Type 2 - Had a low last night, scared to sleep tonight!

I was dx in August of last year. I immediately started eating a lchf keto diet. I was put on, and still take 2000mg of metformin daily. One 1,000mg in the morning, and one at night. I have had several episodes of waking up very hot, sweating, heart racing/pounding - but last night I actually checked my BG and it was 39. I ate 4 Smarties while lying in bed and ten minutes later my BG was 79. (I never checked my BG during these episodes before because I was under the impression that Type 2s don't get dangerous low. ALSO, right before bed my BG was 89...about 4 hours before the low of 39 woke me up.)

I called my doctor and got to talk to the nurse who said to eat a snack - so I grabbed a handful of my son's cereal. I asked the nurse if I should reduce my metformin and she said not to do that. My BG went to 147, which is SO high for me at this point, but at least it wasn't low anymore.

So, I was tired later because of not sleeping well and was scared to go to sleep - so I ate 5 Ritz crackers before laying down. I slept for 3 hours and it seemed okay, but had a lot of nightmares - so, not restful in any way.

As you can imagine, I'm exhausted, but scared to go to sleep tonight. I don't think I should take my metformin. Should I eat a snack before bed? I'm at a loss.

The nurse moved my A1C appointment up from next week to Friday, and then moved my follow-up with my doctor to June 12th rather than the third week of June. So, I won't really know how to handle going to sleep until then. That's 9 days away and I really cannot handle the stress of this right now - thinking that I'm going to die if i fall asleep - with everything else that's going on in my life at the moment.

Please, any advice would be so appreciated. Thank you in advance.

Edited to add: My last A1c - 3 months ago - was 6.1, down from 6.9 3 months prior to that, and 8.9 prior to that when I was diagnosed. My BG is 106 right now, but I just ate dinner 2 hours ago. All I desperately want to do is sleep.

I still haven't slept. would love input, and many thanks to all of you in advance.

satindoll said:

Hi spiroll, yes t2s can hypo but its more usual for t2s on insulin to do this, may I ask have you lost a lot of weight since starting the LCHF diet, if you have it may be that the amount of Metaformin is now too high, as an insulin user myself and never been on tablets I'm not really the right person to advise, but it does seem a lot of Metaformin if your strictly LCHF, I hope someone with a better understanding will be along soon to help.

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I have lost 35 pounds since I started metformin almost 10 months ago. I always thought it was a lot of metformin, too, especially because of my diet. The odd thing to me is that I know that I experienced these same symptoms of extreme lows about 9 months prior to my diagnosis during a time when i was extremely ill, and could not eat for several days...even water was hard to take. I was very sick for 3 weeks, and had these same symptoms of a low without the metformin. I don't know if that means anything. Although, at the time, since I didn't know that I was diabetic, I wasn't eating low carb - just happened to be very sick and not eating or drinking anything. I appreciate your response.

graj0 said:

Although a low carb diet is recommended, it's possible to go just a bit too far. You say you're on a LCHF Keto diet, is your GP/DN aware of this?

I'm not a doctor but for the time being I think a carb based snack before going to bed should do the trick, I very much doubt that you're going to die in your sleep though, extremely unlikely. Stop worrying about it and get some decent sleep.

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Thank you very much for your response. My GP is aware of my diet, but I only see him every three months. I had blood drawn today for my A1C and cholesterol, and will see him in a week for the results and consultation.

I would venture to guess that I may be taking Low Carb too far. The day before this happened I had only consumed 1200 calories, 10 carbs, 85g fat and 62g protein. That really isn't much food. I am just not a hungry type of person.

I will add in more carbs, especially just prior to going to bed, until I see my GP next week. Again, I thank you very much for your response. It was very reassuring.

Brunneria said:

Hi All,

My first instinct is yes, too much metformin, especially with the weight loss.

My second instinct is to wonder what you had eaten during the evening before your hypo in the night?

@graj0 is thinking like a diabetic - as he should. For 'normal' diabetics, a carb snack before bed will raise blood glucose through the night, preventing any lows.

I think like a reactive hypoglycaemic. If I eat carbs before bed, I am guaranteed to wake up sweating, shaking, in the throws of a terrifying nightmare, because those carbs will have triggered a reactive low ( the worst ever was after I ate an entire mango at 11pm. Back before I knew anything about anything!)

So, @spiroll , what did you eat the evening before your nighttime hypo?

(By the way, the fact you woke up feeling like that is a sign that when your own body realised your blood glucose was too low, it released a powerful cocktail of adrenalin and other stress hormones, which forced your liver to release glucose into the blood. They are what woke you up and made you feel so scared and dreadful. by the time you woke up, realised what was happening, your BG was already rising due to the glucose release. It's a powerful self defence that your body uses to prevent your BG dropping too far. So that shaky feeling is a good thing, because it proves your own body is looking out for you)

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Hi, and thank you for responding!

The evening prior I had a chicken breast grilled, and steamed broccoli with butter and lite-salt. Decaf coffee with a small amount of heavy cream after dinner. I had sugar free Jell-o for a snack about 2 hours before going to sleep. You can see my food log here: http://www.myfitnesspal.com/food/diary/HeyTalina?date=2015-06-02 (If you scroll to days following it will show odd foods - as I've been trying to deal with the low, but days prior are standard.)

