Nighttime hypo's

[Foligno]

I've had diabetes type two for a number of years. In addition, I take medication for hypothyroidism, BPH, and hypertension. For my diabetes, I take Metformin SL 500 mg twice daily, and empagliflosin 50 mg once daily. I was taking ozembic up til about five weeks ago. I didn't experience a loss of appetite or weight loss, but I did suffer severe nausea. I stopped taking the ozembic after developing severe pain on my right side and a UTI caused by a kidney stone blockage. I've since had a stent fitted, and I am due to return to hospital to have the stone removed. I have been advised by my diabetic nurse to withhold restarting ozembic until I have my operation to remove the kidney stone. Due in part to concerns with my physical health, I've started to use Libre sense to monitor my blood sugars more effectively. I am eating more carefully to try and stay within normal blood sugar range. I am achieving 79% in optimal range, 19% in amber range and 1% in critical range. I can work out why my blood sugars get to high - diet. I am more worried that I am having hypo's in the night while ai am asleep. I started using the sensor four days ago, and I have experienced three out of four hypo's during this time. I not sure what is happening, I'm not going to bed with a low blood sugar reading to begin with, and sometimes I am in the amber range. The sensor is set to an alarm whenever it is out of range - which causes me to wake up. It can be as low as 2+. It causes me some anxiety and I get up. I've noticed that from a very low read, it bounces back up to a normal range, even without me eating carbs.
Prior to having started to use the sensor I had been getting up most nights to snack. I have stopped snacking since using the sensor, I am always thirsty and drink water in the night. I also sweat.
Any advice would be gratefully received.
KRM.

 

[Jaylee]

I've had diabetes type two for a number of years. In addition, I take medication for hypothyroidism, BPH, and hypertension. For my diabetes, I take Metformin SL 500 mg twice daily, and empagliflosin 50 mg once daily. I was taking ozembic up til about five weeks ago. I didn't experience a loss of appetite or weight loss, but I did suffer severe nausea. I stopped taking the ozembic after developing severe pain on my right side and a UTI caused by a kidney stone blockage. I've since had a stent fitted, and I am due to return to hospital to have the stone removed. I have been advised by my diabetic nurse to withhold restarting ozembic until I have my operation to remove the kidney stone. Due in part to concerns with my physical health, I've started to use Libre sense to monitor my blood sugars more effectively. I am eating more carefully to try and stay within normal blood sugar range. I am achieving 79% in optimal range, 19% in amber range and 1% in critical range. I can work out why my blood sugars get to high - diet. I am more worried that I am having hypo's in the night while ai am asleep. I started using the sensor four days ago, and I have experienced three out of four hypo's during this time. I not sure what is happening, I'm not going to bed with a low blood sugar reading to begin with, and sometimes I am in the amber range. The sensor is set to an alarm whenever it is out of range - which causes me to wake up. It can be as low as 2+. It causes me some anxiety and I get up. I've noticed that from a very low read, it bounces back up to a normal range, even without me eating carbs.
Prior to having started to use the sensor I had been getting up most nights to snack. I have stopped snacking since using the sensor, I am always thirsty and drink water in the night. I also sweat.
Any advice would be gratefully received.
KRM.

Hi,

That almost sounds like a “compression low” to me…
It’s a false low that bounces back up when pressure like sleeping on the sensor sends if scatty for a brief while..
(Like a V shape dip in the graph..)

Do you have a screenshot on the Libre graph of these incidents?
It’s always prudent to test with a meter when these happen to be safe..?

 

[Melgar]

I agree with @Jaylee. How low is your cgm reading? Are you getting low blood sugar symptoms like waking up clammy, vivid dreaming, shaky , feeling very hungry, nauseated and or headachy ? I get low blood sugars , for me my lowest night times blood sugars seem to come around 3am. After which they start to rise. On occasion they rise a bit but remain low. Mine were not compression lows. I have not had night time low blood sugars for a while now, but when I was getting them I would cross check with a blood prick.

 

[Foligno]

Hi,

That almost sounds like a “compression low” to me…
It’s a false low that bounces back up when pressure like sleeping on the sensor sends if scatty for a brief while..
(Like a V shape dip in the graph..)

Do you have a screenshot on the Libre graph of these incidents?
It’s always prudent to test with a meter when these happen to be safe..?

Thank you - that's something I have not thought of. I'll cross reference check with my standard monitor next time it happens. The low reading has shown up when I've manually scanned, but not otherwise.

 

[KennyA]

I've had diabetes type two for a number of years. In addition, I take medication for hypothyroidism, BPH, and hypertension. For my diabetes, I take Metformin SL 500 mg twice daily, and empagliflosin 50 mg once daily. I was taking ozembic up til about five weeks ago. I didn't experience a loss of appetite or weight loss, but I did suffer severe nausea. I stopped taking the ozembic after developing severe pain on my right side and a UTI caused by a kidney stone blockage. I've since had a stent fitted, and I am due to return to hospital to have the stone removed. I have been advised by my diabetic nurse to withhold restarting ozembic until I have my operation to remove the kidney stone. Due in part to concerns with my physical health, I've started to use Libre sense to monitor my blood sugars more effectively. I am eating more carefully to try and stay within normal blood sugar range. I am achieving 79% in optimal range, 19% in amber range and 1% in critical range. I can work out why my blood sugars get to high - diet. I am more worried that I am having hypo's in the night while ai am asleep. I started using the sensor four days ago, and I have experienced three out of four hypo's during this time. I not sure what is happening, I'm not going to bed with a low blood sugar reading to begin with, and sometimes I am in the amber range. The sensor is set to an alarm whenever it is out of range - which causes me to wake up. It can be as low as 2+. It causes me some anxiety and I get up. I've noticed that from a very low read, it bounces back up to a normal range, even without me eating carbs.
Prior to having started to use the sensor I had been getting up most nights to snack. I have stopped snacking since using the sensor, I am always thirsty and drink water in the night. I also sweat.
Any advice would be gratefully received.
KRM.

