Concerns following a long overnight Hypo

[Chris501]

Hello,

Whilst I was sleeping my blood sugars had dropped below 3.9 mmol/L for about 2.5 hours. 3 mmol/L was the lowest I reached during this period. I was absolutely exhausted and slept right through my alarms and only noticed when got up to get a drink of water. I use a FreeStyle Libre 2 sensor to monitor my sugars. Naturally I am very frustrated with myself! I am very worried however, in thinking of the amount of damage something like this can do! Asking for honest opinions on this matter on what type of damage can arise short-term and long-term from a hypo like this? Is this something you will just recover from without any issues? Please say it as it is! I also attached a screenshot of what happened from my glucose sensor. Many thanks for your help and support!

Best Regards

Chris

 

[Pipp]

Hello @Chris501.
I am sorry you haven’t had any replies yet. I have no advice to offer, but will tag some members who may be able to help from their own experience of insulin use and hypos.
@EllieM , @Antje77, @Juicyj, @Jaylee, @InResponse, @Hopeful34 , are you able to offer any advice support for @Chris501, please.
Not limited to these members. Anyone who has experience and knowledge would be welcome to give advice.
Thanks.

 

[ElenaP]

Hello,

Whilst I was sleeping my blood sugars had dropped below 3.9 mmol/L for about 2.5 hours. 3 mmol/L was the lowest I reached during this period. I was absolutely exhausted and slept right through my alarms and only noticed when got up to get a drink of water. I use a FreeStyle Libre 2 sensor to monitor my sugars. Naturally I am very frustrated with myself! I am very worried however, in thinking of the amount of damage something like this can do! Asking for honest opinions on this matter on what type of damage can arise short-term and long-term from a hypo like this? Is this something you will just recover from without any issues? Please say it as it is! I also attached a screenshot of what happened from my glucose sensor. Many thanks for your help and support!

Best Regards

Chris

Do not worry. No damage would have been caused. Just keep a record of any low episodes and flag them up to your hospital diabetes nurses. They may want re-adjust your insulin doses. Although sometimes night-time lows happen purely if you have had extra exercise during the day, such as a walk.
Just popped in to add that it may have even been a 'compression low', i.e. you may have been sleeping on the arm where you have the Libre. Always check you Libre readings with a finger-pricker glucose monitor if you are awake.

 

[Jaylee]

Hello,

Whilst I was sleeping my blood sugars had dropped below 3.9 mmol/L for about 2.5 hours. 3 mmol/L was the lowest I reached during this period. I was absolutely exhausted and slept right through my alarms and only noticed when got up to get a drink of water. I use a FreeStyle Libre 2 sensor to monitor my sugars. Naturally I am very frustrated with myself! I am very worried however, in thinking of the amount of damage something like this can do! Asking for honest opinions on this matter on what type of damage can arise short-term and long-term from a hypo like this? Is this something you will just recover from without any issues? Please say it as it is! I also attached a screenshot of what happened from my glucose sensor. Many thanks for your help and support!

Best Regards

Chris

Hi Chris,

OK, so you are here with us surviving to tell the tail..

Did you treat the hypo when getting up for the drink?
How long have you been using insulin?
There can be a lag with Libres after treating & recovery from a low. It seems that interstitial fluid which a sensor measures is last on the list as blood sugars come back up, the brain being priority..?
2.5 hours seems a little too long to be a false pressure low. Caused by lying on the sensor. There could be a possibility there was a liver dump keeping you out of totally going under with a possible seizure? Or possibly your basal dose backed off backed off to bring you round & awake? (Assuming the bolus dose wore off from supper.)

I’m not a “doom & gloom merchient.”

Just covering certain possibilities from personal experience looking at your graph…

 

[becca59]

@Chris501 it happens. Sometimes we are aware and treat. Other times we are unaware. Years ago before all the technology we have today diabetics had many more of these events and would be totally unaware. Today technology is in our face allowing us to micro manage and ultimately worry far more.
My advice would be stop worrying about what has happened, it would take dozens of these events to incur terrible effects. Instead concentrate on finding out why. Why did you not hear your alarm? What do you have it set at for lows. I personally set mine at 4.9 at night as I can then assess and head any problems off at the pass relatively quickly. Perhaps look at your basal needs. Do you always dip in the night or is this a one off? If it’s a one off did you still have bolus insulin working when you went to sleep? Any alcohol involved? Had you had a heavy days exercise?
Look at solving rather than worrying about what has happened that you cannot change.

 

[Jaylee]

Why did you not hear your alarm?

Good question. One reason can be blue tooth ear buds (or BT “cans.)
I find with mine, they don’t always switch off when put back into the case to charge? One can remain tethered.

I always check the headphone icon isn’t present along with setting my alarm to wake for work.
Other wise it can play Inaudibly though an ear piece in the other room.
Unless the battery has run flat due to not charging?

