Night time hypos

[jessie]

Hi,

I've noticed a few questions on here recently, amongst other threads, about night time hypos so I thought I'd start a new topic.

As a newbie (and maybe for everyone else?), the idea of having a hypo during the night is petrifying. I spoke to my consultant about this last week, telling her that I often run my BS a little high in the evenings to avoid a hypo. She told me it was an irrational fear.

I had my first one last night, after testing 9.9 at 10pm I took 1 unit of Novorapid to bring my blood sugar down a bit. At 11.30 I was 6.9 so I went to bed thinking all was OK. I woke however at 1.30am to use the bathroom and on standing up realised that my BS was very low. Managed to test (1.9) and drink Lucozade (kept under pillow) and had a midnight feast of half a cereal bar. What worries me is that I only woke up as I needed to use the bathroom.

People have advised before that your body will always wake you up when you get low, but you can't help but think 'what if'...

I live alone and it is something that genuinely scares me, I'm sure others feel the same?

Jessie. x

 

[farmerfudge]

I'm certain I have regular hypos in the night while I sleep. I've woken on 2 occasions in the morning and my tongue is swollen as it seems I was biting down on it; also you just have that post-hypo feeling that you'd get when your consious that can only be explained away by a hypo occurence. I dont worry about it too much because I was told that the body will work through the excess insulin eventually. There's no point adding a fear of nighttime hypsos to the list of things to worry about if your diabetic already in my view.

 

[totsy]

i do have to say before i went on basal bolus i was having awful nighttime hypos, i would drop to under 2 most nights and noone knew why,
this petrified me as i lived alone with my kids, although i was always woken by my hypos, at the time i did look into a medical phone and hypo alert watch, the medical phone would ring every morning at a certain time if u hadnt rung in, if there was no answer they would phone somebody you had named, thank goodness since going on b/b i have not had one night time hypo but do know how u feel

 

[JER]

I used to get very bad hypo's during the night and they were the scariest thing I have ever experienced in my life. Often I wakened up and not know where I was had no concept of time reason or anything , sometimes my wife was wakened by the fact that I had been restless and she sorted me out. For anyone living alone I can imagine how much of a worry it must be. I got to a stage when I was almost frightened to go to sleep for fear of having a really bad hypo.
However after quite a bit of work with my Specialist Diabetic Nurse (who is excellent) she recommended that I attended the DAFNE course and since then, about 18 months now, I have hardly had any night time hypos. Changing from Lantus to Levemir also helped because when I changed to Lantus, can't remember what BI Itook before Lantus, the number and severity of night time hypo's increased.

 

[jessie]

Does anyone else have a monitor for the night time - are they worth the money?

 

[mikeyuk]

I read on another board about the danger of nighttime hypos being slightly overstated, and that it wasn't possible to actually "die" in your sleep from them. Really tried to track this link down for you but cant seem to find it unfortunately. Of course it's never good to hypo badly but trying to let you know that even if it happens your body has ways of coping.

From personal experience before I got off the rollercoaster of a high carb diet I would hypo often in my sleep, and I always woke up though it wasnt a particularly pleasant experience. (even after hard nights on the sauce )

Here is a blurb taken from another website:
-----------------
It seems to me that your main concern is that you're going to go too low whilst asleep and something bad will happen. Let me reassure you of something. The human body is an amazing thing and has the ability to respond to danger when faced with it. Low blood sugar is a danger - so your body has the ability to respond to it, even when you're asleep.

Most of the time, if you have a hypo at night, your brain will spring into action and wake you up. If you have low blood sugar, trust me, your brain is going to be the first to know about it and it's going to make sure that the rest of you is #2 on the list. So if that happens, you wake up, you realise you're having a hypo, and then you can do something about that.

Now, admittedly the human body isn't perfect. On (rare) occasions, your brain might not wake you up. However, even if you're asleep during a hypo, your brain isn't. Your brain never sleeps, and it's there constantly monitoring everything that's going on in your body. It's always flipping switches and pressing buttons to make sure that you're fine. Sadly, the switch that's marked 'insulin' doesn't work in you or me. However, the switch marked 'add sugar' works just fine.

When you have a hypo, your brain releases adrenaline, which is what causes the shaky, panicky feeling you might have when you have a hypo. This is your brain's way of telling your body to go find some food. However, if for some reason your body doesn't find any food (for instance, you're asleep), your brain releases glucogon into your blood. Glucogon is a hormone that tells your liver to start pumping out the glucose you've got stored in your liver.

