Hypo

[No1DeadlyPoison]

Hey everyone! This is the longest hypo I think I have ever had! Has anyone else had a hypo for this long without waking up? Slightly worring if I am honest!

 

[MarkMunday]

Why is it worrying? It looks like your liver supplied the required glucose and you came out of the hypo. This is what is supposed to happen.

 

[Juicyj]

Hi @No1DeadlyPoison did you feel as though you had been hypo when you woke up ? Libras are well known for reporting false hypos if compressed during sleep - I had quite a few when I wore one so if it’s a repeat pattern then action is required but if a one off and not verified by a glucose meter then safe to assume it wasn’t a hypo.

 

[ert]

I would start setting a couple of alarms overnight to check by a finger prick to investigate if this is something that's still occurring.
Some Freestyle Libres run high, and some low, depending on the sensor.
I use X-Drip or Glimp phone apps as they calibrate the data - you can enter your finger prick value and it changes your graph.
It's worth contacting your diabetes nurse to ask about your background insulin. They may ask you to eat low carb at dinner to check your dosing.

 

[EllieM]

Some Freestyle Libres run high, and some low, depending on the sensor.

And some sensors read low if you lie on them for prolonged periods...

 

[No1DeadlyPoison]

I tend to have hypos either in the night or early hours of the morning. I did feel like I had had a hypo, been feeling pretty ****** all day. I have scanned my sensor when it has read low before and then checked with my meter to make sure I was and it has always been right. I think I'll need a change the carb ratio of my meter. Thank you for your replies.

 

[MarkMunday]

... I tend to have hypos either in the night or early hours of the morning. ... I think I'll need a change the carb ratio of my meter. ...

Sounds like you could be getting too much basal insulin action overnight. Basal testing would help figure that out. It helps to ensure basal coverage is good before changing carb ratios and boluses. You may not even need to change it.

 

[JMK1954]

Overnight hypos are dangerous. My sister died as a result. Please do something about this at once. DSNs always say a hypo 'should' wake you, but there is no guarantee it will.

 

[Fairygodmother]

What kind of basal insulin are you using @No1DeadlyPoison? When do you inject it? Have you had many overnight hypos, even if they’ve not been as prolonged as this one? (The post-hypo symptoms the next day are really good to avoid.)
As already said, a basal test might clear up the question of whether and how much to reduced the dose.
Different basal insulins have different profiles, so this might also be something to consider.

 

[KK123]

Overnight hypos are dangerous. My sister died as a result. Please do something about this at once. DSNs always say a hypo 'should' wake you, but there is no guarantee it will.

I agree and there's no guarantee your liver will kick in and release glucose either so yes, night time hypos are serious and need attention especially if they are happening frequently. x

 

[Juicyj]

@No1DeadlyPoison You certainly know about it the next day if you've been low - also curious to see which basal you're using ? The best basal for avoiding night time hypos is tresiba due to it's flat extended profile, worth having a chat with your nurse and seeing if you can switch, agree it's vital to avoid them during the night so a call to your team today would be advisable.

 

[MarkMunday]

... there's no guarantee your liver will kick in and release glucose ...

Why not? It happens to all of us every night. After carbohydrate from the last meal has been used up, blood glucose falls and blood glucose falls. The liver releases glucose to keep the body ticking over while we sleep and until breakfast. You ever heard a non-diabetic not waking up because of low blood glucose?

 

[KK123]

Why not? It happens to all of us every night. After carbohydrate from the last meal has been used up, blood glucose falls and blood glucose falls. The liver releases glucose to keep the body ticking over while we sleep and until breakfast. You ever heard a non-diabetic not waking up because of low blood glucose?

Hi Mark, I do know that but there is still no guarantee that enough glucose will be released to get you out of a hypo so it certainly cannot be assumed. For example my Mum (described as a brittle diabetic) was found numerous times unconscious having suffered a hypo during the night and was whisked off to hospital several times. On some occasions her liver had released glucose enough to bring her round in the morning but on some occasions nowhere near enough, if at all. My point was that should anyone really be relying on an 'Oh well, if I go very low during the night I'll be fine because my liver will release glucose'?, how do you account for those that unfortunately haven't survived? I always say a hypo, especially a severe one is dangerous no matter what time of the day but especially when you are asleep and unable to do anything about it. What about a severe hypo during the day then?, are we told to do nothing and wait for our livers to kick in or are we told to eat fast acing carbs immediately? As for never having heard of a 'non diabetic' not waking up because of low blood glucose, well no, I haven't because they are not having to take a medicine that risks continued lowering of glucose regardless of whether it's already low.

