Coma

[R55vsy]

I am diabetic type 1.5 they say , I inject insulin in
I have the libre sensor and have been controlling well , the sugar level Average is around 8.7 with a 53 mmol
But last night I had a very strange Event happen it was worst experience ever , I think I went into a coma in the night , the alarm did not set off , I woke up in like bed of sweat and my wife was very upset
When I woke I was delearious could not reconise her or where I was after 5 minutes of eating biscuits etc etc I eventually came around , I felt very cold , and pins and needles feeling all over my body , to be honest it was quite scary
Has anyone else experienced this and was I in a diabetic coma
My reading when I came round was 2.9
I have been low on that before in the day when excercisng and stopped and took a sweet and relaxed for 15 mins and level went up slowly to 5
But last night I was sleeping
And I don’t know what happened
I did drink more alcohol than usual but was not drunk
I’m a bit worried as am on holiday in Asia at the moment
Any help or similar experiences?
Michael reeves

 

[Juicyj]

Hello Michael,

Sorry to hear about your experience, sounds incredibly frightening for you and your wife.

This can and does happen when levels fall very low, however your alarm should of gone off to alert you, have you checked your settings to ensure there is an alert set ? It could of happened quite quickly and because you were already low it didn't register so start there, if you can contact Abbott to see if a customer service member can check the settings with you over the phone ?

Going forward you need glucogel, which your wife can rub into your gums if this happens again - it's a quick acting glucose treatment but will act faster than biscuits, biscuits are ok if your going low but not to treat a hypo and a low one at that, glucogel is the best hypo treatment.

Also get a glucogon pen off the pharmacy if you can, if you are in a hypo coma then your wife can administer this to bring you round.

Exercise, alcohol, heat will all affect glucose levels and through the night too so tread carefully on holiday, hopefully you won't let this episode affect your time away but do take it very carefully as your body recovers from this episode and see a doctor if necessary to get checked over.

 

[R55vsy]

Thankyou , it’s never happened before
I’ve been on insulin for about 9 years now ,
Had the Libra sensor in place for 2 years
This image is best I’ve got down to by cutting down on carbs

 

[Melgar]

I am very sorry that happened, it must have been very stressful and frightening for both you and your wife.Thank goodness it was caught in time. It is one of my biggest fears. They do not know what type of diabetes I have, the Dr's think I'm in the very early stages of LADA. My blood sugars are very unstable. I woke up the other night with a pounding head and clammy. My night wear was damp. My partner works from home four nights a week, so I was alone. Got up checked my blood sugars, going low. I ate my usual carb fix. Went back to bed. My blood sugars went up, then I found myself having a reactive low. I don't drink alcohol because that makes my sugars even more unstable. I am really into my exercise so I'm guessing I depleted my glucose reserves. I'm not on insulin. It is very scary. Thank goodness you were able to turn it around. I set my alarm at 4.5 to give me time to stop the tumble. Again so sorry that happened to you.

 

[SimonP78]

Before the advent of CGM and when on twice a day injections (before the days of basal bolus) this used to happen to me from time to time, I would gradually become aware of being somewhere as if in a dream and gradually realising it wasn't actually a dream, not ideal, but once you realise it happens you do recognise what has happened to you when it happens again.

Mine often involved alcohol as a student. It's not a coma mind you, if you'd not been asleep you would have been doing things, but not remember what they were. My school and uni friends had lots of entertaining stories to tell me. Apparently I was fairly normal, just rather single minded in wanting to get food of some description and would have short shrift with anyone who disagreed with me or got in the way. With that said I'm told I could be quite argumentative (saying I wasn't low), though I think this very much depends on how someone tries to persuade you (or me anyway) that you are low - saying please rather than arguing worked much better with me.

 

[KennyA]

T2 here. I regularly experience lows around 3-5am - at first I didn't realise they were lows - I have nightmares, waking up drenched in sweat, cold, confused. This all would clear up of its own accord very quickly.

It was only when I tried a CGM that I realised these experiences coincide with my BG falling very sharply and recovering equally quickly. talking about this at my local low carb group reveals that others, including non-diabetics, have had similar experiences. Without CGMs we'd not have known of the association.

I don't have a graph of my own thanks to a phone change since I last used a Libre but this one (anonymous find on the internet) is similar.

 

[AndBreathe]

I came back from SE Asia a couple of weeks ago now. Unless your climate differs a lot to ours, it will be very hot and in our case, humid overnight. One thing to be very careful of is managing your hydration. I'd suggest drinking more than you perhaps feel you need in the earlier part of the day (in an effort not to disturb your sleep_, and if you are perspiring a lot, use dehydration salts.

