• Guest - w'd love to know what you think about the forum! Take the 2025 Survey »

Uncontrollable Nighttime Hypoglycemia

ShadowDragon

Member
Messages
12
Type of diabetes
Type 1
Treatment type
Other
Greetings all,

I'm new to this forum and would really like some help with a problem that I'm experiencing.
I'm a type 1 diabetic. I've had this for nearly 9 years. I went on an overseas trip in February and after returning I've started having major hypoglycemia specifically at night. I often fall out of bed and wake up several hours later not knowing what happened. I started recording my sleep and after speaking with a specialist, it was diagnosed to be nighttime hypoglycemia and hypoglycemia unawareness.

Another problem is that I no longer have any symptoms of highs and lows. I've started using a CGM device and it is helping me iron things out but there are some things I don't understand. According the the sensor, my level drops to to nothing when I go to bed and then elevates very high when I wake up. All by itself. No food, no insulin.

Last night I was going low before bed (3.4mmol) so I ate a PVM Energy Bar, waited 20 minutes and my level dropped further. So I had some honey. Waited again and then my level started to rise. I waited for a bit more and checked my level and went to bed. According to the sensor, my level went to 9 or 10 mmol and then dropped to below 3.(The graph doesn't display readings below 3). Then when I woke up, my level had started elevating before 6am and was then, at roughly 7am, sitting at 12mmol.

This happens every night. I used to take long acting insulin at night but for the past week I've been taking it in the morning. I take 2x Glucophage XR 500 tablets at night so maybe its that. What I don't understand is why at night my level drops drastically and then in the morning it elevates without food or anything. Some mornings its as high as 21mmol and rising. Also, how has my body become completely unaware of hypo and hyper glycemia?

Another problem would be that my short acting insulin seems to be taking longer to work in the mornings. I have breakfast, take a normal dose and then an hour later it's like I haven't taken any insulin. The insulin I'm using is Apidra and Lantus. I know that when it first had diabetes, the pharmacy ran out of my insulin and they gave me Humalin and Humalog. I used that for a month and they worked well however I got headaches every time I used the Humalin and the headache would last for roughly 30 to 60 minutes. Should I look at changing my insulin? I would prefer not to go on a CSII device.

Thanks for taking the time to read this post. I really need some help in fixing this.
 
I think that you have lower insulin resistance in the late afternoons and evenings and need to take that into account - it is something type twos often report, and so we eat fewer carbs in the mornings, but can add in berries and cream after dinner.

We are approaching the same problem with very different regimes to try to cope with it, but the symptoms are pretty classic.
 
A few things here...

Regarding the overnight swings, is your basal correct? Usually, you'd test this by doing an overnight test, but in your case this is not possible. Can you do a fasted test? Do this by measuring your BGs in between meals; if there is significant change, then your basal will need to be changed.

Regarding hypo unawareness. This is common and is caused by frequent hypos. The only way to get it back is by avoiding hypos.

Regarding rebounding BGs after a hypo. This is often caused by your liver dumping a load of glucose into your BGs when it detects really low BGs. It's called "liver dumping", or "hypo rebound".

The morning insulin resistence that you are experiencing is common and is known as the Dawn Phenomenon. This is where the liver produces a bit of glucose first thing in the morning, to basically give you energy after you've fasted overnight. The only way to treat it, is to cover it with insulin.

Finally, there are some phone apps that work with CGMs to alert you when your BGs are dropping. You could use these in the night by the sound of it.
 
Hello @ShadowDragon and welcome to the forum.

Sorry to hear about your nocturnal hypos, that's a not a great situation to be in. Have you done any basal fasting tests to check your background dose ? Running low overnight particularly around 2-3am indicates your basal is too high so a fasting test is a good way to confirm it: http://www.salforddiabetescare.co.uk/index2.php?nav_id=1007

Another suggestion is to switch basal insulins to tresiba which is a much more stable basal insulin and recommended for people experiencing nocturnal hypos.

Also to check what CGM you are using ?
 
More positive if you changed metformin or its routine.
Ask your dn if you can reduce evening meal metformin?
 
Hi Juicyj

I'm not sure what you mean by basal. I've never heard that term before. I know what it means so which dose should I be looking at? Long acting or short?
The CGM is the Freestyle Libre. I'm changing the sensor tonight. Will be the third sensor.
 
Hi Ickihun

I don't use metformin but I'm assuming you're talking about the Glucophage XR. I'm going to move the dose to the morning and see if there are any changes.
 

Hi SamJB
Unfortunately my CGM is a NFC sensor. It does not alert me of lows or highs. Even though I've been a diabetic for some time, I do not know some of the terms that are being used. I'm assuming BG is blood glucose and Basal is my base dosage of insulin. The thing is, when I returned from overseas, I had a severe hypoglycemic episode. The doctors are saying it was a coma. That was the first time I ever had one. Since then, the symptoms of hypos started changing and then disappeared altogether. I spoke with a specialist and he told me to keep my level elevated at about 12 mmol for two weeks to try to 'reset' my awareness and all that it did was cause hyperglycemia unawareness. Now I cannot 'feel' if I'm having highs or lows.

In terms of my basal, if I'm correct in what is meant by it, my level after fasting overnight was roughly 7 mmol before all this started. Another note is that my insulin went through the x-ray machines at the airport. (despite having a letter from my doctor) Now according to some resources, that shouldn't affect the insulin at all but I think it did as I started experiencing different results with my doses almost immediately. I had to halve them. When I returned and had the episode, the pens were discarded as no one was interested in testing them and I got new ones but I've been having problems since.
 
Hi Jimberlands

I do one 24hr basal injection at night. I moved it to the morning a week ago and I still get hypos at night.
 
