Sleep: Signs of a hypo?

[Bryce74]

I am not diabetic but I am diagnosed with reactive hypoglycemia and there are periods when I wake up after 4-5 hours of sleep and I feel hot (not necessarily sweaty) and really, really terrible, depressed/agitated, bit confused too, it feels like between mentally and physically ill, it's hard to explain. Sometimes it's so bad I wish I were dead. Often, after waking up, I feel too weak to get up and only after 15-30 minutes I find the strength to finally come out of bed and get some food, after which I start feeling better.
My experiences are so bad that often I dread going to sleep, being afraid I will wake up so terribly ill again.
I only recently got a blood glucose meter again (hadn't used one for years) and I still haven't been able to test during the worst "attacks".
Also, I notice that it usually gets worse in hotter weather or when the temperature in my bedroom is neither very warm or cold and when it is difficult to decide to use a blanket, a bedsheet or a duvet. It seems my body has problems regulating its own temperature.

My question: Are these hypo-symptoms?

 

[billybadger]

Some people will have symptoms like you describe during and after hypos, so could be related. Difficulty in regulating temperature can be signs of other medical conditions so worth speaking to a doctor I think

 

[xfieldok]

I can't help, I don't get hypos, but could you keep something by the bed like a piece of cheese to nibble on when you wake.

I hope someone more knowledgeable will stop by soon.

 

[Bryce74]

Some people will have symptoms like you describe during and after hypos, so could be related. Difficulty in regulating temperature can be signs of other medical conditions so worth speaking to a doctor I think

I already saw too many doctors in my life The most important/relevant diagnosis I ever got was reactive hypoglycemia. I have confirmed hypos during the day, just these night-time events aren't easy to interpret.
It's interesting to hear that also after hypos one can feel like that - that could explain why, in the past, I never measured real low numbers.

 

[Deleted Account]

I can't help, I don't get hypos, but could you keep something by the bed like a piece of cheese to nibble on when you wake.

I hope someone more knowledgeable will stop by soon.

If this is a hypo, the OP will need to eat something with fast acting carbs not something with no carbs like cheese.

However, the only way of knowing if this is a hypo is to test. Otherwise, it is just guesswork.
If it is not possible to test in that state, perhaps it is worth investing in a Libre to review the morning after if this happens regularly.

 

[Bryce74]

If this is a hypo, the OP will need to eat something with fast acting carbs not something with no carbs like cheese.

However, the only way of knowing if this is a hypo is to test. Otherwise, it is just guesswork.
If it is not possible to test in that state, perhaps it is worth investing in a Libre to review the morning after if this happens regularly.

Yes, I have been thinking about trying a Libre. Maybe that is the only possibility to be sure if I suffer from night time hypos or not. After years of not using one, I have a blood glucose meter since last week and I'll first try that.

As to the carbs: because I have reactive hypoglycemia, slow carbs are better for me, so usually I eat bread with something on it, but I felt that if I eat something sugary or cookies after an "event" I feel the energy flowing back into me.

 

[Emile_the_rat]

You say that you never really experience low numbers. What is the lowest number you have got? And how did you get the diagnosis?

I never feel «hot» when getting a hypo, rather cold and the opposite. I might get agitated but never depressed when having these episodes.

How are your vision and movements when having these «episodes»?

 

[Brunneria]

The Libre would be a really useful tool for this.

I have RH, and I have v similar nighttime experiences. Often they are related to dreams (often nightmares) and tend to occur act the same point in the night. They also happen on days when my blood glucose seems well controlled.

The Libre has taught me a couple of things about what seems to be happening to me. Your experience may, of course, be different

1. The Libre screen invariably shows a dip in blood glucose just prior to the symptoms. Not a hypo. A dip. I have caught RH hypos on the Libre, but what happens at night doesn’t go anywhere that low. However, there is consistently a dip on the Libre graph at that point in the night.

I have tried all sorts of different things (variations in snacks and food times and routine and activity), but haven’t managed to prevent the dip from happening. Although the lower carb I go, the shallower the dip.

2. Following The Dip, there is always a slight bump in my blood glucose. A night time liver dump. This is when I wake up. Sweaty, heart pounding, etc. etc.

