Type 1 Diabetes and Sleep

Recently I've been experiencing a lot of anxiety, panic attacks and upset during the late evening and just before going to bed as for most days of the week at night it has been taking me 1 to 3 hours to go to sleep due to the sudden onset of hypoglycaemia after resting for a matter of minutes. These hypo's are different to the usual hypo that I may experience at other hours of the day as it takes up to 45 minutes for liquid glucose (typically orange juice) to increase my blood sugar levels. Having to wait for such an amount of time to achieve a normal blood sugar level leaves me feeling agitated and wound up making it difficult for me to relax and, well, sleep! As the hypo usually makes me sweat and tremble this also disrupts the process of getting some sleep.

Because I have experienced this agitation most nights over a very long period of time I am finding that I feel panicky/jumpy and very nervous when it gets to "bed time" and often have irrational thoughts such as "I'm going to die from sleep deprivation". I try to curb the panic by distracting myself with music, but have also took an obsessional interest in learning when neighbours typically go to bed (they typically turn their lights off if they have!) to work out if I'm the only one still up with what is increasingly looking like secondary insomnia.

I'd be interested to know if anybody here has experienced sleep problems or disruption due to problems relating to their diabetes and, if applicable, what you have done to tackle the problem. I used to get to sleep quite quickly but sometimes awoke in the early hours with the shakes from a low blood sugar; now though, my problem is getting to sleep .


Mark.

noblehead said:

Mark, you need to eliminate the cause of your hypo's to help you with your anxiety problems. Going hypo means your taking too much insulin or not eating enough food (carbs) to balance it out, you should not be going hypo at bed-time every night as this is totally unacceptable and it's no wonder your frightened to go to sleep.

You need to get in touch with HCP's asap and seek help with adjusting your insulin doses, whilst there they may also offer you some help with your anxiety problems, if your on basal/bolus (MDI) you should ask about going on a carb counting course such as DAFNE to teach you how to adjust your insulin to reduce the amount of hypo's you are experiencing, there's an on-line version of it in the following which will give you the basics until such times that you get on a course yourself:

http://www.bdec-e-learning.com/

Do seek help and don't put it off any longer, we all need to sleep well in order to stay healthy.

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Hi Noblehead,

I have sought advise from my Diabetes Nurse in relation to adjusting my insulin to carbohydrate ratio. She advised reducing my bolus for evening meals and supper by 50% which is advice that I've followed. After following this advice I don't experience hypo's every night but I still do most nights so its always on my mind before I sleep. Last night I was able to get to sleep 1 hour and a half after initially getting into bed and didn't experience any hypo's due to the fact that I had had some slow release carbohydrate porridge and had given 50% less insulin for it's carb content.

I usually go to bed at around 12:00 am. Perhaps this is too late and is part of the problem of getting to sleep?

noblehead said:

You should also see if your basal insulin isn't set too high, this can lead to hypo's between meals and when fasting (during the night). The link I provided will cover this but you can also take a look at the following which gives a good explanation on how to carry out basal testing:

http://www.salforddiabetescare.co.uk/index2.php?nav_id=1007

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Thank you for the links.

My basal rate is relatively high between 6:00 am and 12:00 pm as I like to know there is a bit more insulin stacking up for the following reason:

• Before having a relatively high basal rate (at the aforementioned time range), at 10:00am in the morning I used to typically become fatigued and irritable within 10 minutes after having got out of bed; I would test my blood sugar to try and get an explanation for these symptoms and I found that my blood sugar would be 2-3 points higher than 10 minutes prior. My continuous blood glucose monitor had confirmed a blood sugar increase of over 1.0 m/mol for every 5 minutes that pass. Unusually, giving correction boluses (using my pump), injecting insulin with a pen and/or increasing my basal rate (in some cases by 500% on the advice of a DN) would not bring the blood sugar down until 2-3 hours had passed. The only thing that would counteract the high blood sugar would be rigorous exercise combined with more insulin.

So my way of dealing with the above is to treat with insulin proactively BEFORE my blood sugar rises rather than reactively as I get nowhere. My Diabetologist cannot explain why my blood sugar goes so high in the morning!

Other than the above, my basal rate before rest is relatively low and I'm 99.9% sure that it is my bolus insulin triggering the hypo's before rest.

noblehead said:

It's called the Dawn Phenomenon, better known as DP in diabetes circles. Sorry for yet another link but the following gives a brief explanation about it:

http://www.diabetes.co.uk/blood-glucose/dawn-phenomenon.html

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It's ok. The more links the better!

I have put to my Diabetologist that it may be suffering from Dawn Phenomenon before to which he has replied "but you would have the symptoms of DP in the morning and regardless of whether you're awake or not".

This left me feeling confused and a bit scared at the prospect of having no medical term to describe what I was and am still experiencing.

This spike in blood sugar always occurs after waking, whether it's after having had a cat-nap in the evening or after waking up in the afternoon. Does this still sound like DP in your opinion?

noblehead said:

Not DP if it's occurring in the afternoon and evenings after a cat-nap. DP, as far as I'm aware can occur anywhere between the hours of 3 - 8am.

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Thats what I thought, and clearly is what my Diabetologist thinks too. No one seems to be able to put a name to what I'm experiencing. It's like having a secondary illness that can't be categorised