Most People with Type 1 Don't Wake Up from Hypoglycemia

[Funnygrl]

Patients with type 1 diabetes don't wake in response to hypoglycemia (http://www.eurekalert.org/pub_releases/2007-02/plos-pwt022207.php)

Patients with type 1 diabetes don't wake in response to hypoglycemia

A study of 16 patients with type 1 diabetes mellitus (T1DM) and 16 normal individuals shows that only one of the 16 T1DM patients, as compared to ten healthy control participants, awakened upon hypoglycemia.

Bernd Schultes and colleagues from the University of Lubeck induced hypoglycemia with insulin under controlled conditions and then assessed sleep with polysomography. A fall in plasma glucose to 2.2 mmol/l, which provoked an awakening response in most healthy control participants, did not provoke awakening in most patients with T1DM. On a control night, with no hypoglycemia, none of the participants from either group awakened. The researchers also looked at hormonal changes and found that in all the study participants from both groups who woke up, and in five of the study participants who did not awaken (three T1DM patients and two healthy control participants), plasma epinephrine concentration increased with hypoglycemia by at least 100%. In all participants who awakened increases in epinephrine always started before polysomnographic signs of wakefulness.

These results suggest that the awakening response to hypoglycemia is impaired in T1DM patients. It appears that awakening forms part of a central nervous system response to hypoglycemia and that failure to awaken increases the risk for T1DM patients to suffer prolonged hypoglycemia.

In a related perspective Harry Shamoon and Ilan Gabriely, from the Albert Einstein College of Medicine, discuss the paper further and conclude although further work is need to investigate the precise mechanisms involved, it “strongly supports and further advances the current notion of T1DM susceptibility to nocturnal hypoglycemia”


I'd like to see this repeated with a larger group. ****, I'd volunteer!

[blue_eyed_devil]

i'd give them a run for their money... i'm pretty sure i wake up everytime (well at least most times...). studies never seem to prove the reality of what actually happens... interesting though.

[dgrilli]

I actually get the weirdest nightmares you can imagine and I'm a tough cookie to wake up. I don't hear very well.

I do not like to go into the 80's couple of days ago I was 82 but not feeling low.

When I was high for a while 150 felt low.

Be carefull

[lgvincent]

When I had Sidney, I had no problem waking when my blood sugar was low. He would bite me on the toe and it always worked. I don't know how he developed such a plan but he came up with it by himself. Brandy would slightly extend a claw and paw my face. That usually worked but not for the bad insulin reactions. I sure wish they were here now.

[BlueSky]

You sometimes have to wonder what motivates research. What are these researchers trying to prove, and why are they trying to prove it? Reminds me of a study on the effects of walking on heart disease. The study found that walking downhill provides bigger cardiovascular risk reduction than walking uphill! I mean, so what? I suppose it might make a difference to someone who had devised a downhill stepping machine. :T

[someone]

I know I go low at night, because nearly everytime I wake up to test I am low. It never wakes me up though, and has never been a problem.

[christie]

i don't remember before if i could wake up but now i cannot wake up during lows,i never have the feeling that its low.

[Injecto]

16 patients is NOT a study, it's anecdotal...

That's no more scientific then my saying that my grandfather died of cancer because he drove by a nuclear power plant one day. I can randomly pick 16 people here at work alone who can't drive safely, but that' doesn't mean ALL drivers in the world are unsafe because of my "study"...


Sorry, I took research methodology in University and small samples just don't cut it.

[Funnygrl]

16 patients is NOT a study, it's anecdotal...

That's no more scientific then my saying that my grandfather died of cancer because he drove by a nuclear power plant one day. I can randomly pick 16 people here at work alone who can't drive safely, but that' doesn't mean ALL drivers in the world are unsafe because of my "study"...


Sorry, I took research methodology in University and small samples just don't cut it.
I didn't call it a study- the article did.

[Injecto]

I didn't call it a study- the article did.


No no, I didn't mean you at all. I just find these kinds of "studies" almost baseless. At BEST they provide an introductory glance at something that should maybe perhaps one day be researched in a more serious and profesionally scrutinizable maner. Making a statement like "strongly supports...." is ridiculous with 16 test subjects.
I was taking a pot shot at the article and study, not you. :)

[BriOnH]

http://www.diabetesforums.com/forum/type-1/14527-do-you-wake-up.html?highlight=wake

73% of us awake during them.

Wich means:
Most Patients with type 1 diabetes wake in response to hypoglycemia; in our sudy.