 

[Circuspony]

Why not? It happens to all of us every night. After carbohydrate from the last meal has been used up, blood glucose falls and blood glucose falls. The liver releases glucose to keep the body ticking over while we sleep and until breakfast. You ever heard a non-diabetic not waking up because of low blood glucose?

Well not a non diabetic, but its a different story when many of us have injected insulin floating around confusing our endocrine system.

My Sister in law's cousin died from an overnight diabetic hypo the same month I was diagnosed T1. She couldn't bring herself to mention what he died of for over a year....

 

[JMK1954]

In a person who is not a diabetic, insulin is produced by the body to deal with any carbohydrate eaten and the blood glucose level is maintained at a steady level by releases of glucagon and insulin, in response to tiny changes. Only 'fine-tuning' is required, ie. tiny adjustments. In a diabetic on MDI, a ''job lot' of insulin is injected all at once to cover the carbohydrate in a meal. Most of the time this more or less works, or none of us would be here, but it's not how our bodies were designed to work.

The glucagon produced naturally deals with small drops in blood sugar level in every normal person, but no non-diabetic wakes up feeling the way we do after a over-night hypo ! In this situation, the liver is likely to have been forced to produce glucose for several hours, to cover the continued action of the insulin. In my experience, the longer we have experienced low blood glucise levels, the worse we feel afterwards.

A dramatic drop in glucose level overnight can happen and is life-threatening , because the individual concerned is not eating and unaware of what is happening. I have read that if you have had an unusually active day, you may be liable to abrupt drops in blood glucose for more than 24 hrs.afterwards, which will always include a period of sleep. I can confirm this from personal experience. I know myself that after a series of exams finished I would always have an overnight hypo, as a reaction to the sudden ending of a period of stress. In addition, some of us are more sensitive to insulin than others. Our insulin requirements change over time and other hormones affect them. We are not all the same, we eat differently and live different lives, with different amounts of physical activity. We take different amounts of different insulins, (at different times) that have different profiles. Because of all of this, I don't believe anyone should regard a hypo during the night as less than dangerous. We cannot know what the future consequences of such advice will be.

 

[KK123]

In a person who is not a diabetic, insulin is produced by the body to deal with any carbohydrate eaten and the blood glucose level is maintained at a steady level by releases of glucagon and insulin, in response to tiny changes. Only 'fine-tuning' is required, ie. tiny adjustments. In a diabetic on MDI, a ''job lot' of insulin is injected all at once to cover the carbohydrate in a meal. Most of the time this more or less works, or none of us would be here, but it's not how our bodies were designed to work.

The glucagon produced naturally deals with small drops in blood sugar level in every normal person, but no non-diabetic wakes up feeling the way we do after a over-night hypo ! In this situation, the liver is likely to have been forced to produce glucose for several hours, to cover the continued action of the insulin. In my experience, the longer we have experienced low blood glucise levels, the worse we feel afterwards.

A dramatic drop in glucose level overnight can happen and is life-threatening , because the individual concerned is not eating and unaware of what is happening. I have read that if you have had an unusually active day, you may be liable to abrupt drops in blood glucose for more than 24 hrs.afterwards, which will always include a period of sleep. I can confirm this from personal experience. I know myself that after a series of exams finished I would always have an overnight hypo, as a reaction to the sudden ending of a period of stress. In addition, some of us are more sensitive to insulin than others. Our insulin requirements change over time and other hormones affect them. We are not all the same, we eat differently and live different lives, with different amounts of physical activity. We take different amounts of different insulins, (at different times) that have different profiles. Because of all of this, I don't believe anyone should regard a hypo during the night as less than dangerous. We cannot know what the future consequences of such advice will be.

Hi JMK, I absolutely agree. When we have hypos during the day we have to act rapidly and aggressively but at least we may feel it in advance and be able to act. When we are asleep we cannot rely on ourselves immediately waking up to rectify it, if we go low it is effectively a drug overdose (insulin or glucose lowering drug) so does someone who has overdosed rely on their metabolism to kick in and save the day? Nope. I personally feel that implying this is dangerous especially to newbies or those not yet fully conversant with how it all works. x

 

[MarkMunday]

Hypos come with the territory, they can have unfortunate consequences and must be avoided if possible. The important point is that if, for whatever reason, a hypo is not treated you will survive. The average liver can supply 130 grams of glucose, enough to deal with a severe hypo. In the absence of a complicating co-morbidity, this always happens. So there is no need for unnecessary anxiety over this. You won't die because of a hypo.

