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Night time hypos

DaisyChloe

Member
Messages
22
Location
London
Type of diabetes
Reactive hypoglycemia
Treatment type
Diet only
Hello there,

I read, while researching, that if someone has a hypo while asleep and they don't wake up, that they may know they had a hypo because of damp sheets etc.

Does that mean that the person's blood sugar levels corrected themselves in the night? What stopped them going lower? If they were still as low as they were when the hypo started, they wouldn't need to work it out from damp sheets or other signs because they would have their normal hypo signs surely?

I've not been able to find much about this. I'm worried because I sometimes have hypos in the middle of the night just before I fall asleep - what if I was asleep??

Appreciate any responses

Oh, also - I do not take insulin, I have hypos but I am not diabetic, and awaiting further tests.
 
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Hi @DaisyChloe and welcome to the forums.

Your post is interesting and I am wondering if you hypo at other times - after eating for instance? If not taking insulin, are you on any other meds and how long has this been going on for?
 
Yes, @DaisyChloe ,that is an interesting question, and you may well want to have a look at the reactive hypoglycemia forum, which is specifically for people with this sort of problems (non diabetics who produce too much insulin and have blood sugars that go too low).

https://www.diabetes.co.uk/forum/category/reactive-hypoglycemia.70/


The answer (for most people) is a combination of a feedback loop between the pancreas and the liver. You probably already know that if your blood sugar is high the pancreas produces more insulin to bring someone's blood sugar down to normal levels. If your blood sugar is too low, however, the pancreas reduces the insulin and sends out glucagon, which signals the liver to pump out stored sugar, so that your blood sugar goes back up.

This is one reason why diabetics on insulin are warned to be careful with alcohol: if you've been drinking your liver is busy processing the alcohol and not so good at picking up on the glucagon, and a night time hypo can become much more serious.
 
Hi @DaisyChloe,
Good questions!
From my experience and reading, not as professional advice or opinion:
Parts of our brain need glucose as the only fuel that will do. So it one's BSL drops too low for any reason
our body has safety mechanisms in place to help defend these parts of our brain against a fuel shortage.

As @EllieM mentions: glucagon, another hormone from our pancreas gland is activated to release when blood glucose levels start trending low. Also adrenaline is released from the adrenal gland as our hormone for emergencies.
And it is the effects of adrenaline which cause the pallour, sweating, tremour, pounding heart that we tend to associate with symptoms of low bsl.

Both these hormones influence our liver to release stored glucose ( called glycogen) back into the blood stream. This can be so effective that i have witnessed a diabetic on insulin who was having a full- on hypo, whose bsl at the time was 15 mmol/l. Yes, the symptoms from the adrenaline release were still presnt whilst the glucose release from her liver had produced a rebound in bsl from low to high. And this blood test was done before the traditional at the time tea and bikkie were provided.

In one sense this type of scenario is reassuring, that our bodies may be able to handle a hypo without external assistance - i say may because it depends on a whole lot of factors - if i have suffered repeated hypos, my liver may have liw stores of glycogen only.
If i have done some strenous exercise, that may have depleted some muscle glycogen stores and leave me prone to a hypo when my muscle cells demand to have their own, 'in- house'
glycogen depots refilled, depots which are reserved for muscles only, and the exercise may have depleted some of the liver's store of its glycogen, too.

And compared to a non-diabetic, if I am having a hypo, i cannot switch my insulin supply to the blood off. It keeps working and that may make my hypo more prolonged and liver glycogen release less effective.

But hypos can certainly make me hungry and from past experience i am aware that eating to combat a hypo can also contribute to a rebound high bsl. So these days i use gluco-tabs, which are chaulky in taste and do not encourage a 'binge' of sugary food/drink.

Night hypos can be shocking, but when i did not wake, then the damo shhets, umoored from from their tucked-in position, a headache and a high bsl were there to greet me on the new day! And one's sleeping partner woukd not be imoressed either and i was unlikely to sleep through a hypo because i was nit allowed to!

Fortunately on a low carb diet i am now much less prone to hypos, and particulrly to severee ones, because i need much less insulin these days. Less insulin, less swings in bsl.

And i could not agree more with @EllieM, alcohol blocks the liver from releasing glycogen, a very, very dangerous situation - the brain's fuel protective emergency mechanism is temporarily disabled - whikst the brain itself is at some levelof intoxication itself. It is a no-brainer. Do not drink alcohol if you wish to avoid brain damage!