[tanyatype1]

No no, I didn't mean you at all. I just find these kinds of "studies" almost baseless. At BEST they provide an introductory glance at something that should maybe perhaps one day be researched in a more serious and profesionally scrutinizable maner. Making a statement like "strongly supports...." is ridiculous with 16 test subjects.
I was taking a pot shot at the article and study, not you. :)

I totally agree Injecto! Although it's interesting to read, you can find a study to support anything these days! Flip the page and you'll see another study debunking the first study! Frustrating really. Some people, especially the newly diagnosed, could read that "study" and be totally worried and stressed out by it - not really thinking about the fact that it was ONLY 16 people.

[kel4han]

Oh man...I was just asking the moms elsewhere what thier kids do to indicate a low when sleeping. I shouldn't have asked becuase I kept assuring myself there would be signs. Now I am more freaked out than before! Most of them said thier kids dont wake up when low, probably because kids sleep so heavily. Back to checking 3 x's a night instead of just once!

[BriOnH]

Oh man...I was just asking the moms elsewhere what thier kids do to indicate a low when sleeping. I shouldn't have asked becuase I kept assuring myself there would be signs. Now I am more freaked out than before! Most of them said thier kids dont wake up when low, probably because kids sleep so heavily. Back to checking 3 x's a night instead of just once!

If my mom would have tested me even once a night I think I would be a much more fragile, and different person. She is the best mom a diabetic could ask for. Thank god I wasn't put through that.

[Funnygrl]

http://www.diabetesforums.com/forum/type-1/14527-do-you-wake-up.html?highlight=wake

73% of us awake during them.

Wich means:
Most Patients with type 1 diabetes wake in response to hypoglycemia; in our sudy.
But "our study" had no way to determine if the people who voted that they awake during lows were sleeping through some too.

Oh man...I was just asking the moms elsewhere what thier kids do to indicate a low when sleeping. I shouldn't have asked becuase I kept assuring myself there would be signs. Now I am more freaked out than before! Most of them said thier kids dont wake up when low, probably because kids sleep so heavily. Back to checking 3 x's a night instead of just once!
Testing 3x a night is excessive. You and your child both need your sleep. Lows during sleep can be dangerous, but most aren't. I'm sure I go low at least 3x a week during my sleep- and I never wake up. But by the morning my bs is normal again. If your child has adequate nutrition and proper basal insulin, odds are very good that the liver will take care of any drops in blood sugar throughout the night, and that drops will be minimal. I would say limit night time checks to nights when there was excessive activity during the day, sick days, and when the bed time blood sugar is out of range, or there's a lot of IOB at bedtime.

[Just_Plain_John]

Patients with type 1 diabetes don't wake in response to hypoglycemia (http://www.eurekalert.org/pub_releases/2007-02/plos-pwt022207.php)

I'd like to see this repeated with a larger group.

Absolutely - a bigger sample size is very important as Injecto noted. I'm surprised that any sort of researchers don't know this already ! It makes me question either their skill or objectivity (fishing for funding ?).

Sixteen *hundred* subjects with half of them as a control group would be a lot better.

Personally, I think any Type 1 who knows you are inducing a hypo is going to have a hard time sleeping at all :eek: - so we need another 800 Type 1s who get saline and NO hypo as a second control group for the hypo T1s.

:D You can't accuse me of thinking small...

[Dewey]

Couple of things....;)

1. We ought to do a new poll on how many of us wake up when lows have occurred, but make the poll less restrictive (i.e. don't just put "I wake up when lows happen", "I don't wake up"....put more options like, "I Sometimes wake up when lows occur." etc..). That'd be interesting to read & even do a self-comparison. :nerd: (EDIT: Sorry Brian, forgot you'd done one in the past...)

2. I never hold much trust in ANY "study," etc. All too often, statistics on the "studies" are skewed to what those who run them want them to be. :thumpdown

[DeusXM]

Frankly I'm not really fussed whether anyone else wakes up during a low. I'm more concerned with whether I do.

[JediSkipdogg]

2. I never hold much trust in ANY "study," etc. All too often, statistics on the "studies" are skewed to what those who run them want them to be. :thumpdown

They had on the news a talk about cancer studies. I don't recall the exact numbers but they were close to these I'm about to post (within 5%.) They said that studies funded by pharmaceutical companies show an 86% positive rating. Yet the same exact study funded but a college or some outside non-biased group had a 56% positive rating.

They said that generally the key part is who is not included in studies. Independent studies generally take anyone and keep them in the entire study whereas pharmaceutical ones will throw someone out if something changes (say they get a cough unrelated to the drug.) Therefore the results may be skewed.