Your local pharmacy will have all this stuff, cheap as chips, and in my experience all the pharmacists we encountered had excellent English.
Of course, that doesn't necessarily help with your hypo, but dehydration just adds further complexity to any challenge.

 

[In Response]

T2 here. I regularly experience lows around 3-5am - at first I didn't realise they were lows - I have nightmares, waking up drenched in sweat, cold, confused. This all would clear up of its own accord very quickly.

It was only when I tried a CGM that I realised these experiences coincide with my BG falling very sharply and recovering equally quickly. talking about this at my local low carb group reveals that others, including non-diabetics, have had similar experiences. Without CGMs we'd not have known of the association.

I don't have a graph of my own thanks to a phone change since I last used a Libre but this one (anonymous find on the internet) is similar.

That attached graph looks like a compression low rather than a real low.
It is easy to assume that CGMs are always correct or always wrong but due to things like physics, there are times when this is not the case.
For example, when pressure is applied to a sensor, fluid is not able to access the filament which results in a false low being recorded.
This most commonly happens when you turn over in your sleep and is identified by a sudden drop and almost immediate rise to about the same level.

 

[KennyA]

That attached graph looks like a compression low rather than a real low.
It is easy to assume that CGMs are always correct or always wrong but due to things like physics, there are times when this is not the case.
For example, when pressure is applied to a sensor, fluid is not able to access the filament which results in a false low being recorded.
This most commonly happens when you turn over in your sleep and is identified by a sudden drop and almost immediate rise to about the same level.

The problem with the compression low theory is that it doesn't explain why artificial compression lows (if that's what they are) coincide with the nightmares, sweating, and waking confusion. I'd been having these for eight years before I ever tried a CGM.

 

[Melgar]

T2 here. I regularly experience lows around 3-5am - at first I didn't realise they were lows - I have nightmares, waking up drenched in sweat, cold, confused. This all would clear up of its own accord very quickly.

It was only when I tried a CGM that I realised these experiences coincide with my BG falling very sharply and recovering equally quickly. talking about this at my local low carb group reveals that others, including non-diabetics, have had similar experiences. Without CGMs we'd not have known of the association.

Your body worked just the way it should, even though you went low, and yes those distressing nightmarish, clammy situations are extremely unpleasant, but you said it yourself, "This all would clear up of its own accord very quickly." And I dare say that would be the same for none diabetics as well. I'm guessing the question is why didn't your liver correct the fall sooner. Possibly Insufficient insulin secretion, insulin signals the liver to manufacture glucose and glucagon. You depleted your liver's storage of glucose and glucagon through diet or exercise, and then there is the question of alcohol which as we all know can lead to lows because the liver is prioritizing its metabolism. I am of course excluding insulin therapy and blood sugar lowering meds. I've pondered all these scenarios myself due to my own continuing hypo issues. My blood sugars go very low. I do not have the guts to see how low they would go without intervention.

 

[In Response]

The problem with the compression low theory is that it doesn't explain why artificial compression lows (if that's what they are) coincide with the nightmares, sweating, and waking confusion. I'd been having these for eight years before I ever tried a CGM.

It could be that the cause and effect are the other way around. The nightmare sweats do not explain the compression lows but when your sleep is more disturbed (e.g. when experiencing nightmare sweats), you will be tossing and turning so more likely to turn into (and then off) of your arm with the sensory on it.

 

[KennyA]

It could be that the cause and effect are the other way around. The nightmare sweats do not explain the compression lows but when your sleep is more disturbed (e.g. when experiencing nightmare sweats), you will be tossing and turning so more likely to turn into (and then off) of your arm with the sensory on it.

I've tried this explanation, but while simple it doesn't reflect how I sleep - I don't do tossing and turning at all. The effect also appeared when I wore the sensor on my chest.

It's not a classic "hypo" in the sense that correcting it needs outside intervention via added glucose, but there does seem to be something going on that produces a short and temporary sharp fall in blood glucose. It might not even be diabetes related. It might be "normal".

 

[Sophielouise]

I am diabetic type 1.5 they say , I inject insulin in
I have the libre sensor and have been controlling well , the sugar level Average is around 8.7 with a 53 mmol
But last night I had a very strange Event happen it was worst experience ever , I think I went into a coma in the night , the alarm did not set off , I woke up in like bed of sweat and my wife was very upset
When I woke I was delearious could not reconise her or where I was after 5 minutes of eating biscuits etc etc I eventually came around , I felt very cold , and pins and needles feeling all over my body , to be honest it was quite scary
Has anyone else experienced this and was I in a diabetic coma
My reading when I came round was 2.9
I have been low on that before in the day when excercisng and stopped and took a sweet and relaxed for 15 mins and level went up slowly to 5
But last night I was sleeping
And I don’t know what happened
I did drink more alcohol than usual but was not drunk
I’m a bit worried as am on holiday in Asia at the moment
Any help or similar experiences?
Michael reeves

A hypo in the night will feel a lot more disorientating than a daytime hypo. I have been below 3.0 in the day and it has felt like a panic attack but in the night it has felt like I am going to collapse. My diabetic nurse explained this is due to the bodies adrenaline kicking in to wake you up. Sometimes if you’re in deep REM sleep it can take a little longer so you can dip lower.