There are cases where people go to bed, are thought to go hypo and don't wake up. So called dead-in-bed syndrome. Yes, hypos during the night may be an aggravating factor. But the underlying problem is thought to be an otherwise benign congenital heart defect. The heart stops beating because of the defect. It is very rare and happens to people under age 30.

Low blood glucose by itself is not that dangerous, even if a lot of insulin is driving it down. Suicide attempts using insulin are seldom successful. While a large amount of insulin may cause passing out, the person doing it is usually discovered in time. Don't let the alarmist media and social networking narrative on this freak you out.

 

[Juicyj]

Low blood glucose by itself is not that dangerous,

Mark I disagree, hypos starve the brain of glucose, this is incredibly dangerous and can cause seizures and unconsciousness - relying on the livers ability to produce a response whilst sleeping is like playing Russian roulette and shouldn’t be relied upon, it’s vital to wake and treat the hypo.

 

[MarkMunday]

... hypos starve the brain of glucose, ... it’s vital to wake and treat the hypo.

No one disagrees with that. However, it is helpful to understand what happens during hypos so we know what risk may be involved should a hypo not be promptly treated.

The unpleasant and scary hypo symptoms we all have experienced are not actually caused by the brain being starved of glucose. They are part of the stress response that, if given time, pumps glucose into the bloodstream. The paranoid thoughts, anxiety and sweating are caused by stress hormones - cortisol and epinephrine. These same hormones promote glycogenolysis : the conversion of liver glycogen to glucose that is released into the bloodstream.

Passing out is a defense mechanism for conserving scare blood glucose, a situation that rectifies itself by utilising stored glycogen. The stress response starts well before glycogenolysis gets underway, which is why hypos are often over-treated. Hypo driven anxiety prompts excessive consumption of carbs which, together with liver glucose, causes blood glucose to go very high. AKA the 'rebound effect'. When you sleep through a low and have high blood glucose in the morning, it is called the 'Somogyi effect'. Sound familiar? Yes, hypos can cause seizures. They can also cause accidents if they happen during the day. So precautions should be taken to avoid them.

Neuroglycopenia (glucose starvation of the brain) occurs when blood glucose is 1.1 mmol/l. You ever seen such low blood glucose? Stress hormones from it would wake the deepest sleeper. Most people treat their hypos well before this level is reached because of stress response symptoms.

We are advised to not let blood glucose fall below 3.5. The reason for it is that lower blood glucose down-regulates the hypo stress response, making hypos harder to recognise and treat promptly. It has nothing to do with the brain being starved of glucose.

I have 'hypo unawareness' from too many hypos as well as age. I am able to function comfortably below 2.5. The brain gets enough glucose and there is no stress response. It is a precarious situation to be in, especially if lots of carb is consumed and bolus insulin used. I have not been able to regain hypo awareness and my solution is to eat very low carb. That way blood glucose never changes fast and testing every 2 hours is adequate.

Yes, we should take precautions, be responsible, be vigilant and act promptly when blood glucose goes out of the target range. I have been working at this for 43 years. Sometimes life gets in the way, though, so don't be too concerned if for whatever reason a hypo isn't treated.

 

[Juicyj]

@MarkMunday I am not disputing the symptoms of low blood glucose I was simply concerned that your view that hypos are not dangerous is in itself a dangerous statement, the fact that the brain is starved of glucose when it needs a constant supply and can cause starvation which can trigger seizures etc means this needs to be a priority for all t1's to be aware of. My DSN always questions the amount and range at which I am hypo, I pressed her once on this and she stated that it can cause brain damage, there is research now available to the NHS hence the focus on this element with patient care, I am unsure if this is the article in question, but it does highlight the point: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1838950/#:~:text=Hypoglycemia commonly causes brain fuel,of fuel deprivation per se.

Operating with no hypo awareness is in itself dangerous as you can put yourself at risk particularly if exercising as well as with sleep and you sacrifice your driver's licence as well. A member who used to post here reported having no hypo awareness so had hypos in her sleep and posted a few times about having seizures as well as vomiting episodes, as she lived alone it was a grave concern.

Although vital to treat hypos, we know as functioning t1's that this isn't always possible, I myself experienced one from around 2.30am this morning till waking, but didn't awake to treat, this is the reality of living with this condition.