So my body reacts to The Dip by flooding me with hormones to trigger the liver dump to raise my blood glucose. And as far as I can tell, it isn’t the low or rising blood glucose that wakes me up. Instead it is those pesky stress hormones with their fight or flight stuff. I know from waking hypos that these cause more of a ‘hypo hangover’ effect than the actual blood glucose levels themselves.

3. I thought The Dip was unavoidable. Just something I had to put up with, because of my body, my RH and general ‘life’.

Then, a few months ago I dropped to the lowest carb way of eating I have ever attempted (basically carnivore). And, over several months, I have noticed The Dip getting shallower, the subsequent liver dump getting less, and my sleep has improved. It has taken months. And reintroducing my previous carb levels again causes the Dip/Dump to return (like it did last night after eating out). It will now take several days of carnivore eating to settle again.

So, for me, it looks like the Dip/Dump were just another consequence of having more carbs than was optimum for my body.

Your mileage may vary, of course.

But I would recommend the Libre as an excellent tool to discover what YOUR body is up to when you get these experiences.

 

[kitedoc]

Your symptoms MAY be possible hypos but that is just my personal, non-professional guess.
Some form of CGM monitoring is a strategy to discuss with your GP.
Also I have two friends who had her reactive hypoglycaemia diagnosed by what she called an extended glucose tolerance test (extended GTT). rather than the 2 hour test it goes for at least 3 hours to see what the insulin and sugar levels are. One of these persons was found to have pre-diabetes and, against Govt-funded prescribing policy in Australia, was prescribed Metformin.
As you point out slow-release carbs (low GI, low GL) are better. My friend found that too. She also said that having protein seemed to help in addition to the slow carbs, Not sure why ? slower release of carbs as fat from protein could alter GI, ? conversion of some protein to carbs during fasting at time ??
The other friend had a cortisone deficiency (? Addison's disease). Not sure of more details and please do not assume you have pre-diabetes or Addison's disease, but your GP can help sort this out if need be.

 

[Bryce74]

You say that you never really experience low numbers. What is the lowest number you have got? And how did you get the diagnosis?

I never feel «hot» when getting a hypo, rather cold and the opposite. I might get agitated but never depressed when having these episodes.

How are your vision and movements when having these «episodes»?

I only last week got a new blood glucose meter after several years of not measuring. I started to feel weak during normal exercise, like walking and biking. Then my GP and I decided I should start measuring my glucose again. And I was kind of surprised to see it went below 4 after almost every meal, during the day that is, which of course is typical for reactive hypoglycemia. I didn't yet have an "opportunity" to measure during the night.
Th strange thing is, my hypo symptoms always used to start below 4.4 but now, during the day, even when they go lower and are "officially" a hypo, I almost feel no symptoms. Maybe because I also have sleeping problems and already often feel not good because of that. Or maybe I have hypo unawareness like people with diabetes can have.

The lowest number I read last week was 3.3, so clearly hypo and often 3.8 but I never waited to see if it would drop even more, I immediately started adjusting my eating plan.

I had an oral glucose tolerance test, an extended one I think.

My vision is ok I think when I have these nightly "episodes", but as I said, I often just lay there for 30-45 minutes when they are really severe, unable to get myself to raise to get some food.

 

[Bryce74]

The Libre would be a really useful tool for this.

Thank you for your very elaborate and interesting post. Is it possible you wrote the same in one of your blogs?
I think I remember having it read before and what is/was happening to you during sleep might well be the same that I am suffering from.

It would be very interesting to use the Libre and see if what's going on in me is the same, but unfortunately I would have to pay myself for the sensors and as I don't eat meat (very) low carb is not an option for me.

Before I was diagnosed with reactive hypoglycemia I woke up almost every night with hypo symptoms and my former GP advised me to put sugar lumps on my nightstand which is good for people with diabetes who have hypos but not for people with reactive hypoglycemia. Moreover, I later found out I had hypo's during the day, too.
This whole problem with waking up sick started with the reactive hypoglycemia, so I guess I ca be quite sure hypo's/dips are the cause. I was tested for sleep apnea, I have had 24-hour Holter monitoring several times and nothing was found that could explain my "episodes". So low blood sugar is the most probable explanation.

