[Dimes]

Hi everyone,

It's great to find this forum.

I have a question about overnight lows.. I noticed in the last couple weeks especially I have been very tired. My bags under my eyes are getting bigger and I feel less energetic during the day. I am curious if this can be caused by the bedtime insulin, and having low blood sugar episodes?

I'm on NPH insulin before bed, and my morning numbers are usually between 5 and 6, but perhaps something is happening at night. I rarely wake up in the middle of the night so I haven't been able to test. I've been getting pretty consistent 7 hours sleep so I'm not sure why I'm getting the bags under my eyes.

What usually happens in an overnight hypoglycemia episode?

Thanks,

newbie (3 months in)

[KCP]

I know that when i have overnight hypos i am definately more tired than i am rested the next day and I found i would wake up with the most attrocious headache!!
But thats just me

[BlueSky]

Originally Posted by Dimes

... What usually happens in an overnight hypoglycemia episode?....

It usually wakes people upand they eat/drink something to increase their blood sugar. Sometimes they sleep through it and may have have a rebound high blood glucose when they wake up, like 15+mmol/l. It sounds like you are sleeping well and your blood glucose is in the target range. You could set your alarm for 2:00am so that you could test it.

[someone]

For a while I was going down to about 40 mg/dl every night. I never seemed to lose sleep over it and would just wake up slightly disoriented.

[Italian]

HI there

I was recently diagnoised with Diabetes type 1 .I usually eat a meal just after the long acting insulin .I eat 2 slices of low gi bread , a cup of yougurt and a cup of tea with 3 sweetners . I don't have any episodes during the night because of this meal . If I don't eat this I run the risk of a sugar low during the night . I only go to bed at 11:00 or 12:00 pm because of this but its worth the good sleep I have .

[Subby]

Dimes,

I find that blood sugars either way can make for less quality sleep.

If I go high I wake up groggy and fatigued.
If I go low I usually get woken up and can fix it, but often then need much more sleep to recover my balance from the low.
If I go low then rebound to high I wake up groggy and fatigued.

As Blue Sky says your blood sugars suggest you are not going low. A rebound would be expected to be up above 10 (usually about 14 mml/l for me)

If you feel there might be some fluctuation that is causing poorer sleep the only effective thing to do is set alarms or get someone to wake you up in the might for testing.

By the way, what are your bedtime numbers?

[REDLAN]

As Blue Sky says your blood sugars suggest you are not going low. A rebound would be expected to be up above 10 (usually about 14 mml/l for me)

this is not always true. A guy recently at our clinic, went on 3 day CGMS to see how his blood sugars were doing during the day - everyone thought his night times were OK.

turns out his BG dropped like a stone during the night - he was averaging 2.5 - 3.0 mmol overnight - and then would recover before dawn. He had absolutely no idea he was low overnight.

so it is possible for you to be low overnight, and wake up normal and not know that you were low.

If you can't get yourself on a CGMS, then I suggest that you set the alarm for the middle of the night - wake yourself up and test to see what your Bg is doing.

there was an excellent post by Xmenace on testing overnights - can't find the thread I'm at work and I've got to go back to work (

[Subby]

Very happy to get corrected Redlan, you learn something new every day with this friend of ours

[xMenace]

Originally Posted by Dimes

What usually happens in an overnight hypoglycemia episode?

It varies. If you are under 35 or so, then typically the shakes wake you up and you go on a safari to the fridge and hunt for juice, or whatever your fix routine is. If you are over 35, then you may sleep right through them if they are mild or degrade into convulsions if low enough. You may also go on aimless excursions very similar to a bull in a china shop.

If you are going low every night, then there's a good chance your hypo-awareness is dampened. Our 'reactions' are largely hormonal responses. Consider another hormonal response - sex. Can you engage in sex every night? If you let more time elapse between episodes is your response any different?

Depending on your activity, there are some decent ways to profile your nighttimes.

- stay up until 2am or later. Many of us do this regularly, so use these times to test every half hour and build that part of the profile. Don't eat after dinner, or if you have a set evening routine, don't change it. If you don't ever stay up late, once or twice won't kill you.

- get up early, say 4am. Sometimes I'll wake up this early and not be able to get back to sleep. Get yourself up some morning after a normal night and build this part of the profile.

- pick a time to wake up and test, say 3am.

By using these and piecing them together, you can get an idea of what is happenning. Keep in mind the 2am to 3am hour is probably the most critical. You'll want some overlapping times to splice teh samples with. In my experience, our overnight pattern shapes are generally pretty consistent

Another exercise you can do is pull an all-nighter and test every half hour. The advantage is you get it in one shot with no splicing. They are not easy to do as you get older, but they are well worth the effort. There is a question about whether this changes your normal overnight behavior. Anecdotal evidence so far suggests no, at least doing it once doesn't.

[Dimes]

Originally Posted by Subby

Dimes,

I find that blood sugars either way can make for less quality sleep.

If I go high I wake up groggy and fatigued.
If I go low I usually get woken up and can fix it, but often then need much more sleep to recover my balance from the low.
If I go low then rebound to high I wake up groggy and fatigued.

As Blue Sky says your blood sugars suggest you are not going low. A rebound would be expected to be up above 10 (usually about 14 mml/l for me)

If you feel there might be some fluctuation that is causing poorer sleep the only effective thing to do is set alarms or get someone to wake you up in the might for testing.

By the way, what are your bedtime numbers?

My bedtime numbers are usually around 6-8, with spikes upwards of 10 once or twice a week. They aren't usually low, and if they are I will have a snack. So maybe this isn't diabetes related..

I think I will do an overnight test to get more information..

Thanks for the responses!

[HollyB]

If you're taking NPH before bed it will likely peak in 3-5 hours, so you may well be dropping a bit low and then cruising back up. I'd set an alarm and check for a few nights -- try 2 am and 3 am. Then you'll know, and either have the info you need to prevent it happening again or be able to sleep with good peace of mind.

[1type2go]

Hey dimes

Just my two bits

I found out I was Allergic to the ACE inhibitor Altace.........Puffy eyes each morning for probably a month and I didn,t put it together but also had hives each morning for years (small and went away after 20 min.)I guess this is called a sensitivity so I wasn't worried about them until I noticed bee sting sized[no redness] lumps around my mouth {one every 4 or 5 days }

read up on any pharmaceuticals

Donovan

[xMenace]

Originally Posted by Dimes

My bedtime numbers are usually around 6-8, with spikes upwards of 10 once or twice a week. They aren't usually low, and if they are I will have a snack. So maybe this isn't diabetes related..

On Lantus I'd have to go to bet at at least 8. I drop like a 16 ton weight in my sleep.

[thomasb]

I had huge problems with lows during the night before i started pumping. To make sure i would wake up at 2am and then 4 am, using an alarm and check.

I have yet to find any research on whether your actual sleep cycle get's disturbed by a low or high even if you don't wake up during the night. Chances are that if you tend to sleep all night without waking up you'll go trough the 4 cycles(like REM sleep, slow-wave sleep etc) as you should. Hm... I¨m gonna look around some more.
oh, and since my sleep is messed up anyway, i test a lot during the night. it's interesting.

[Dimes]

I tested it about 4am.. which was about 5 hours after I took the NPH.. I was 6.1 before bed, had a small snack (maybe 10g carbs max), was 6.5 at 4am, and 6.3 in the morning..

I'm glad I checked though, just to know what is happening.