I wish you all the best with the sorting out of your own low bsl troubles. As others have mentioned there is a "Reactive Hypoglycaemia' forum on this site.
 
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urbanracer said:
Hi @DaisyChloe and welcome to the forums.

Your post is interesting and I am wondering if you hypo at other times - after eating for instance? If not taking insulin, are you on any other meds and how long has this been going on for?
Click to expand...

Hello,

Yes I have hypos fairly frequently, multiple times a week. It's been going on since childhood/early teens, but I've always been dismissed as soon as I have a negative test for diabetes. I have evidence now though with a bgl monitor so hopefully I can start getting some help - been trying for more than 10 years...

No medication for it as of yet, I just carry glucose tablets. Blood sugars are never high
 


Thanks @EllieM and @kitedoc for the information, it's really useful. I know quite a bit about the healthy functioning of the endocrine system but finding info that goes into substantial detail about hypoglycaemia, especially non-diabetic, is tricky. Seems to just be symptoms and possible causes, maybe a few hormones mentioned.

I suppose I need to wait and see why my bgls drop before knowing why or how further symptoms do/will affect me.

Glad to hear yours have dropped on your current diet ​
 

Definitely have a look at the reactive hypoglycaemia forum. I'll tag @Lamont D for you, as he is very informed on the subject.
How low do your blood sugars go?

And doctors (endocrine experts anyway) are becoming more informed about folk who suffer low blood sugars. If you can get yourself referred to a consultant you may do much better (GPs are fairly clueless).
 

All the GPs I've seen have been AWFUL! I've just been having a look on that thread, loads to look through.

Annoyingly I never manage to record the worst ones - only recently got given a machine and they either happen when I'm out and don't have it with me, or when the GP wouldn't prescribe more strips so I had to wait until I could afford them. Lowest recording so far is 3, but I'm going to keep it on me from now on
 
@Brunneria and @Lamont D may be able to provide experience and references in your search plus an idea of who are the best doctors to help you sorting out, what is ghappening, what type of tests are useful and what solutions they have found.
Best Wishes
Some of that information will be on the Reactive Hypoglycaemia forum site, plus by using the question box on the right upper corner of the general Forum page, maybe search words like ' hypos at night', non-diabetic hypo, prolonged GTT, OGTT extended etc
 
Hi and welcome @DaisyChloe

If you have already been reading the RH section of the forum, then you probably have a good idea of what we RHers do to control the situation with our eating patterns.

However, there are a number of other things that can cause hypos, or hypo like symptoms, including PMT and other hormone dysfunction and other medications.

As you have probably already seen, there are ways to identify RH (and all those other conditions). RHers with an official diagnosis have usually had those other conditions ruled out, and gone through a prolonged glucose tolerance test to monitor what actually happens to the blood glucose for hours after eating.

Hopefully with some evidence of hypos recorded on your glucometer, you can nudge your doc into referring you to somewhere able to carry out and interpret the further tests.

You have my sympathy - it is often a very uphill struggle to get anyone to take hypos seriously if we don't have diabetes. Some people even believe that hypos without medication to cause them are impossible - but we are living proof that they are wrong.

One point of hope though - if you do have RH, then you may well be able to get good control of it, and be rid of the endless misery of hypos, by adjusting your eating and removing the triggers that lead to the hypos. I have. And you will find quite a few other members who have found the same. And you don't need a diagnosis or a doc's permission to try some low carb experiments and see whether the hypos diminish.

Keep reading, and best wishes getting your doc to refer you.
 
Hi,

Yes I’ve been having a read, it’s all quite overwhelming really and I’m doing a lot of speculating because I don’t know the cause yet. I’m hoping to get a referral to an endocrinologist.

It’s good to hear you’re managing well, and others on the forum
 

I wanted to ask as well- you have RH, when you say blood sugars rising then falling, is that rising above 7 and falling below 4? Or rising a ‘normal’ amount and then falling below 4?

And is RH considered the case if it’s within 5 hours after eating or is it less time?
 

RH varies between different people.
So some people with RH get high then low blood glucose. While others get not-high, then low blood glucose.
As I understand it, it isn't the height of the blood glucose rise that triggers the hypo, it is the amount of insulin produced.

