5 and 4, for a long time. It's not low enough to rind alarm bells and wake me up, or even notice when I'm awake if I'm not doing much that needs co-ordination or brain work, and if it stays that way for a while I get the worst humdinger of a headache. Neuralgia in the left temple and down my cheek when it's really bad. Very occasionally my migraine tablets don't even work - especially if I have put off taking them for too long, because their side effects are horrible - and then (and I really don't recommend this at all) I just eat till my BS goes into the high teens or even beyond. It kills the headache. Doesn't do any good in any other way, but then I very carefully and gently bring it back down again so I don't trigger a roller coaster, and the headache stays away instead of coming back for days. Before the DAFNE education, I always triggered a roller coaster because I had no idea how to work out how much insulin I needed to balance things correctly.

I wake up with night time hypos now since I have been on the new insulins. Actrapid used to knock me out so badly that my husband frequently had to bring me round with honey rubbed on my lips - and I know you're not supposed to do that either in case of choking, but the doctors live a long way away and needs must, I'm a bad girl. I don't remember a hypo that hasn't woken me since I've been on Humalog. The hypos still go as low as before but without the sledgehammer effect so it is much easier to manage and I don't get knocked unconscious as so often used to happen. Crumbs! It's scary thinking of back then. Thank God for research and progress.

 

[New2T1D]

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.

I am new to this. May I ask why moving from your old regime to basal/ bolus was a mistake? I don't know what treatment/ management options there are and it strikes me that, if you were on a regime that worked for you for a long time, then maybe there is not a "one size fits all." It seems that newly diagnosed people are just directed down a route. For us: basal/ bolus (Lantus/ Humalog). Are there other options/ possibilities? Also, we were advised: 5.8 or above: no bedtime snack needed; under that a snack was needed. If in doubt: have a snack, unless over 13.

 

[TorqPenderloin]

I am new to this. May I ask why moving from your old regime to basal/ bolus was a mistake? I don't know what treatment/ management options there are and it strikes me that, if you were on a regime that worked for you for a long time, then maybe there is not a "one size fits all." It seems that newly diagnosed people are just directed down a route. For us: basal/ bolus (Lantus/ Humalog). Are there other options/ possibilities? Also, we were advised: 5.8 or above: no bedtime snack needed; under that a snack was needed. If in doubt: have a snack, unless over 13.

This thread is 6 years old and Margi isn't logged in in 5 years so I doubt you'll get a response.

There is certainly not a One size fits all but basal/bolus or a pump are the two most approaches and they make the most sense for 99.9% of people (and probably even higher than that).

Now, which basal you use and which bolus insulin you use is an important topic. I personally think there are much better options than Lantus but that's just me. Levemir was good for precision as I took it twice a day and it allowed me to address morning highs due to the extra injection. I then switched to Tresiba and it's just a fantastic insulin all around. I'm currently using novorapid (called Novolog here in the USA) as my bolus which is about the same as humalog. I'm excited about the Fiasp or ultra fast acting insulin though it's not quite available here.

Side note- I also have some Afrezza which is inhaled insulin. It's very interesting and I'm still new to using it but it's a bolus-type insulin either way.

One good thing about being here in the USA (and having excellent insurance and fanatical stability) is that I can try pretty much whatever I want in terms of current medications and technology.

 

[New2T1D]

This thread is 6 years old and Margi isn't logged in in 5 years so I doubt you'll get a response.

There is certainly not a One size fits all but basal/bolus or a pump are the two most approaches and they make the most sense for 99.9% of people (and probably even higher than that).

Now, which basal you use and which bolus insulin you use is an important topic. I personally think there are much better options than Lantus but that's just me. Levemir was good for precision as I took it twice a day and it allowed me to address morning highs due to the extra injection. I then switched to Tresiba and it's just a fantastic insulin all around. I'm currently using novorapid (called Novolog here in the USA) as my bolus which is about the same as humalog. I'm excited about the Fiasp or ultra fast acting insulin though it's not quite available here.

Side note- I also have some Afrezza which is inhaled insulin. It's very interesting and I'm still new to using it but it's a bolus-type insulin either way.

One good thing about being here in the USA (and having excellent insurance and fanatical stability) is that I can try pretty much whatever I want in terms of current medications and technology.

Thanks for replying! That's interesting. I find that the Lantus which my son takes at 10pm "runs out" around 7pm and his bs rises. I might ask about Tresiba. He needs an extra half unit of Lantus around 6pm, to take account of this - my solution.Looking at your A1c, it's fantastic, for someone not honeymooning. We're in the UK and most of our treatment is free, but I pay for Freestyle Libre, which is great. We're off to the US in August Much obliged to you for taking the time to respond.

 

[Lulu9101112]

I would say the answer to your question depends on does the person recognise hypos like if he's sleeping does he automatically wake up. because then you know how to treat it
Personally when I'm asleep and if I ever had a hypo I automatically wake up because when ever I get low I just recognise by my fingers and toes go tingally and that I feel colder than usual.
but If you don't recognise hypos easily then it's dangerous as if it's to late you can end up in a coma

 

[ManUtdGal!]

I have been Type 1 for 46 years and if I go hypo it is normally when I'm asleep. My husband has got very good at giving me Glucogen to bring me round (on prescription) I have been as low as 1mmol but the jab doesn't seem to raise my sugar levels by much the next day. I still run at about 7-9. I do eat before bed too! Adjusting my insulins hasn't done much either. I start to run too high if I lower my basal. I've just got a HypoBand1.1 to try.

 

[tim2000s]

I have been Type 1 for 46 years and if I go hypo it is normally when I'm asleep. My husband has got very good at giving me Glucogen to bring me round (on prescription) I have been as low as 1mmol but the jab doesn't seem to raise my sugar levels by much the next day. I still run at about 7-9. I do eat before bed too! Adjusting my insulins hasn't done much either. I start to run too high if I lower my basal. I've just got a HypoBand1.1 to try.

Hi hld1904, please don't take this the wrong way, but if you are regularly going hypo in the night and needing assistance from your husband, you need to really sit down and discuss this with your diabetes team. This type of issue, especially if linked with trying to change to different insulins and it not making much difference, is classic territory for giving you a pump.

 

[Jhinchley1985]

Well I am having hypos at night even thought eating and my blood sugars are in the 20s. I am currently in hospital with This problem at the minute as I drop so low and so quick they have to get the crash team out to bring me round. I have tried all the long acting insulins their is and none of them work. I am now being referred to Manchester to have a pancreas transplant as their is no more then can do for me.

 

[azure]

Sorry to hear that @Jhinchley1985 That sounds awful for you to drop so very quickly. Terrifying.

I know you said you've tried all the long acting insulins, but have you tried a pump? No long acting insulin suited me, but a pump works fantastically.

 

[col101]

I agree he has a responsibility to you and the kids as well as to himself.
Freestyle libre are often available on free trial from dsns. Also some clinics will lend out a full blown cgm which will fire an alarm if he goes hypo. Might enable him to see just how low he is going and provide some food for thought and discussion with medics.
Please do take care of yourself though.

 

[TheBigNewt]

PM sent.

 

[O_DP_T1]

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.

I'm getting the same kind of issues, I've been advised to go on MDI basal/bolas so let's see. Like your husband I am well controlled in the day and go to the gym 3-4 time week.