[xMenace]

These **** things need to show results by age. Age, IMHO, is the biggest factor of reduced sensitivity. The adrenal gland slows down as you age, and those insulin reactions are largely adrenalin dumps.

Before the age of 30 I awoke 100% of the time. Now at 46 I wake up < 5%.

[poodlebone]

For the first 15 years with Type 1 I most definitely woke up from lows. Now only would I wake up, but I'd be drenched in sweat and shaking. As I tried to get tighter control, my awareness went away. That's not good. Instead of waking up when I'd go low during the night, I'd wake up having a seizure, freezing to death, after my body had already gone so low that my liver finally decided to kick in and help me out. I've been told that the cold feeling comes as your BG is rising.

[JediSkipdogg]

I think another key is what insulin one is on. I know when I was on NPH I woke up 0% of the time. Now on a pump I'd say I wake up 60% of the time.

[Injecto]

I think another key is what insulin one is on. I know when I was on NPH I woke up 0% of the time. Now on a pump I'd say I wake up 60% of the time.

Perhaps playing a bit of devil's advocate, and also just plain curiosity, but how do you know if you only wake up 60% of the time? From your perspective, wouldn't you then still think it was 100% of the time? LOL :) ...and seriously too.

Unless of course you are on a CGMS, but then wouldn't there be an alarm for lows?

[JediSkipdogg]

Perhaps playing a bit of devil's advocate, and also just plain curiosity, but how do you know if you only wake up 60% of the time? From your perspective, wouldn't you then still think it was 100% of the time? LOL :) ...and seriously too.

Unless of course you are on a CGMS, but then wouldn't there be an alarm for lows?

I say 60% because there are mornings where I wake up to the alarm clock and test (which I always test within 5 minutes of waking) and I will find out I'm running 50something. Therefore I concur I musta been low for some time but didn't wake up. Whereas some nights I'll wake up at 70 and wake up from that low.

[Cyborg]

How would you know if you woke up during a low, or after the recovery period?

From what I understand most people sleep through lows. I wake up low sometimes and I'm covered in sweat. I take that as meaning I slept through the low and finally woke upon the liver kicking in. In fact, when I wake up in the morning low, I want to simply go back to sleep, but I force myself to get up and get some glucose tabs.

[right2fight]

Jedi, Why do you think insulin type is a factor? A low is a low and all people with diabetes experience lows at some time. Margaret

[JediSkipdogg]

Jedi, Why do you think insulin type is a factor? A low is a low and all people with diabetes experience lows at some time. Margaret

Because a low on Lantus comes on extremely slow. Therefore giving the person time to maybe recognize the low coming on. But a low on NPH can come on in 15 minutes due to the nature of the peak it has.

[right2fight]

Ironic, but while typing in this thread last night, Luke woke up with a BS of 50. Hasn't had one in a long time and expressed how crappy he felt. Once treated he went back to bed. It seems to me and him that as his body is changing through adolescence so are his symptoms, sensitivity to insulin and let's not forget the attitude. lol
Luke is on NPH/novolog and has done well with it. We did try Lantus about 6 months ago, but after developing ketones and dealing with highs for some 21 hours and a call to the pharmaceutical company, I discovered that the dose given was not at all comparable to the NPH, so it screwed everything up. We have our next endo this month some time and I have already asked about Levemir. Any recommendations? Thanks, Margaret

[JediSkipdogg]

Margaret....did you give up on Lantus after only 21 hours of total use? If so that's not enough time to tweak the dose. The problem with Lantus is you have to find out first if it will last 24 hours in the body or if it will only be 22-23 hours. Then you have to tweak the dosing because you no longer have the peak of NPH. So you may have to increase the total insulin amount to make up for that peak.

Levemir will be exactly like Lantus. Just give it a few days and be ready to give extra injections of Novolog if needed. I'd also recommend doing this on a weekend or day where he won't be doing anything and will be with you the entire day.

[right2fight]

Thanks Jedi, Luke's endo is still under the impression that you should not split the Lantus, so I'm thinking the Levemir would be a better option.
I guess Luke was really discouraged with what happened with the Lantus. The doc told him he could not eat until his bs was under 150 and that took 21 hours. So, he wanted no part of change at the time and we resumed with the NPH/novolog regimen. It has been working until recently, but that I see is Luke being a **** teenager. He has never experienced a bad diabetic episode and I just don't understand why he is suddenly losing interest in good control, other than he is being a **** teenager. Something to be said for learning by mistakes, I am just afraid of the future complications and I would love some input on how to get this through his head!
Thanks, Margaret

[Injecto]

I say 60% because there are mornings where I wake up to the alarm clock and test (which I always test within 5 minutes of waking) and I will find out I'm running 50something. Therefore I concur I musta been low for some time but didn't wake up. Whereas some nights I'll wake up at 70 and wake up from that low.