Ideally, we should all produced exactly the correct amount of insulin to keep our bg steady while dealing with the amount of glucose released into the bloodstream from food or glucose stores in the liver or big muscles. In a perfect world, there would be a balancing act where glucose was released, or tucked away for storage (by the action of insulin), and our bg would stay fairly steady and in the 'normal' range.

But when we get bg dysregulation, all sorts of things can go wrong. If bg rises before the insulin kicks in, then that is when RHers get high bg after eating. But if the insulin is released at the correct time, then no 'spike' in bg occurs.

However, with a lot of RHers, including both of the two groups I mentioned in the last paragraph, the amount of insulin produced is excessive. So there is more than is needed, which tucks too much of the glucose away - removing it from the blood stream, and causing a hypo because the blood glucose is now too low.

Again, in an ideal world, the body produces exactly the correct amount of another hormone called glucagon. This acts as an insulin antagonist, and stops insulin from working. Which prevents too much glucose being tucked away, and prevents a hypo. But some RHers may have a problem with glucagon production too...
https://www.endocrineweb.com/conditions/diabetes/normal-regulation-blood-glucose

So for a Rher, it is the excess insulin production, followed by the body's inability to prevent the blood glucose dropping too low, that is the cause of the hypo. Even if their blood glucose never rises high, they have produced more insulin that necessary => hypo

Therefore, for those of use who can control it by diet, the answer is often to simply avoid eating in a way that triggers excess insulin production. And since carbs, particularly quick release carbs such as potato, rice, pasta, bread, cakes, sugar, sweet fruit, etc. are what trigger insulin release, by avoiding eating those we can avoid the ensuing hypo.

You asked if a hypo is glucose levels falling below 4.
The answer is 'maybe'.

People with diabetes who are on glucose lowering medications, such as insulin or gliclazide, are told to treat a number below 4 as a potential hypo, since their medication may be working to lower their blood glucose further.

People not on glucose lowering medications (i.e. non diabetics) rarely get hypos at all, and may have blood glucose in the 3s with no problems. They feel fine, and (since they never test their blood glucose) may spend quite a lot of their lives with sub-3 blood glucose. Or be in the 4s, 5s, and 6s... Whenever their bg dips a little, their body takes care of it, by any one of the following; hunger, reducing activity levels, releasing stored glucose from the liver stores, releasing a bit of adrenalin to trigger those glucose stores to release, releasing glucagon, or even by continuing to digest the meal they ate an hour or two ago.

RHers's bodies will do all of those things, but since they have a bit of glucose dysregulation somewhere in the complex balancing act, they dip lower, into hypo territory before their own body, or their own hunger, brings the blood glucose back up.

As for 'what constitutes a hypo for an an RHer', I suspect you would get very different answers depending on who you spoke to.

For myself, after 40+ years of RH, my body has decided that it DOES NOT LIKE going below 5mmol/l and will release glucose from stores to bring my blood glucose back up to above 5.
But I don't call it a hypo, just a 'bit lower than usual, and maybe feeling like I want to eat'.
However, I have on occasion (v rare nowadays since I usually have things under control) measured blood glucose in the 1s and 2s, and those were most definitely hypos, which a whole host of hypo symptoms.

If I find myself dipping a bit low (or heading for a hypo like an out of control train), then I eat something. Nuts, or a little very dark chocolate, or a coffee with cream. I do NOT fall head first into a pile of sweets, or a lucozade, since eating carbs would just cause another insulin over reaction, and a short time later I would be back in hypo-land.

Sorry this post has been so long!
Hope I have answered in a way that makes sense.
 
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kitedoc said:
Hi @Brunneria and perhaps on behalf of @DaisyChloe, do you find that the rate of fall of BSL as well as the actual level the BSL reaches can cause symtoms of hypoglycaemia?
Click to expand...

Yes.
That is often called 'a false hypo' and can happen when bg dips lower than we are used to (but not actually low enough to be classed as a hypo), or when blood glucose is dropping fast (but before dropping low enough to classed as a hypo).

Fortunately, I now (usually) recognise what is happening and eat something (nuts, dark choc, a coffee with cream, or a protein snack) before my blood glucose level drops into hypo territory.

Although my best defence against RH is definitely to avoid eating the foods that set the roller coaster off in the first place - which for me means eating very low carb/keto AND gluten free.
 

