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3 a.m. Hypo. Suggestions as to why?

mountaintom

mountaintom

Well-Known Member
Messages
574
Location
Lauragh, Kerry
Type of diabetes
Type 1
Treatment type
Insulin
Hi all,

Hope you are all well today.

Last night was the first time since my January diagnosis (that I’m aware of) of having a night time hypo.
I woke from a terrifying dream (the content of which I cannot remember) and couldn’t move my legs at all and was sweating.
Somehow I went back to sleep (had been having an awful time actually trying to get to sleep that night so was pretty shattered). Woke at 6.30/7 as normal and scanned my libre to find a massive dip between 3 and 4 a.m. Not a major hypo though - probably low to mid 3’s.
I had done nothing different yesterday from every other day this week. And I’ve had such a fantastic week numbers wise, waking at around 7.0 and going to bed around the same number. And when I tested my bloods with a strip before my breakfast it read 9.0. Higher than normal.

Any idea as to why? I’m half expecting some elaborate and mad explanation to follow: that the liver sucks away glucose on the 16th of January every year because of the moon phases or if the air pressure outside drops it can affect your bloods.

Thanks in advance.
 
Hi @mountaintom I am half tempted to say that your theory of the moon activated blood sucking liver is absolutely correct !!!

Ok serious head on, firstly keep some glucose next to your bed, it's much easier to reach into a drawer and suck on a glucogel than to find the strength to wake, walk to get glucose and treat it, night time hypos are the worst, so we need to avoid them as much as possible.

As to why they happen.. If you have taken an incorrect bolus with night time meal so too much quick acting or not eaten enough carbs, then it can present itself as a night time hypo - or it's a case of re-adjusting your basal dose overnight and reducing, however this is only really done if you have a repeat, 2-3am is the point at which the BG levels are at their lowest point, hence the fact it's a common time for us to see them happen around this time.
 
Did you do a comparison BG test?
My Libre shows nocturnal hypos fairly regularly at around 5.30/ 6am and that combined with hba1c of 40 has led the endo to halve my meds
That having been said, when Ive been awake enough to do a comparison BG test, there has sometimes but not always been a lot of difference between the two. That may have something to do with the time lag between blood and interstitial fluid levels but lying on the arm where the sensor is can apparently also muck readings up - Im such a restless sleeper who knows what arm Im lying on but I also doubt Im consistently lying on the sensor arm at 6am
 
Juicyj said:
Hi @mountaintom I am half tempted to say that your theory of the moon activated blood sucking liver is absolutely correct !!!

Ok serious head on, firstly keep some glucose next to your bed, it's much easier to reach into a drawer and suck on a glucogel than to find the strength to wake, walk to get glucose and treat it, night time hypos are the worst, so we need to avoid them as much as possible.

As to why they happen.. If you have taken an incorrect bolus with night time meal so too much quick acting or not eaten enough carbs, then it can present itself as a night time hypo - or it's a case of re-adjusting your basal dose overnight and reducing, however this is only really done if you have a repeat, 2-3am is the point at which the BG levels are at their lowest point, hence the fact it's a common time for us to see them happen around this time.
Click to expand...

thanks Juicyj.

I have my evening meal at around 18.30 so can my bolus really affect things 9 hrs later?
I do have my little bumbag with all my gear in including dextrose tablets by my bed but I don’t think I could’ve reached for them! Weirdly I wasn’t that bothered by it, probably because I was so tired.
 
Boo1979 said:
Did you do a comparison BG test?
My Libre shows nocturnal hypos fairly regularly at around 5.30/ 6am and that combined with hba1c of 40 has led the endo to halve my meds
That having been said, when Ive been awake enough to do a comparison BG test, there has sometimes but not always been a lot of difference between the two. That may have something to do with the time lag between blood and interstitial fluid levels but lying on the arm where the sensor is can apparently also muck readings up - Im such a restless sleeper who knows what arm Im lying on but I also doubt Im consistently lying on the sensor arm at 6am
Click to expand...


I didn’t do a strip test at the time no. I was on another plain I think. Do you think the high reading this morning before breakfast is some sort of compensation for the hypo?
 
I would hazzard a guess at yes, when Ive seen hypos on the libre and the BG test is in broad agreement, I seem to run higher (1.5-2 mmol) than (my) average BG over the next day, I also seem to get a run of nocturnal hypo readings for a few days after the first one
Im T2 on a sulfonylurea rather than insulin
 
I don't like those night hypos... they can be sneaky. :( I can get them anywhere between 12-4 am. The only thing I do differently is adjust my basal dosage and see if that helps. Although I don't think sugar levels are always predictable. I keep juice by my bed so I can treat if I wake up. I half wake up sometimes with my head spinning and wake up with high BGL... usually have the hypo hangover with it as well so that's how I know I had one I didn't treat. I hope you can get a handle on it... and sorry to hear it was a bit of a scare.
 
If it continues it may make sense to review your basal insulin.
When I got my Dexcom (because of some nasty night hypos) it became clear that I was dipping at around 2:00am, sometimes enough for a hypo, occasionally a serious one like yours. I experimented with different timings with Lantus but in my case a move to Levemir has been a great improvement.
 
DunePlodder said:
If it continues it may make sense to review your basal insulin.
When I got my Dexcom (because of some nasty night hypos) it became clear that I was dipping at around 2:00am, sometimes enough for a hypo, occasionally a serious one like yours. I experimented with different timings with Lantus but in my case a move to Levemir has been a great improvement.
Click to expand...