Therefore, typically you aren't going to have a hypo in your sleep that is going to be really dangerous to you. Your body is geared up for low blood sugar whislt sleeping and can protect you from it. If you go low in your sleep then you'll still wake up the next morning, or perhaps even earlier. Keep a bottle of Lucozade near your bed - that way if you wake up, you've got some emergency sugar right next to you. Either way, you're going to be fine, although you'll probably feel like you've got a hangover the next morning if you have to liver-dump.

----

Point I'm trying to get accross is that Hypoing is never good and try to avoid it as much as you can, but don't lose sleep over it ^_^

 

[totsy]

i was interested in a watch so borrowed one, it did wake me up but also woke me when i wasnt hypo too :? basically if you sweat the alarm goes off which is good if you sweat when hypo but will happen if you sweat for other reasons,
this is why they are only useful on a night, as i say i didnt buy one as the alarm went off a few times falsely, what works for one may not work for another :? hope this helped, if you decide to buy one the cheapest i have seen is 39.00

 

[jessie]

Mikey - thank you. Exactly the info I was looking for - and hoping to hear!!

I might consider getting an alarm if this becomes a regular thing but in the meantime I'll keep practicing my carb counting and, hopefully, sleep easy!

Thanks all. x

 

[LittleSue]

Generally yes, if you don't wake up your liver will rescue you. Many people do always wake if they go hypo, but not everyone does. I suspect they say you'll always wake if hypo, to try to reassure you.

The important thing to remember is if you've drunk alcohol, your body sees this as a poison and your liver will prioritise clearing the poison before it gets around to pumping out glucose to cure your hypo. Hence the advice to have a snack after drinking alcohol, to minimise the risk of hypo in the early hours.

I live alone and have a history of sleeping through hypos, or waking but not feeling hypo unless I walk around for some other reason. Scary, but I've found some ways to cope with it. I've noticed that if I wake up feeling like it must be nearly breakfast time but in fact its much earlier, then I tend to be hypo. Or if I've had a strange dream. Feeling 'hungover' or having a headache at breakfast time can also indicate a hypo and liver dump have occurred. So usually if I wake in the early hours, I test. If I've changed my overnight basal, I test around 3am. That not only tells me if I'm hypo, but also if I've dosed correctly for a bedtime snack I should be back to baseline by then, and if my 3am and breakfast readings are v.similar I know my basal dose is right. DAFNE regime (or similar) helps as bs tends to stay even and hypos tend to be milder.

 

[chocoholic]

I am a very deep sleeper but when I was on a mixed insulin, I always awoke if I was hypo.....sweating, shaky etc and treated it accordingly.
Since going over to basal/bolus though I feel almost sure I have lost my hypo awareness. I did my third night-time test last night, trying to work out a pattern, to see if my background insulin dosage is correct. It's proving a nightmare as all three tests have shown something different.
Last night, I went to bed late with a reading of 6.8. set my alarm to test at 3.00 a.m. I felt really hypo.....sweating, shaky etc. but it was the alarm that woke me, not feeling bad. On testing, reading had gone UP to 7.6. Went back to sleep and it had gone up to 8.3.by morning.So, what happened there, who knows? Did I go hypo and the liver dumped glucose just prior to alarm waking me or what? I am certain food did not come into play with night-time readings, as I've been careful to do testson nights when readings are neither low nor high and ate nothing after about 6.00 p.m.
I am trying SO hard to work out how my body reacts to insulin but when there seems to be no set pattern, it's very disheartening.
I've had my mother telling me today to stop worrying so much and just test if I feel funny. I can't seem to make her understand that this was meant to be a temporary phase of trial and error testing, to get my dosages sorted.She told me someone she knows had been on a DAFNE course and she feels that would sort me out. Well, a) they don't run DAPHNE courses where I live and b) can anyone who has done a DAPHNE course tell me.....can that sort out personal dosage problems? (I think I can guess the answer to that one but I'd like it confirmed)
Off out to a quiz now but I'd be really grateful if anyone can tell me how else I can approach things. Thanks.

 

[jopar]

chocoholic

Even though 3am is considered to be when the body is at it's lowest ebb of hormone production and the in theroy your BG should be at it's baseline.. Like everything in diabetes this can be indvidual indeed...

What you can do though to help build a picture of what yoru BG's are like at night is one of these two methods..

1st, you can take a BG starting at 10pm and every two hours throught the night, which is hard going..