I would advise glucose liquid shots in times like these as they get into your system a lot faster than eating anything containing fibre/protein/fat.

If you’re very worried about losing consciousness then you can get prescribed a glucogel injection that your wife can administer to you should you lose consciousness ever. I always have one in the fridge to reassure me.

This is completely normal, it was not a coma, this is just the rubbish thing about diabetes.

 

[Nick25]

Been T1 for 50+ years and have had very similar attacks a few times over those many years. I recognise several factors in your description of events.
The quick fixes whilst you are away.
Alcohol - Be much more careful drinking more that usual. Holiday drinks ( or even just different beers) often have higher carb levels that you are used to, which immediately starts upsetting your normal control and can lead to adjustments to insulin doses to compensate, but alcohol also affect rates of absorption leading to a later lows. Finally ( and I think this is probably the major factor in your case) do remember that drinking more means that you sleep more heavily and so miss the early tell tale signs of falling glucose.
One of the posters above describes it as “warning Adrenalin“ which I have not heard before, but I do know that I often wake and feel glucose going low , and that having had drinks that warning did not overcome the deeper sleep.
Climate - I found over a period of 20 years that going on holiday to a hot climate always reduced my insulin requirement , at some points I was reducing dosage by 20/25% , although some of that may be due to extra activity and eating different food. I eventually moved to Caribbean for 15 years and there permanently reduced my insulin dosage by 10/15 % , so have a personal theory that a hotter climate has some direct effect.
Several people have mentioned de hydration , which in itself is factor all in itself affecting your body . That night sweat you experienced will have reduced your hydration - so pay extra attention to regular hydration (but not with alcohol !). I still ended up being rushed to hospital for dehydration ( not diabetes ) after 12 years in Caribbean .
Treatment in case of another event - biscuits take too long time to act. Find something much sweeter. When I was diagnosed 50 + years ago, the advice was to carry sugar lumps and the official warning card issued advised “If you find me ill or unconscious please feed me 4 lumps you will find in my pocket or bag, preferably with water”. That advice still holds good. That said for years, I chose mini Mars bars as my go-to , but was advised more recently that even chocolate takes time to absorb, so have switched to the latest advice - jelly babies! I can confirm that a couple of those does give a real glucose kick.
Longer term advice for when you get home
The advice above to get a glucagon pen ( or better 2) is good. My wife has had to use one on me twice over the years when she could not wake me - very frightening for her , so I strongly advise that you sit down calmly together when you really both have time , read the instructions carefully and let her rehearse the procedure, stopping before actually injecting of course! ( You cannot “ save” the syringe after mixing for later use , hence the advice to get 2 if doc will prescribe - if not they have expiry date so save until you get renewal and practice with expired one) . Worth practicing. that rehearsal if possible because my wife described the procedure of “ mixing “, avoiding air bubbles etc as “frightening” in the middle of an emergency. Also worth going into the detail of deciding the option of where she could inject you . Side note - when I suffered those very severe hypos( which of course I cannot remember) I apparently became quite aggressive, refusing to take sugar, gel etc and waving my arms about , so she advises preparing the glucagon pen well away from the bed , approach and inject quickly and decisively.
And lastly - do not underestimate how upsetting it was for your wife. Let her tell you about it, and then agree a plan for the future with which she is comfortable .
Sorry this is so long, but hopefully some of it might help.

 

[In Response]

Treatment in case of another event - biscuits take too long time to act. Find something much sweeter.

I completely agree that biscuits are not the best hypo treatment although this is due to the fat content which slows down the sugar content. This is why chocolate is not a good hypo treatment.
The problem with searching for "something sweeter" nowadays is that often this sweetness is provided by artificial sweetness which do nothing to raise BG.
The usual suggestions are Jelly Babies, fruit pastilles, wine gums, fruit juice or something dedicated to raising BG such as Dextrose tablets.
The other thing is that these must be kept with you at all times. I have a tube of Lift (GlucoTabs) in the drawer next to my bed, in most rooms of my house and in most bags.