Thanks Duneplodder. I sincerely hope not as I’ve just got settled with Toujeo after giving up on Lantus. My morning and evening readings are usually spot on. I might set my alarm tonight for 3am and test with strip.
 
Hi @mountaintom The symptoms you described when you woke around 3am fit perfectly with experiencing a hypo, so disagree that as @Boo1979 mentioned, that there could of been a difference between your reader and BG meter on this one, yes there generally is a time lag between devices, but experiencing symptoms of this nature clearly show you were low during the night.

As I said earlier as an insulin dependent diabetic, it is important to avoid them at night. As you had eaten earlier and your quick acting would of depleted before your night time BG reading then the blame lies with your basal dose, personally I wouldn't wait for a repeat of a night time hypo before adjusting, simply because again you may or may not wake and then when you wake in the morning you will be high again and feeling pretty rubbish. You can still set an alarm for 2am and check on your meter to check though as it's good to see how you have responded to the dose change.
 
Juicyj said:
Hi @mountaintom The symptoms you described when you woke around 3am fit perfectly with experiencing a hypo, so disagree that as @Boo1979 mentioned, that there could of been a difference between your reader and BG meter on this one, yes there generally is a time lag between devices, but experiencing symptoms of this nature clearly show you were low during the night.

As I said earlier as an insulin dependent diabetic, it is important to avoid them at night. As you had eaten earlier and your quick acting would of depleted before your night time BG reading then the blame lies with your basal dose, personally I wouldn't wait for a repeat of a night time hypo before adjusting, simply because again you may or may not wake and then when you wake in the morning you will be feeling pretty rubbish. You can still set an alarm for 2am and check on your meter to check though as it's good to see how you have responded to the dose change.
Click to expand...

Appreciate the advice. However, if I decreased my basal I would run the risk of being too high in the mornings and generally when fasting. My fasting bg is around 7 and that’s with no exercise.
I think I’ll have a chat with my dsn (who is on annual leave til next week!) soon and see what her recommendations are...
 
Hi @mountaintom It's probably a much safer suggestion as you're newly diagnosed to munch on a slice of toast before bed, until you speak to your DSN, however in time you will become more comfortable with adjusting your own doses and knowing which insulin is responsible. Also reducing your basal, doesn't necessarily mean you will wake high though, you're still pretty new into this and there may be a touch of the honeymoon going on with your pancreas producing some insulin still, which will mean adjusting your doses if you do go low.
 
@mountaintom . Welcome to night time hypos. Best avoided but almost impossible to avoid completely.
Horrific dreams as well!!!!!!!!!!!! If it's not enough for your sugars to drop you get to have a bl**dy nightmare as well.
Second everything @Juicyj has said.
With such a recent diagnosis ( January I think ) it's quite possibly that you're still honeymooning. If you are now keeping good levels on a regular basis this will take a lot of pressure of your not completely defunct pancreas. This reprieve will give a burst of life to your pancreas enabling it to provide a bit more insulin. Problem is it can do this at the most inconvenient times, like 3am possibly. It may prove to be a one off, but a few finger prick tests in the night wouldn't go amiss.
As for being high on waking, that's because your liver responded to going low hours previously.
Of course the other alternative is that you've fallen into this months moon phase. Try sleeping with one leg on the floor and your left eye held open with sellotape. ;)
 
Thanks guys. I’ve just taken a strip reading pre meal and it’s lower than normal (5.4). Usually gliding around 6/7 when hungry. So perhaps the basal does need adjusting. I’ll hold out though and possibly just eat more food!
 
mountaintom said:
and scanned my libre to find a massive dip between 3 and 4 a.m.
Click to expand...

If you're going to be using libre long term, there's a small bluetooth transmitter called blucon from www.ambrosiasys.com which you can pop on top of libre with a sticking plaster, then pair it with an android app, xDrip+ from https://github.com/NightscoutFoundation/xDrip/releases

It'll read the sensor every 5 mins and ring your phone once you get below a level set by you, say, 4.3 or 4.4 to give you a bit of leeway.

The blucon is a one off cost of £96, mines is working fine after 10 months. Not waterproof so need to take off for showers but no big deal seeing as it turns libre into full on cgm.

Here's a snap of me on a slow slide down to just above 4 (basal adjustment needed, or aftermath of a night on the town, can't remember!), phone wakes me at 4 am after getting to 4.2 just past my 4.3 alarm threshold, took 5g, wanders back up to 6. That would very likely have been a modest hypo but wasn't.

It's a great security blanket.

Screenshot_2017-09-27-18-03-45.png
 
Scott-C said:
If you're going to be using libre long term, there's a small bluetooth transmitter called blucon from www.ambrosiasys.com which you can pop on top of libre with a sticking plaster, then pair it with an android app, xDrip+ from https://github.com/NightscoutFoundation/xDrip/releases

It'll read the sensor every 5 mins and ring your phone once you get below a level set by you, say, 4.3 or 4.4 to give you a bit of leeway.

The blucon is a one off cost of £96, mines is working fine after 10 months. Not waterproof so need to take off for showers but no big deal seeing as it turns libre into full on cgm.

Here's a snap of me on a slow slide down to just above 4 (basal adjustment needed, or aftermath of a night on the town, can't remember!), phone wakes me at 4 am after getting to 4.2 just past my 4.3 alarm threshold, took 5g, wanders back up to 6. That would very likely have been a modest hypo but wasn't.

It's a great security blanket.

View attachment 25715
Click to expand...

That is pretty cool. Full on cyborg. It might be worth looking at.
 
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