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Nocturnal hypoglycemia

Discussion in 'Type 1 Diabetes' started by Yazeed, Aug 28, 2020.

  1. Yazeed

    Yazeed · Member

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    Dear all.

    I hope my thread finds you well.

    I'm having a really terrible anxiety these days because i researched hypoglycemia during sleep and just panicked.

    How much should your BG be before bed if i want to sleep for 8 hours without experiencing hypoglycemia? I bought CGM and if a sleep at 250mg/dL i wake up with more or less 160mg/DL after

    I used lantus 15u and novorapid before meals.

    Please help me. My life is falling apart
     
  2. MarkMunday

    MarkMunday Type 1 · Well-Known Member

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    When do you take the Lantus? If it is before bed, that is why you are going hypo overnight. I use 13 units of Lantus in the morning to avoid nighttime hypos. I would prefer a shorter acting basal, but only Lantus is available here. Blood glucose should stay much the same overnight. If it doesn't, adjustment of dosage and/or timing of basal insulin should be considered.
     
  3. LaasLaaf

    LaasLaaf · Newbie

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    I'm also suffering from what I think are nocturnal hypos as well. My last HbA1c test came back at 33mmol and the Dr doesn't think I am diabetic. But during the night my blood sugar drops down to 3.2-3.9mmol on 3 or 4 occasions a night. I wake up sweating, exhausted, and I get headaches in the morning.

    Should I be pushing the Dr harder or is this normal? During the day I get dizzy and sometimes sweaty palms then at this point I check my CGM Libre that I brought myself and outs always between 3.9-4.5mmol so I know it's time to eat something.

    This isn't normal right??

    The highest it's gone is to 8.5mmol in the day after food, but usually sits between 5.5-8mmol

    I'm very confused by the symptoms
     
  4. Lamont D

    Lamont D Reactive hypoglycemia · Master

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    Hi and welcome to the forum,
    No, it's not normal and I'm not surprised you are confused.
    Your Hba1c levels are very good, what are your fasting levels? You mention that you usually around 5.5 (normal) and 8 (diabetic) is this after food and how long after food?
    Cgms are notorious for having hypoglycaemic readings during the night. If you use a finger prick test you will find that it will probably not in hypo levels.
    The symptoms you describe are for some reason usually quick drops in blood sugar levels, but it could be any metabolic or hormonal imbalance.

    Like myself, I am non diabetic but have a condition that is caused by my hormonal response to food.

    So unless you can get the tests and the necessary information about what is happening to you and then convince your doctor to get a referral,.
    Did you have a full blood panel test?

    Keep safe
     
  5. MarkMunday

    MarkMunday Type 1 · Well-Known Member

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    Sounds like 'reactive hypoglycemia'. Hypos caused by too much insulin being produced in response to rising blood glucose. It is often caused by consuming carbohydrate. Are these hypos preceded by a glucose load? You could try eating no carbohydrate with your evening meal and after dinner and seeing how his affects Libre readings during the night. If the hypos go away, apply the same logic during the day. Also be aware that there is a 15 minute delay between Libre readings and blood glucose, so it could be lower than your Libre shows hen you start feeling hypo.
     
  6. LaasLaaf

    LaasLaaf · Newbie

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    Thank you both for the help.

    I have been eating a Keto diet for a fortnight, and still experiencing these lows and symptoms overnight. Only switched to the CGM this last week, before that I was using a finger prick testing kit in the day where the levels were high after carbs or sugar (up to 8.5) but down in 4-4.5 range when I would be dizzy and shaley. But I have never tested using this kit overnight. I guess I need to compare the CGM and the other kit for consistency.

    I had a full blood count yes, not sure what other markers are useful to check? The only reading that was slightly low was my Urea GFR level which was under 60. And I am experiencing pain / aching around my kidneys on my back, so might it be connected?

    I should mention, I suffer from ulcerative colitis and I am slightly underweight due to this condition. I tend not to eat sugar anyway to help treat this, but only recently switched to keto properly, I was vegan for 12 months up until a fortnight ago.
     
  7. LaasLaaf

    LaasLaaf · Newbie

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    My fasting levels are around 4 normally. Each morning. The hypos are typically when it's time to eat (approaching lunchtime for example), or after exercise I typically very weak and shakey and then come the headaches if I don't eat soon after. If I miss lunch then it's game over, I have a migraine all day. Been like this for years
     
  8. MarkMunday

    MarkMunday Type 1 · Well-Known Member

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    4-4.5 is in the normal non-diabetic range. If you feel hypo symptoms at this level and as Hba1c is normal, perhaps there are hormonal issues. Verify low Libre readings with a testing metre. If blood glucose is dropping below 4, it is not a reactive hypo and as you don't inject insulin, you may want to be checked for an insulinoma. Are you seeing an endocrinologist? In any case, as you are not injecting insulin, don't worry too much about the hypos. They usually correct themselves.
     
  9. Lamont D

    Lamont D Reactive hypoglycemia · Master

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    After rereading your posts, the only thing I get is that you are getting symptoms of a hypo or a false hypo because sometimes you can have insulin resistance and this causes the glucose derived from food can go high, then as you approach meal times your blood sugar levels drop down back into normal levels and you get the symptoms. I cannot say wether it is a type of hypoglycaemia because you have never had a finger prick reading below 4. As I said that cgms are known to have low readings during the night.
    But then again, if you have normal hba1c and fasting levels, have high glucose levels after carbs, then actually go hypo a while later then that is reactive hypoglycaemia.
    But then again only tests can get you a diagnosis.
    But then with your other health issues it could be metabolic.

    We do have a forum on Reactive Hypoglycaemia, please read and see if it helps.

    Stay safe
     
  10. EllieM

    EllieM Type 1 · Well-Known Member

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    Getting back to your original post, we are not allowed to recommend dosages on here but it sounds like you need to talk to your medical team and possibly reduce your lantus. How long before your lantus injection is your last novorapid dose? (If your lantus is correct your morning reading should match your night time one, with the proviso that if your night time reading needs to be long enough after your evening meal and injection for the insulin and carbs in that meal to have ceased acting on your system.)

    How is your hypo awareness? Most people wake for night time hypos, and if you sleep through them then then your liver normally pulls you through, though you might have a headache in the morning.... If you're one of the unlucky ones who doesn't wake, then you could get an alarm for your cgm so it wakes you if you get too low (miao miao for libre, I believe). My dexcom has changed my life but I have to self fund and I am very fortunate to be able to afford it.
     
  11. LaasLaaf

    LaasLaaf · Newbie

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    Thanks guys. I'm on the case for further tests as it's clear that's it's not that clear. All the best
     
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