And I wonder: I think I read people with diabetes have more hypo's during hot weather? Is that correct?
It seems I suffer from it more during the summer.

 

[Bryce74]

Your symptoms MAY be possible hypos but that is just my personal, non-professional guess.
Some form of CGM monitoring is a strategy to discuss with your GP.
Also I have two friends who had her reactive hypoglycaemia diagnosed by what she called an extended glucose tolerance test (extended GTT). rather than the 2 hour test it goes for at least 3 hours to see what the insulin and sugar levels are. One of these persons was found to have pre-diabetes and, against Govt-funded prescribing policy in Australia, was prescribed Metformin.
As you point out slow-release carbs (low GI, low GL) are better. My friend found that too. She also said that having protein seemed to help in addition to the slow carbs, Not sure why ? slower release of carbs as fat from protein could alter GI, ? conversion of some protein to carbs during fasting at time ??
The other friend had a cortisone deficiency (? Addison's disease). Not sure of more details and please do not assume you have pre-diabetes or Addison's disease, but your GP can help sort this out if need be.

Thank you. I had the extended glucose tolerance test, too.
Adding protein to carbs lowers the GI indeed. But it's a complicated story: there is also the insulin index and some proteins can/could raise insulin levels.

I don't have pre-diabetes, but Addison's might be possible, I'll ask my GP. Thank you very much for your input!

 

[Brunneria]

Yes, temperature certainly affects my blood glucose levels. Also stress and exercise, with knock on effects on insulin resistance.
It gets pretty complicated, doesn't it?

 

[Lamont D]

I am not diabetic but I am diagnosed with reactive hypoglycemia and there are periods when I wake up after 4-5 hours of sleep and I feel hot (not necessarily sweaty) and really, really terrible, depressed/agitated, bit confused too, it feels like between mentally and physically ill, it's hard to explain. Sometimes it's so bad I wish I were dead. Often, after waking up, I feel too weak to get up and only after 15-30 minutes I find the strength to finally come out of bed and get some food, after which I start feeling better.
My experiences are so bad that often I dread going to sleep, being afraid I will wake up so terribly ill again.
I only recently got a blood glucose meter again (hadn't used one for years) and I still haven't been able to test during the worst "attacks".
Also, I notice that it usually gets worse in hotter weather or when the temperature in my bedroom is neither very warm or cold and when it is difficult to decide to use a blanket, a bedsheet or a duvet. It seems my body has problems regulating its own temperature.

My question: Are these hypo-symptoms?

Yes, I have been thinking about trying a Libre. Maybe that is the only possibility to be sure if I suffer from night time hypos or not. After years of not using one, I have a blood glucose meter since last week and I'll first try that.

As to the carbs: because I have reactive hypoglycemia, slow carbs are better for me, so usually I eat bread with something on it, but I felt that if I eat something sugary or cookies after an "event" I feel the energy flowing back into me.

Thank you. I had the extended glucose tolerance test, too.
Adding protein to carbs lowers the GI indeed. But it's a complicated story: there is also the insulin index and some proteins can/could raise insulin levels.

I don't have pre-diabetes, but Addison's might be possible, I'll ask my GP. Thank you very much for your input!

Why, if you have had a diagnosis are you still getting hypos, symptoms and sleep deprivation?
Since diagnosis, I have only had one hypo, and that was during my last eOGTT.
I have had a few higher than normal blood sugar levels but no hypos during the last four years.
The treatment and avoiding hypers then hypos is logical. The only way is avoiding the trigger!

The sleep deprivation is part of the hyper/ hypo roller coaster.
You do not have control of your blood glucose levels, hence your GP telling you to use a glucometer to see what is happening.

I suspect, that your meals are carb laden and despite lowering your carbs intake, it still isn't enough to stop the ride, the fluctuations and the awful symptoms you are getting.

This is how I started after diagnosis, small meals, complex carbs, fluctuating blood glucose levels, symptoms galore, and it wasn't until I started going very low carb and found that my blood glucose levels stabilised in or near normal levels that I found that the symptoms dissipated and I felt better and my sleep was better.

If you read my blog, my dreams are there, really weird and vivid.

Best wishes