 

[SimonP78]

I very often ran low overnight while at school and university (my hba1c was consistently below 5% - effects of old-school insulins and lots of activity, and at university alcohol and dancing). I've not noticed any problems, though I do now manage to avoid going low quite so often (especially at night) with faster insulins in pens and CGM alarms. I wouldn't worry too much.

 

[Captain_Sensible]

Do not worry. No damage would have been caused. Just keep a record of any low episodes and flag them up to your hospital diabetes nurses. They may want re-adjust your insulin doses. Although sometimes night-time lows happen purely if you have had extra exercise during the day, such as a walk.
Just popped in to add that it may have even been a 'compression low', i.e. you may have been sleeping on the arm where you have the Libre. Always check you Libre readings with a finger-pricker glucose monitor if you are awake.

Hi Chris I've had Type 1 64 years! I've had plenty of really bad hypos in my time & been unconscious for hours sometimes- waking up - not knowing where you are- trying to get up- take some carbs etc- have a good sleep to recover fully- anybody near fussing - feeling freeezing cold etc etc . I guess the liver dump came to my rescue on a few occasions, so I don't think you need worry unduly but I would get your Db nurse or doc to adjust your insulin downwards. Libre 2 is good- make sure it's on full volume and well charged before you go to bed.

 

[Tony337]

Hi
Another old hack here but only 50 years a type 1. lol
There are too many variables to the cause and too many possibilities relating to the accuracy of the libre and blood machines so lets look at the affect or is it effect i always get those two mixed up.
Anyhoo 50 years in most of which without current tech im 56 fit as a trombone driving and working.....

When things go wrong as they surely do i just pick myself up dust myself down and start all over again.

I've never been hospitalised either and when i think back to when i was in my twenties i was just plain lucky whereas now my last hba1c was 42 which takes a bit of thinking about.

I do wonder these days what healthy non diabetics think about all day?

Food for thought?

I wish you well

Tony

 

[SimonP78]

I do wonder these days what healthy non diabetics think about all day?

TikTok? Perhaps we're the lucky ones after all

 

[AndyC123]

Hi - I'm a newbie and this is my first post, so hello to all

I've only been using Insulin for a few months, and I'm also having increasingly frequent night time hypos. Typically these events are accompanied by night sweats, so I find that my Libre alarm (set to 4.1) is going off around 3AM and I wake up to find I am in soaking wet bedsheets.

I am on a Basal / Bolus regime, but my numbers are fairly low. I'm current taking 8 units of Basal a day and normally, on average, around 3 units of Bolus with a meal. During the day my blood sugars are usually within range, but I am noticing the occasional dip where I need to pop a glucose tablet or two to stay in range.

Should I consider lowering my Basal units? I'm assuming that at night I've got too much Basal insulin in my body which is causing the problem, but I appreciate that might be an over simplistic way at looking at the problem.

Thanks in advance for your comments.

 

[EllieM]

Hi @AndyC123 and welcome to the forums.

I have to be very careful what I say as I am T1 on insulin and not T2 (so I am cross posting) and also because we aren't allowed to give medical advice on the forums.

Having said that, as a long term insulin user I find that too many hypos can make me lose my hypo awareness, which is really undesirable, as though I use a cgm I don't want to have to rely on it to forestall them.

So I would definitely want to avoid hypos as much as possible and reduce insulin or increase carbs if I was getting regular hypos at certain types of day. Are you able to discuss your night time hypos and your insulin doses with your diabetic team, with particular reference to your basal dose? (Most fast acting bolus insulins run out after about 5 hours.)

As you are on very low doses you may also want to ask your team about insulin pens that dispense in half units, which are available for some insulins.

Once more, welcome.

 

[AndyC123]

Hi @AndyC123 and welcome to the forums.

I have to be very careful what I say as I am T1 on insulin and not T2 (so I am cross posting) and also because we aren't allowed to give medical advice on the forums.

Having said that, as a long term insulin user I find that too many hypos can make me lose my hypo awareness, which is really undesirable, as though I use a cgm I don't want to have to rely on it to forestall them.

So I would definitely want to avoid hypos as much as possible and reduce insulin or increase carbs if I was getting regular hypos at certain types of day. Are you able to discuss your night time hypos and your insulin doses with your diabetic team, with particular reference to your basal dose? (Most fast acting bolus insulins run out after about 5 hours.)

As you are on very low doses you may also want to ask your team about insulin pens that dispense in half units, which are available for some insulins.

Once more, welcome.