I think it is less likely to be a compression low. I get just this, and it's always marked by sweats, nightmares and invariably waking somewhere around 3-5am. I also know that some non-diabetic people experience it as well. I appreciate the compression l0ow issue, but why would an artificial compression low cause the physical symptoms?

See also this study on non-diabetic people using new gen CGMs, in particular Table 3 and subsequently - the study records that 18% of the study group had one or more hypoglycaemic daytime event and 14% had one or more hypoglycaemic night time event during the study period but cannot explain why this happened:

Continuous Glucose Monitoring Profiles in Healthy Nondiabetic Participants: A Multicenter Prospective Study - PMC

Use of continuous glucose monitoring (CGM) is increasing for insulin-requiring patients with diabetes. Although data on glycemic profiles of healthy, nondiabetic individuals exist for older sensors, assessment of glycemic metrics with new-generation ...

pmc.ncbi.nlm.nih.gov

As far as I'm concerned, it's something i'd been aware of for years but did not link it to BGs until using the Libre. Unfortunately, despite the evidence from things like the above study, there is still a belief around that "T2s do not get hypos" - well, at least this T2 does.

As far as the overnight ones go, I don't need to do anything about them: my liver will push out some fresh glucose and BGs will start to rise and turn into dawn phenom. It's been suggested (by @Jasmin2000) that this could be because of insulin over-production, followed by a correction.

 

[Jaylee]

It's a common reported phenomena.

Could be that the composition of the interstitial fluid changes when compressed or pinched??
Reading glucose content in interstitial fluid is how the sensor interprets BG levels.

 

[KennyA]

It's a common reported phenomena.

Could be that the composition of the interstitial fluid changes when compressed or pinched??
Reading glucose content in interstitial fluid is how the sensor interprets BG levels.

Yes, but I have never understood how a sensor reading error is supposed to produce physical symptoms. Isn't it more probable that the physical symptoms are reflected by the sensor reading?

 

[Jaylee]

I think it is less likely to be a compression low. I get just this, and it's always marked by sweats, nightmares and invariably waking somewhere around 3-5am. I also know that some non-diabetic people experience it as well. I appreciate the compression l0ow issue, but why would an artificial compression low cause the physical symptoms?

See also this study on non-diabetic people using new gen CGMs, in particular Table 3 and subsequently - the study records that 18% of the study group had one or more hypoglycaemic daytime event and 14% had one or more hypoglycaemic night time event during the study period but cannot explain why this happened:

Continuous Glucose Monitoring Profiles in Healthy Nondiabetic Participants: A Multicenter Prospective Study - PMC

Use of continuous glucose monitoring (CGM) is increasing for insulin-requiring patients with diabetes. Although data on glycemic profiles of healthy, nondiabetic individuals exist for older sensors, assessment of glycemic metrics with new-generation ...

pmc.ncbi.nlm.nih.gov

As far as I'm concerned, it's something i'd been aware of for years but did not link it to BGs until using the Libre. Unfortunately, despite the evidence from things like the above study, there is still a belief around that "T2s do not get hypos" - well, at least this T2 does.

As far as the overnight ones go, I don't need to do anything about them: my liver will push out some fresh glucose and BGs will start to rise and turn into dawn phenom. It's been suggested (by @Jasmin2000) that this could be because of insulin over-production, followed by a correction.

I've never subscibed to oral meded T2s not getting hypos..
My dad had a couple caught with a meter.
Surprisingly 1 after his doctor pulled him off metformin..

It would be interesting to see the libre graph.
There is a distinct pattern on a CL compared to the response to a real event.?

 

[Jaylee]

Yes, but I have never understood how a sensor reading error is supposed to produce physical symptoms. Isn't it more probable that the physical symptoms are reflected by the sensor reading?

To me when it happens it's like reminds of a fuel gauge sender issue on a vehicle?
The earth is interrupted to the chassis & the tank reads empty.. regardless of how much fuel.?

What I do know without exception.
Is if I am actually going low. I seem to get 10 minutes heads up before I feel anything or test, for that matter.
But recovery line from an actual hypo looks alot different from a compression low.

 

[Melgar]

I agree , the low then "it bounces back up to a normal range, even without me eating carbs." Is suggestive of a compression low. If I go low at night, my blood sugars don't immediately rise upwards. It's more gradual. Not saying it's not a genuine low, but it sounds like a compression low. The graph would be very helpful.

I frequently have night sweats and thirst, but it's not blood sugar related.

Edited to change a sentence.