 

[CottonCutiePies]

I am diabetic type 1.5 they say , I inject insulin in
I have the libre sensor and have been controlling well , the sugar level Average is around 8.7 with a 53 mmol
But last night I had a very strange Event happen it was worst experience ever , I think I went into a coma in the night , the alarm did not set off , I woke up in like bed of sweat and my wife was very upset
When I woke I was delearious could not reconise her or where I was after 5 minutes of eating biscuits etc etc I eventually came around , I felt very cold , and pins and needles feeling all over my body , to be honest it was quite scary
Has anyone else experienced this and was I in a diabetic coma
My reading when I came round was 2.9
I have been low on that before in the day when excercisng and stopped and took a sweet and relaxed for 15 mins and level went up slowly to 5
But last night I was sleeping
And I don’t know what happened
I did drink more alcohol than usual but was not drunk
I’m a bit worried as am on holiday in Asia at the moment
Any help or similar experiences?
Michael reeves

Yes I've been there and had to be given a glucagon injection by paramedics. While I was in that state which isn't a coma as such, I had very vivid dreams. Usually the body can recover on its own which sounded like what yours was doing just enough to wake you up. I've been there several times. I was told to eat a small banana before bed without insulin for it as it would prevent lows. Heat can go either way too high or too low. Another thing you can do is get yourself small cartoons of orange juice, choose one with high sugar carbs and place next to your bed. Also carry one around with you and check your bg more frequently.

 

[Melgar]

@In Response , @KennyA - I am not trying to preach to the converted here and I know you are both very knowledgeable.

It is in the normal range for blood sugars to drop to 3.5 at night for anyone, diabetic or not. It's not a problem when your liver then corrects it. Obviously, it is far more dangerous for those on insulin or taking bs lowering meds, ref the point of this discussion. It is not normal for anyone if your blood sugars drop to the low 3's and that arrow is pointing straight down and your liver is failing to dump. That's when you need to look at your lifestyle, your none diabetic meds or speak to your Dr for other none diabetic reasons. The simplist explanations are either you, and I am not trying to diagnose you, are exercising a lot and depleting your glucose stores during the daytime or your diet is not sufficient, for you personally, to replenish your glucose stores. Assuming you are not drinking alcohol.

@KennyA , I would suggest, as a type 2, if your insulin levels are lower than usual because of your keto diet then, I am suggesting that it is very feasable that your insulin signalling process is being impeded. I know keto is the holy grail for type 2's so I'm not trying to 'diss' keto diets. I am also assuming that your keto diet means your Libre blood sugar graph remains reasonably flat with slightly raised peaks after eating ,so it's unlikely to be reactive nightime lows. Or as @In Response says it's a compression low.

 

[KennyA]

@Melgar - interesting. The thing is, it only ever happens between 4 and 6 am while I'm asleep. You'd think if there was something up with the insulin receptors it would happen at other times. And the same goes for the compression low explanation - only between 4 and 6 am, and by coincidence only when I'm having nightmares and sweats?

The other factor is that the rise (after the fall) seems to be part and parcel of dawn phenom - my BG will continue rising (slowly) until I eat.

Well, it might be an excuse to get a Libre again for a month. I wanted to do that anyway to see what effect my football was having....

 

[Melgar]

@Melgar - interesting. The thing is, it only ever happens between 4 and 6 am while I'm asleep. You'd think if there was something up with the insulin receptors it would happen at other times. And the same goes for the compression low explanation - only between 4 and 6 am, and by coincidence only when I'm having nightmares and sweats?

The other factor is that the rise (after the fall) seems to be part and parcel of dawn phenom - my BG will continue rising (slowly) until I eat.

Well, it might be an excuse to get a Libre again for a month. I wanted to do that anyway to see what effect my football was having....

I think this is the key, it only happens between 4 and 6am. Check out this link , in particular:

2. CIRCADIAN AND DIURNAL RHYTHMS IN METABOLISM
2.1. Glucose Metabolism.

You may find this section interesting.

Circadian Regulation of Glucose, Lipid, and Energy Metabolism in Humans

The circadian system orchestrates metabolism in daily 24-hour cycles. Such rhythms organize metabolism by temporally separating opposing metabolic processes and by anticipating recurring feeding-fasting cycles to increase metabolic efficiency. Although ...

www.ncbi.nlm.nih.gov

 

[Melgar]

So @KennyA reading that article I'm minded to think that your insulin sensitivity and glucose tolerance is greater in the AM than later in the day. This has been well documented in other research papers. In metabolically healthy people insulin resistance rises during the day, peaking around dinner time. Your Keto diet will, I'm thinking, allow your body to metabolise fats and glucose in a 'normal' way as with metabolically healthy people, hence the lows in the early hours. If your lows are around 3.5 mmol/ls and do not go any lower that is considered normal. I am also minded to think your glucose reserves will be depleted as you would not have eaten for around 8 hours. Just my thoughts.