Not one GP has been useful to me, so it's no wonder that you are having difficulty getting any answers!
Hi, and welcome to our forum.
Most GPs don't get or have the training to recognise any form of Hypoglycaemia.
You need that referral to a specialist endocrinologist who has experience with Hypoglycaemia, because only a specialist can authorise the tests necessary for a true diagnosis, as has been posted already! There are endocrinologists who are not up to date with the latest knowledge about hypoglycaemia! (Which is a bit frightening!)
I had a specialist who never realised or had a clue what was happening to me!
I was lucky to find my second endocrinologist, who witnessed me having a hypo in front of him, and helped me so much afterwards.

There are other tell tale symptoms of hypos through the night, such as toilet visits, sweating, hunger, and others including very vivid dreams.
But none of us are the same, we all have different symptoms.

What you describe, during the day and of course the night, could be your blood sugar levels going continually up and down, rapid rises and then sudden drops are the cause of the symptoms. Taking glucose tabs, as a quick fix, will result in the fluctuating blood sugar levels.
If you are ploughing through the RH forum, the recurring theme is food and how to avoid the rollercoaster ride of fluctuating blood sugar levels.

I am non diabetic, have RH, and if I eat or drink the wrong foods, I will trigger the excess insulin, if I avoid these foods, I don't!

It's not easy but it can be done!

Hope this helps, again, read the forum and best wishes.
Let us know how you get on!
 
DaisyChloe said:
I suppose I need to wait and see why my bgls drop before knowing why or how further symptoms do/will affect me.
Click to expand...

Just a thought, and one reason why you need to see an endocrinologist for diagnosis. There are other possible reasons than RH for repeated hypos. For example, there is a (rare) condition called insulinoma where a small (benign) tumour in the pancreas makes you produce too much insulin. This is curable by the removal of the tumour. You really need to get your GP to refer you to a specialist, as most GPs are pretty clueless about diabetes, let alone conditions where the insulin feedback loop is not working quite correctly.
 
I'd never heard of reactive hypoglycaemia until I read this post. I usually wake up in the early hours (about 3-4 am), hot and sweaty. I'm usually pretty groggy at this time. I also have to get up for the toilet at least twice during the night AND I frequently have seriously frightening dreams. In fact, I told my son, only last night, "I don't want to go to bed and sleep, in case I have another frightening dream." I very rarely get to bed before midnight - not because of the dreams, but because I got used to staying awake late when I nursed my husband and fill my time with other things, and I tend to eat quite late in the evening - about 9 pm.

Does this sound anything like reactive hypoglycaemia? Or does it sound like a medication issue - I am on insulin, metformin, diltiazem, furosimide, spironolactone, simvastatin, esomeprazole and levothyroxine.
 
Since I have been lucky enough to have my Flash Libre system, I find that my blood glucose level drops during the night and often the sheets are damp. I am type 1 and always use my monitor before going to bed. depending on the level I take one or even two Glucotabs and these help get me through the night without going hypo but even then the reading on waking can be as low as 2.3.
The medical profession by and large are still very ignorant about diabetes, hypos etc so your best source of information is this Forum where there is a lot of very useful information and members who are always ready and willing to help so use it as much as you can.
I wish you the very best of luck and damp sheets never killec anyone as far as I know!!
 

Hi,

Since you are on insulin injections, i would suggest that it is highly unlikely that you have RH, because RH is when we have an overproduction of our own natural insulin.

Having said that, a hypo is a hypo is a hypo. So if your blood glucose is going low enough at night that you experience a hypo, then you may need to adjust your insulin.

But first, I strongly recommend that you test your theory that these symptoms are caused by blood glucose levels. Test at bedtime, test when you wake in the night, and test on waking. Track everything.

I had no idea that my own 2.30am sweaty wake ups and nightmares were due to blood glucose until I was able to sleep with a Libre sensor on my arm - at that point the hypos could clearly be seen.

Your medications suggest that you have an underactive thyroid, and maybe PCOS, and are on a statin? So there are several factors in play which may be affecting your blood glucose on top of the insulin injections and your food intake. And the thyroid and the PCOS could be producing symptoms that are very similar to a hypo.

Also, though I am no expert on insulin injections, i know there are several different brands, with different speeds of release (profiles), and some people benefit from changing the timing of their basal injections or splitting the dose to prevent hypos or hypers during the night.

You may want to check with your health team about what they suggest.
 
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