Hello @ShadowDragon terminology

Basel = usual refers the long acting insulin in your case the Lantus.

BS = Is indeed blood sugar also you might see the term BSL which is "blood sugar level" so same thing.

The other term you may see is "bolus" this refers to the insulin you give yourself before a meal or short acting in your case the Apidra.

As for the Libre this, out the box will not give you any sort of alarm, because it relies on you scanning the sensor to get a reading as you know, however you can get some extra kit and software which will give you that functionality and I am finding useful it is an extra cost.

As for insulin going through X-Ray machines, I have had a loads of the stuff over the years go through X-Ray machines and never, as far as I know, has it effected how well or badly the insulin works.

Pardon me for being nosey but you say you take Lantus and Glucophage XR 500 tablets why are you taking both?

OOPS Forgot to say Welcome to the forum
 
Last edited by a moderator:
1. Have you confirmed that what the libre is showing what happens over night is correct? the Libre can suffer from 'compression lows' where you're in affect sleeping on it and squash the interstitial fluid away from the filament.

2. if you are having nighttime hypos, then you'd expect to be waking higher and on an upward trend. Don't worry about those for the moment - I'd actually be inclined not to correct them with additional insulin for a bit just in case the liver grabs back the glucose at some point - in fact this maybe what is driving it all.

3. Glucophage XR is metformin a slow release version, it shouldn't cause hypos - it does try to stop/reduce the liver dumps, decrease glucose absorption in the gut and improve insulin sensitivity.

Are you doing any exercising? suffering hypos during the day as well?

Welcome!
 
Could you talk us through a typical day? BGs, food, dosages activity levels etc
 
Hi Knikki

According to my doctor, he suspects that my pancreas is still producing insulin but the cells are no longer sensitive to it. So I've been taking both from the start. I was diagnosed by a diabetes professor. He put me on Apidra, Lantus and Glucophage XR.
My doctor since adjusted my Glucophage to two tablets.
 
Hi Slip

Perhaps this might help.

This is how the sensor has analysed my blood. It can be 2% higher than the actual reading when I do a control test.
No exercise apart from walking. Occasionally move things around and such but pretty much sedentary.

A typical day would be wake up around 6am, go to the office. Have breakfast around 9am, lunch around 1pm and dinner around 7pm. Have a snack later on around 9pm and then bedtime around 10h30pm. Normally have 1 or 2 cups of coffee a day. You can see that my level has increased significantly and I haven't eaten yet. All I've had is water. Plain, still mineral water.
 
slip said:
1. Have you confirmed that what the libre is showing what happens over night is correct? the Libre can suffer from 'compression lows' where you're in affect sleeping on it and squash the interstitial fluid away from the filament.
Click to expand...

@ShadowDragon
This.
I am not suggesting that this is the whole answer, by any means. Especially if you are falling out of bed and waking up hours later!

But I have experienced these compression lows with the Libre. What happens is that if I sleep in a certain position, lying on the arm wearing the sensor, the readings go shockingly low. Then as soon as I roll over to sleep on the other side, the reading rises back to expected levels.

Worth eliminating this as a possibility/contributing factor, although it looks like there is other stuff going on too.

Edited to add: you were just posting your screen shot while I was typing my post. And I have to say that your screenshot looks very different from my 'compression lows' so I withdraw the suggestion!
 
Hi Brunneria
The compression lows make sense however I have tested with the strips as well and sometimes I work a bit late and the level has already dropped. The strips are normally spot on or up to 2% lower than the sensor. Thanks for the suggestion. And I just saw your edit.
Also, I see gaps in the readings from time to time. Could this be caused by the compression lows?
 
I get small gaps in the Libre graph line too.
For me, they seem to happen for one of two reasons.

1 it is a new sensor, still 'bedding in' and the gaps are very short, maybe 10-15 minutes. They stop happening after a day or two. I have never felt that they affect the usefulness of the sensor.

2 i have forgotten to scan the sensor for 8 hours. This is very rare! But it may happen if I sleep in, or forget to take the sensor out with me for the day. The sensor only has a memory for the last 8 hours, so once you haven't scanned for longer than that, there will just be a gap on the graph. Then the next time you scan, it will backfill the last 8 hrs, but no further.
 
I scan the sensor often and try not to miss a scan. If I wake up in the middle of the night, I scan and then go to sleep so I don't think its that. I did notice that one time after a shower, the meter showed a message saying that scanning was unavailable and that I should try again in 10 minutes. Not sure what caused that.
 
small gaps in the graph can be because the BG levels are changing rapidly the Libre just can't hand it.

Thanks for the AGP graph, and the rough daily routine. That is amazing that you don't or didn't have ANY hypos during the day but then again you're pretty much always over target

Could you try having breakfast pretty much as soon as you're up, before going to work? What do you have for breakfast? Do you pre-bolus at all? What are your injection sites like? It's almost as if all the insulin you inject during the day does nothing until you lie down! The only thing I can think of is at rest your liver does the grab back but with no insulin on board it shouldn't consistently drop you that low (as if our bodies always do as they should!). Thats a mighty monster roller-coaster you're on.

What are your Insulin to Carb ratios (I:C) like? How many carbs do you have at each meal?

Just looking I'd say your breakfast ratio needs increasing but that may also because of starting at a high BG - some T1Ds find the higher they are the bigger the correction dose needs to be.

Can't remember if you have tried or if it's already been suggested to do a basal test? could you post an agp of the time since changing your basal dose to the morning only please?

Sorry so many questions!
 
You must log in or register to reply here.
Menu
Log in
Register
Cookies are required to use this site. You must accept them to continue using the site. Learn More.…