Stupid me, I didn't even think of that, and it happens to me during the day...DUH!

[type1tenorlady]

When I was on NPH and Regular the signals that I was going low were much more pronounced (sweating, hands shaking, etc) than when I was on Lantus. Even now on the pump the signs that I'm going low are still very subtle until I get close to 40 so if I'm really busy and don't have time to recognize that I feel a bit off, or I'm not standing or walking and therefore don't notice that I'm starting to feel dizzy, I'm likely to go longer before I realize that things are sliding downward and decide to test/treat.

Now that I think about it, I was on the R/NPH all through adolescence and switched right before college, so age (hormones, etc) is also probably a big factor.

Because a low on Lantus comes on extremely slow. Therefore giving the person time to maybe recognize the low coming on. But a low on NPH can come on in 15 minutes due to the nature of the peak it has.

I actually have the opposite experience. If my BG is dropping slowly and consistently I am likely not to notice for the reasons stated above, whereas if it is dropping very quickly like it did on NPH or now if I significantly over bolus or am much more active than usual, I'll start to feel it almost immediately. Several times I've tested, been 100, waited 20-25 min, tested again and been 80, waited another 20 min and third test comes up 50 or below.

[JasonJayhawk]

Sorry, I took research methodology in University and small samples just don't cut it.

Just you wait! It's even more frustrating when you find out that researchers get millions from government grant money to "discover" things we already know.

For example, a recent study in the USA, funded by the NDIC, found that exercise and insulin results in increased chance for hypoglycemia in children.

[poodlebone]

Thanks Jedi, Luke's endo is still under the impression that you should not split the Lantus, so I'm thinking the Levemir would be a better option.


When I was on Lantus I had to split my dose, 50/50 AM/PM. It lasted only about 18 hours for me and I was waking up low, and was high before dinner. Splitting the dose helped and since I spent years taking NPH twice a day it didn't bother me. A lot of people split the dose, so I'm not sure why your endo objects.

[gobbly2100]

If I go low in the night I wake up wondering why I woke up and then I test my blood and find it is low, it is awfuly tempting to get back to sleep though but thank goodness I have never fallen back to sleep after waking from a low.

[JediSkipdogg]

I actually have the opposite experience. If my BG is dropping slowly and consistently I am likely not to notice for the reasons stated above, whereas if it is dropping very quickly like it did on NPH or now if I significantly over bolus or am much more active than usual, I'll start to feel it almost immediately. Several times I've tested, been 100, waited 20-25 min, tested again and been 80, waited another 20 min and third test comes up 50 or below.

I will agree the symptons of going low on NPH are more pronounced. However, that is generally because of the speed of them coming on and sometimes they can come on faster than you can treat. On Lantus, at least with a subtle drop, you may feel it sooner and can take other treatment methods besides a glucagon shot or just cramming food in your mouth.


I don't know of the true percentages, but I would think about 50% of Lantus users split their dose. There is nothing wrong with it. The problem is the body needs some form of insulin in it at all times. Some people wonder how a split can even work because then you will have two periods in the day where there is say an hour gap from the Lantus running out and only having 50% of the dose in you. Well, the body can maintain control for a short period on less insulin, but on no insulin it just can't survive. The body truely is an amazing creation.

[Tim_Roy]

i'd give them a run for their money... i'm pretty sure i wake up everytime (well at least most times...). studies never seem to prove the reality of what actually happens... interesting though.

I never ever wake up because of a reaction. I may wake up (if I would normally wake up around that time) but generally no. I'd actually be more likely to stay asleep the lower I am.

This study doesn't seem to prove the reality of what happens to YOU. From what little I've read of it, it seems to be saying that it's normal to awaken from hypoglycemia, but that type 1s tend to get acclimated and no longer respond in that way. I'm not sure I've ever woken as a result of an insulin reaction.

Much like the fight or flight response, I'd think the "wake up" bit is an evolutionary response. In animals (and humans in their earlier, more animalesque forms) hypoglycemia is a symptom of hunger/starvation. The "wake up because you're low" would enable the sufferer to go get some food. The fight or flight would make SURE he's willing to do what it takes to get the food. Even if it means beating on cave man or cave woman Og until you get their food.

It's possible that our increasing food supply has made this a less important evolutionary trait.