2nd, which can be a much easier options, is to take at 3am on one night, then another night (you can have a full nights rest between these) then 4am, theh 5am also the hours before the 3am guidline...

Sadly it does take time to build a picture to how the BG's are reacting while we are asleep, and what you have to look for as often the BG at set points will be different, is a pattern of raise and fall of the BG, rather than a actual reading/number you'll looking for

Another tip when doing this, is to do it on nights that you have done very similar through out the evening, so there's no rebound effects sneeking in to disguse your readings, also have your before bed/ nitght time BG around the similar range +/- 2mmolo/l ish it's norm reading as this hopefully give a better and easier picture to see what happening..

 

[diabetesmum]

It is not my intention to scaremonger here, but isn't there a so-called 'dead in bed' syndrome, used to describe otherwise healthy diabetics who are found thus and believed to have died in their sleep during a hypo? I am pretty sure that there was an article in 'Balance' in the last 18 months or so about a young woman who died in this way.

This is a subject very dear to my heart as I have 2 daughters with Type 1 and rarely have an unbroken night's sleep as I am always getting up to check them. Despite my vigilance, they have both slept into/through hypos, the older one has had fits, BM at that stage under 1.0. It's really scary. Quite frankly I can't imagine either of them going off to live alone one day, it would worry me half to death. Sorry to be negative .

Like you, Jessie, my daughter's consultant and the DSNs think I am paranoid and irrational about hypos. My argument is that a) it's not their child and b) they don't have to live with it on a day to day basis. It's very easy for a doctor to say you're being irrational, they have no real idea what it's like :x .
Sue

 

[KimSuzanne]

Mine may have been a thread some have read - I've recently experienced a spate of night time hypos which I have never had before. I'm not trying to frighten anyone just speaking from personal experience - going back 18 months my body always woke me up at around 2 - 3.5 but its not just lately I wake up after the event.
What I can say is that I personally don't think the hypo is the scariest part because I've always woken up but I do wake up incredibly confused and disorientated (falling asleep in the hallway is not the best idea I ever had). For this my Mum is the number in my call list on my phone and always ring that number (trust me my friends have had some odd phone calls from me).
I think for any of us hypoing is frightening - I used to have fits when I went below 1.5 and that wierdly wasn't as scary as the recent spate for me - but there is no point worrying yourself about it the human body can do amazing things for us!

 

[chocoholic]

Hi jopar,
Just wanted to say thanks for your reply. I don't mind trying the test-every-two-hours thing if it comes to it. In fact, I wouldn't mind trying anything IF I could suss what my body is doing.
I just feel like I'm treading water and am no further forward than I was when first put on MDI.
In some respects, although I wouldn't have the flexibility MDI gives, I wish I'd stayed on the bloomin' Novomix.

 

[iHs]

This looks interesting:-

http://www.diabetesincontrol.com/result ... ticle=6319

 

[jessie]

Interesting info, thanks all.

Sue, I looked in to death in bed syndrome and it's described as follows:
'An extremely rare and unexplained condition (not caused by high or low levels of sugar in the blood) found among diabetes sufferers under 40 where, according to coroner Paul Knapman, “tragically one day you just do not wake up.”

So, another thing to worry about...grrr!

It must be very hard having children with diabetes, I'm sure you're doing a great job though

 

[diabetesmum]

Strewth, so it's not even related to high or low blood sugars!! As you say, another thing to worry about. Really, if this was a job, I'd quit, it's just too hard :? . Thanks for looking it up, and for your kind words, Jessie, I do my best, as I'm sure we all do! My lovely girls are worth it all .
Regards,
Sue

 

[jessie]

I know, this is like being at school again, there's so much to learn my poor brain gets a bit too full up sometimes!!

All the best. Jess. x

 

[hanadr]

Perhaps this is the best arguement I have read for the low carb approach in T1. It means insulin doses are kept low and so any hypos won't be severe. Check my logic please Fergus.

 

[jopar]

Hanna

I can see your logic behind the low carb small number theory…

And I must admit it is and yes and no thing…

Yes the small numbers and low carb in theory might help if one is spending time in good control, and the night time hypo is being caused by misjudgement or calculations of insulin carb ratios…

But if the night time hypo is based on other factors that can’t actually be equated into the calculation then on pure logic it would have to be no on that score…

As sometimes which ever method you use to control your diabetes you still have a possibility to suffer a hypo, as part of the equation that needs to be factored into how much insulin you take, will be based on factors that you can’t equate or control at the time of calculation, factors like unknown stress factors, illness etc which makes any regime imperfect…