Thank you for the information about your worst low - that is exactly how it felt! Just awful!!

You have no idea how reassuring it is to have read your "it's a good thing!" paragraph. I appreciate it more than you know, and now I know!!! Thank you so much! Please feel free to critique my food - I will be stoic to criticism, I promise!

Brunneria said:

Your food that day looks great actually. .
Very low carb, and it definitely wouldn't have triggered a reactive hypo in me.
And very restrained at around 1100 cals! I'm very impressed.

How did you feel the next day with a bit higher carb?
Was the peanut butter a late night snack? I find it is fab for that.

And have you had the low happen again?

So, all I can think is that for some unknown reason your body decided to throw out a low. And that could be caused by so many things... Were you stressed the day before? More active?
it looks increasingly likely the metformin really does look like the culprit - but (sorry, I need to keep banging on about this!) since we aren't doctors, all we can do is suggest.

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Thank you
I felt much better the next day with the higher carbs - having a bit of peanut butter before bed. I haven't had the low happen again, but I will be going to bed in about 15 minutes with no snack, (but also skipping the metformin dose) so we'll see what that brings.

I actually was/am extremely stressed about another problem I'm going through - I have bad anxiety and my doctor decided to change my medication dosage without consulting me. It's a very scary thought for me, and although I haven't made the medication change yet, I am still very upset to have not been a part of the decision making process, as well as just being stressed in general about how changing the dose is going to make me feel. (Also...TMI?...I did have my period on the day of the low.)

Thank you again!

nosher8355 said:

Hi @spiroll
Are you on any other meds?
How often do you eat?
You say you were extremely ill, can you describe symptoms?
Have you blurred vision?
Headache?
Shaking?


I would not usually say this until you have answered some more questions.
What was your fasting bloods lately?
How low do you go?
Have a read at the thread Reactive hypoglycaemia on the Ask a question forum.

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I am so sorry that I missed your response! I don't know how i could have done that!!

I am on other medications for treatment of anxiety. Effexor XR, Toprol, and xanax. The toprol supposedly "might" cause an increase in blood glucose levels - and I actually believe that this was what put me over the "diabetic line."

I eat 3 times a day with a snack 2 hours before bedtime, usually. My food diary is here: http://www.myfitnesspal.com/food/diary/HeyTalina Feel free to let me know your thoughts!!

My illness in January 2014, 8 months prior to my diagnosis of Type 2 diabetes: It lasted for about a month. I was weak to the point of sleeping for nearly 23 hours a day. I was incredibly nauseated. I could not eat. I could not drink anything but a few sips of water. I had a headache. I felt so tired and sleep was restless with bad dreams. I did not have a fever. In fact, my body temperature runs low. I went to an clinic and was given Zofran for the nausea, but no tests, and then sent home. I lost about 30 pounds. I was always cold. I have NO clue what it was.

In the month prior to my diagnosis I had a few episodes of very blurred vision...so that would have been in July of 2014. I have had no blurred vision since changing my diet at the time of my diagnosis in August.

I do not get headaches. The only time I experience shaking, is this weird internal shaking feeling when I felt that low the other night - i have had that about ten times and just never thought to check my blood glucose because I was wrongly under the belief that Type 2s do not get low blood sugar. (I do have a bit of a trembling hand if my anxiety is more than my medicine can handle.)

My normal low number is 78 - I generally stay under 105. My average reading ppd 2 hrs is never over 110. The last few days since that low I have eaten a few extra carbs at meals and have gone up to 118 at the highest 2 hours ppd. The 39 that I saw on my meter during that low the other night is the lowest I have ever seen. Before that, the lowest I had seen was 70.

I will read about Reactive Hypoglycaemia. Thank you for any thoughts you may have on this, and again, i really do appreciate your response and apologize for missing it. Again, I don't know how I missed it!

I'm curious now about the RH. For a few years before I got sick and had my first serious low (now i know what that was - but still don't know what the prolonged illness ways) I experienced many of the symptoms of RH. I have been diagnosed with anxiety disorder (and have had panic attacks) for 23 years. I'm 43 now. The curious years before my illness/dx included a really strange symptom of eating out for dinner and then just suddenly I'd fall asleep in the car. It could have been mid-sentence! I was unable to stop myself - I'd just pass out asleep. Thank God I was never driving. I read the RH threads but didn't see anyone else mention the falling asleep - like a sugar or carb crash multiplied 100 times - just going along down the road talking to my husband and suddenly waking up without realizing i'd even fallen asleep. So weird.

Since just after the birth of my second child in 1991 this has been happening - (not the instant falling asleep thing, but other symptoms...) - such as feeling unstable while standing, unbalanced, brain fog, inability to concentrate/focus - especially with anything involving reading or math. Difficulty following conversations. The further along in the day the worse the feelings.

So, lots to research, but again - I didn't see anyone mention the "nodding off."

Thank you to all.