Need some advice about hypos at night / asleep

[Vicky Bydder]

:confused: Need some advice about hypos at night

I would have at least one hypo a week at night when I'm asleep and it wakes me. I have also noticed that a couple of times a week I wake up in the morning with a shocking headache :vollkomme , damp bedsheets (not wee! :eek: ) and high blood glucose levels :frown: (high for first thing in the morning). Am I right to suspect that I am sleeping through a hypo? And if I am sleeping through a hypo is it dangerous? I usually take my bolus shot at supper time - is this the reason I may be hypoing at night? I have tried lowering my dose, but then my day readings tend to be higher during the day.

- Vicky

[Subby]

Hi Vicky. It sounds to me like you have a good grasp what might be going on. It's pretty common for people to have problem with lows at night at times - often basal requirements do ebb in the small hours causing excess long acting insulin (or even a tail end hypo from dinner/supper bolus) to create lows.

First, the reason for your highs in the morning after this seems to occur, is that the body detects low blood sugars and automatically releases glucagon from the liver - you'll see it referred to as a "liver dump". It's the equivalent of your body having some glucose tabs to raise blood sugar - the only problem being, it doesn't allow for the fact your body won't be able to release more short-term insulin to cater for this increase in energy, and therefore arrive back at good levels. Thus the BG goes up and up and you wake feeling decidedly dodgy with inexplicable highs.

Note, that this is NOT the same as Dawn Phenomenon, another regular natural occurance for people. It's worth saying that - as they are very different and mixing them causes confusion.

As for what to do about it. At the moment you suspect it may be your supper bolus. It has to be said it may also be your basal dose or timing as well. How to find out which, and what to do about it?

The first automatic answer is to say "basal testing"... which is a method of testing how well your basal insulin is covering your background needs without sending you high or low. In essence, you remove other influences (food and bolus) for a period of time, and test every hour or so to observe how well the basal insulin does it's job. If you see problems at some point, you can modify your dose or other tactics such as snacks or exercise, then basal test the next period of time.

I wish I was at my other computer as I have a number of links for methods of basal testing - what I suggest is you search this forum for the words "basal testing" and you will find heaps of info. Feel free to ask questions.

This will also deal with the question "is it my supper bolus" - but you know what, if you really suspect this, you can start your investigation there by simply skipping your supper (and bolus) and seeing if the same problems occur.

Whether you embark on fully fledged basal testing, just doing a little basal testing, or skipping or modifying your supper, or whatever, you should consider setting an alarm at points through the night to take some tests and get a better handle on when this might be happening, regardless. As for is it dangerous - well, you see how the body does have it's defenses (liver dump) but I wouldn't rely on this to keep out of trouble, what is more you do suffer effects from a low, both strain on the body and the consequences such as the rebound. it's best to eliminate lows ASAP.

Good luck with it - using these methods you'll sort it out, if not quickly, then increasingly improving it, within a few nights.

[Vicky Bydder]

Hi Subby, thanks for taking the time to reply - I'm still a bit of a newby - I didn't know what a "liver dump" was when people referred to it - thanks for the tip. What is the "Dawn Phenomenon"? Sorry to bug you, but I feel like i should already know these things but don't. I should have been asleep hours ago - but can't - think I am developing "hypo-in-the-night-phobia".

[Subby]

Hi Subby, thanks for taking the time to reply - I'm still a bit of a newby - I didn't know what a "liver dump" was when people referred to it - thanks for the tip. What is the "Dawn Phenomenon"? Sorry to bug you, but I feel like i should already know these things but don't. I should have been asleep hours ago - but can't - think I am developing "hypo-in-the-night-phobia".

No problem, ask anything anytime, that's what the board's here for.

Interesting you should say that about hypo phobia... I have found again and again that an oncoming hypo (even before it's detectable by BG test) will activate my body and make sleep impossible. Unstable blood sugars kept my sleeping habits poor for years. These days with have much improvement, I can see exactly how much impact such things can have in making sleep troublesome. Don't underestimate this...

Dawn Phenomenon is a release of hormones and energy such as adrenalin and glucagon (internal sugar), often in the hours leading to waking. It's a natural reaction of the body to help wake up and activate the body - unfortunately it can also mean that basal insulin requirements suddenly climb over an hour or two. So it also often leads to highs in the morning, also increased insulin resistance at breakfast.

The way I see it, it's not so much a problem that occurs for some people really, it's more likely something that happens to all or most of us, just that we don't really think about it until it may cause a problem. In other words, nothing worth worrying about until you start to have highs and troubles in the morning, and you can rule both general dosage errors, and the low-leading-to-liver-dump issue (your probably current issue). DP seems just to crop up for some people at some stage or other. It can go on indefinitely, or seem to come and go.

People are so different in these issues. I myself have a naturally occurring background fluctuation starting about 6am building to a peak around 2 pm and very suddenly dropping off around 5pm. Can hardly be called a "dawn" phenomenon but it's a similar cyclical background trend. It can be very strong, and made dealing with my diabetes a nightmare on long acting insulin: the pump, with the ability to program differing basal rates from hour to hour, returned to me the ability to lead a life less disrupted by extreme fluctuation, fatigue, and the multitude of effects that come along with it.

[Vicky Bydder]

Thanks Subby - I noticed your a fellow Melbournian, I think I can't sleep tonight because of the bush fire disaster - we have family that live in Kinglake, two of our relatives have lost their respective homes and wer're still waiting to hear on another 3 more :(
Hope you don't mind if I pick your brain over a few more "diabetic issues" over the next few days/weeks. You sound like you know your stuff and I've got so much to learn.

[Subby]

Any time. I am also disturbed by the bushfires and not ready to settle. Nothing like you, but had quite a few friends I'm out of contact with may be living in the area of Kinglake. Some rellies down in Gippsland who should be ok but not entirely sure yet. Up Kinglake is also an area I go to quite a bit and the whole thing is a lot to take in. I keep telling myself I should turn in as I want to go out that way to offer whatever assistance I can tomorrow, even just take down some clothes. I really hope you hear good news soon.

[kgm0612]

Vicky...........fortunately for me, I wake up during a low and I'm able to treat it with some OJ and not wake up in the morning with a high BS reading.

Try having a snack shortly before bed. Some peanut butter crackers or a handful of nuts might help.

Karen