Thanks Ellie - I have already reached out to my Diabetic team, so hopefully they will respond soon. I have the NovoPen Echo for my Bolus injections, which dispenses in half unit increments. My Basal pen is only full units at the moment. Thanks again for your prompt and full reply and your kind note of welcome

 

[mkashani]

Hello,

Whilst I was sleeping my blood sugars had dropped below 3.9 mmol/L for about 2.5 hours. 3 mmol/L was the lowest I reached during this period. I was absolutely exhausted and slept right through my alarms and only noticed when got up to get a drink of water. I use a FreeStyle Libre 2 sensor to monitor my sugars. Naturally I am very frustrated with myself! I am very worried however, in thinking of the amount of damage something like this can do! Asking for honest opinions on this matter on what type of damage can arise short-term and long-term from a hypo like this? Is this something you will just recover from without any issues? Please say it as it is! I also attached a screenshot of what happened from my glucose sensor. Many thanks for your help and support!

Best Regards

Chris

hi,
A diabetic type 2 / 65 yrs. I have similar observation using Libra 2 Plus sensor. I don't know the reason yet, so I am just reporting what seems to be a similar issue. I have low sugar alarm set to 3.8 mmol/l. I seem to hit this level or lower ( 3.7 mmol/l), every night at around 3 am it usually lasts for 1/2 hr ! rises to 7 - 7.5 in the morning. I do worry sometimes that I may drop dead during one of these hypo( < 4.0 mmol/l) incidents! My GP couldn't explain why, except to say it could be medications interaction! I have my diabetes review next month. ( I take heart medication, blood pressure and cholesterol..)

Regards

 

[SimonP78]

I've only been using Insulin for a few months, and I'm also having increasingly frequent night time hypos. Typically these events are accompanied by night sweats, so I find that my Libre alarm (set to 4.1) is going off around 3AM and I wake up to find I am in soaking wet bedsheets.

I am on a Basal / Bolus regime, but my numbers are fairly low. I'm current taking 8 units of Basal a day and normally, on average, around 3 units of Bolus with a meal. During the day my blood sugars are usually within range, but I am noticing the occasional dip where I need to pop a glucose tablet or two to stay in range.

Should I consider lowering my Basal units? I'm assuming that at night I've got too much Basal insulin in my body which is causing the problem, but I appreciate that might be an over simplistic way at looking at the problem.

If it were me I would reduce my basal, the worst that will happen is that you run high the following day. Do you inject basal in the evening? What type is it? Some are not completely flat, so moving to a morning injection might reduce the activity of the basal overnight.

 

[SimonP78]

A diabetic type 2 / 65 yrs. I have similar observation using Libra 2 Plus sensor. I don't know the reason yet, so I am just reporting what seems to be a similar issue. I have low sugar alarm set to 3.8 mmol/l. I seem to hit this level or lower ( 3.7 mmol/l), every night at around 3 am it usually lasts for 1/2 hr ! rises to 7 - 7.5 in the morning. I do worry sometimes that I may drop dead during one of these hypo( < 4.0 mmol/l) incidents! My GP couldn't explain why, except to say it could be medications interaction! I have my diabetes review next month. ( I take heart medication, blood pressure and cholesterol..)

I find that libre sensors often read lower that actual BG level (fail safe from their point of view, with the immediate risk of a hypo being greater than a hyper.) How close are your daytime libre readings to finger prick BG values?

You also be getting "compression lows", where lying on the sensor produces artificially low readings.

 

[EllieM]

I do worry sometimes that I may drop dead during one of these hypo( <

Some non diabetics regularly have sugars going down to 3.5 , they just feel hungry. The reason that hypos are defined as under 4 (or 3.9 if you are in the US ) is that bgs may go much much lower if you are on insulin or certain other glucose lowering meds. The study below looked at the cgm readings of a set of healthy non diabetics.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7296129/ median time spent with glucose levels <70 mg/dL (3.9 mmol/L) was 1.1% (15 min/d).

 

[AndyC123]

If it were me I would reduce my basal, the worst that will happen is that you run high the following day. Do you inject basal in the evening? What type is it? Some are not completely flat, so moving to a morning injection might reduce the activity of the basal overnight.

Thanks Simon - I had reached the same conclusion myself - I've already lowered my Basal from 8 to 6 units, so I'll monitor things and see what happens. I inject my Lantus Basal in the mornings.

 

[jane d]

Try a glass of milk at bedtime. I discovered night time hypos when I started on the libre system. I wondered why I felt so rubbish on a morning when my levels were fine. Its probably not recommended, but I have found that a small amount of chocolate late evening works wonders, the fat content slows down the sugar absorption, so it arrives at the right time.

 

[AndyC123]

Try a glass of milk at bedtime. I discovered night time hypos when I started on the libre system. I wondered why I felt so rubbish on a morning when my levels were fine. Its probably not recommended, but I have found that a small amount of chocolate late evening works wonders, the fat content slows down the sugar absorption, so it arrives at the right time.

Thanks Jane - I'll certainly give it a try - much appreciated.