Nocturnal Hypoglycemia and Type 2 diabetes

[IslanderUK]

I have started using FreeStyle Libre 2 Plus and am glad I have as I notice that I have blood sugar levels averaging 3.8 every night for betwen midnight and 3.00 am.

Does anyone have any advice as to how I can avoid this

I have type 2 diabetes and am on drugs only

Thanks in advance

 

[EllieM]

Have you tried setting an alarm to check with a bg meter? Sensors aren't that accurate and are reknowned for reading low (so called compression lows) when you lie on them.

Non diabetics can regularly go down to the mid 3s without harm, hypos are an issue if you take medication that makes your blood sugar go lower.

Can I ask what meds you are on? If your bg is going low because you are on a medication that causes low bg then you could discuss the issue with your doctor... Some meds can cause hypos, others don't.

 

[KennyA]

Hi - yes I regularly get overnight lows, accompanied by nightmares and heavy sweating. It's not constant, goes in waves. I'll have nothing for a couple of weeks and then a month of it. I haven't been able to establish a trigger - it started around 2014 when my BG was rising but has continued after I came back to normal levels.

It also seems to be something that happens fairly frequently to non-diabetic people as well, and is being turned up by increased availability and use of CGMs. If you have a look at this study - non-diabetic people using a CGM - you'll see that the researchers were a bit baffled to find that "...28% of participants had at least one hypoglycaemic event."

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

 

[IslanderUK]

Have you tried setting an alarm to check with a bg meter? Sensors aren't that accurate and are reknowned for reading low (so called compression lows) when you lie on them.

Non diabetics can regularly go down to the mid 3s without harm, hypos are an issue if you take medication that makes your blood sugar go lower.

Can I ask what meds you are on? If your bg is going low because you are on a medication that causes low bg then you could discuss the issue with your doctor... Some meds can cause hypos, others don't.

Thank you for responding. For my diabetes I am on 30mg of Gliclazid which I take with breakfast, 1000mg of Metformin which I take aboput 18.30 with my dinner an 5mg of Linagliptin that I take before bed. Following some reading I have done I am going to get some glucose tablets and when/if I wake up between midnigh and 3.00am and my levels are below 4 I am going take one of those .

 

[Chris24Main]

Are you waking up with this? and are you feeling any symptoms of hypoglycaemia, sweating profusely; feelings of anxiety, weak and shaking...
The warning levels and most of the fear set into low blood glucose is (and rightly) aimed at type 1 diabetics. I was one for a while, and vividly remember being up in the wee small hours, frantically gobbling dextrose tablets and watching for the line to start going up again.
It turned out (for me) that the stress of the alarm going off, and the loss of sleep were far bigger issues, and once I started to realise that if I was "low" but the arrow was level (or even in the 4 o'clock position) - the level would sort itself out, and I was worrying over nothing (this was one of the first signs for me that I was much more likely to be Type 2).

I had one serious hypo event, and that was because I injected insulin and forgot to eat - but it taught me what a serious hypo felt like, and I never felt that way if my level was dipping in and out of the 3s.

You are on a whole different med regime than I was, so none of that may be applicable to you.

You may want to get an appointment with your support team, two of those meds will actively push down blood glucose by stimulating more insulin production. If your levels are concerningly low through the night, there may be room to safely reduce dosage - I can't say that - but taking more glucose to "match" the effect of the meds may work against you in the long term.

 

[IslanderUK]

Are you waking up with this? and are you feeling any symptoms of hypoglycaemia, sweating profusely; feelings of anxiety, weak and shaking...
The warning levels and most of the fear set into low blood glucose is (and rightly) aimed at type 1 diabetics. I was one for a while, and vividly remember being up in the wee small hours, frantically gobbling dextrose tablets and watching for the line to start going up again.
It turned out (for me) that the stress of the alarm going off, and the loss of sleep were far bigger issues, and once I started to realise that if I was "low" but the arrow was level (or even in the 4 o'clock position) - the level would sort itself out, and I was worrying over nothing (this was one of the first signs for me that I was much more likely to be Type 2).

I had one serious hypo event, and that was because I injected insulin and forgot to eat - but it taught me what a serious hypo felt like, and I never felt that way if my level was dipping in and out of the 3s.

You are on a whole different med regime than I was, so none of that may be applicable to you.

You may want to get an appointment with your support team, two of those meds will actively push down blood glucose by stimulating more insulin production. If your levels are concerningly low through the night, there may be room to safely reduce dosage - I can't say that - but taking more glucose to "match" the effect of the meds may work against you in the long term.

Thanks for your advise

 

[Chris24Main]

No problem - as long as you get that it's not advice ...

Another way to put it - you're aware of the dawn phenomenon, where your liver prepares for the start of the day by creating (or releasing) a bunch of glucose? - well that's because, in the ideal state, where you are having a restful sleep, your blood glucose is naturally low.

 

[IslanderUK]

No problem - as long as you get that it's not advice ...

Another way to put it - you're aware of the dawn phenomenon, where your liver prepares for the start of the day by creating (or releasing) a bunch of glucose? - well that's because, in the ideal state, where you are having a restful sleep, your blood glucose is naturally low.

"as long as you get that it's not advice" Thats fine I should have written "help" instead of "advice" I will discuss with my diabetic team when we meet in April

 

[KennyA]

I've never bothered doing anything about "treating" glucose levels. Partly this is because I was having the episodes for six years before eventual diagnosis, so my liver is sorting things out eventually, and partly because I'm more bothered about being woken at 4am and having to change a soaking t shirt (and occasionally the entire bed).

 

[Antje77]

I've never bothered doing anything about "treating" glucose levels. Partly this is because I was having the episodes for six years before eventual diagnosis, so my liver is sorting things out eventually, and partly because I'm more bothered about being woken at 4am and having to change a soaking t shirt (and occasionally the entire bed).

An essential difference between you and @IslanderUK is that he's on gliclazide and you are not.

If you're on a medication that can cause hypos, please treat the hypo.

But only after double checking with a fingerprick, or when having symptoms.
My sensors always read lower than blood by 1 - 2 mmol/l, for me it's not a hypo until proven by blood.

 

[KennyA]

An essential difference between you and @IslanderUK is that he's on gliclazide and you are not.

If you're on a medication that can cause hypos, please treat the hypo.

But only after double checking with a fingerprick, or when having symptoms.
My sensors always read lower than blood by 1 - 2 mmol/l, for me it's not a hypo until proven by blood.

Yep. It's just what I do. Other people - your mileage may vary.

 

[ianf0ster]

Clarification for other people reading this thread:
There is/may be a difference in the way low Blood Glucose is handled between Type 1, Type 2 on Blood Glucose lowering meds + metformin (which 'discourqages the liver from putting glucose into the blood stream'), Type 2 on just Glucose lowering meds, Type 2 on just Metformin and Type 2 on neither Glucose lowering Meds nor Metformin.

In short: We are all different, so:
1. Consult the professionals
2. Please list all diabetes meds when asking about low BG, or other questions about Blood Glucose levels.

 

[Grandadfatboy]

I am a type 2 insulin dependant diabetic who also takes 1000mg Metformin twice daily. I also have the Libre 2. The alarms on my L2 have warned me several times of an impending hypo, without me actually feeling unwell. That said, we were on holiday in The Lakes and I woke early hours feeling very unwell, shaking and sweating. My wife was so concerned about me she was going to call 999, but between us we managed to avoid a trip to A&E. Since then I have set my low alarm at 5.0. This gives me a chance to finger prick and take action according to that result. Experiencing a "proper" hypo has made me determined to do everything I possibly can to not experience another.