Ways To Prevent Low Blood Sugar At Night
Detecting nighttime dips in blood sugar can be tricky, but these simple strategies can help you prevent nighttime hypoglycemia and sleep without worry.
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Nighttime dips in blood sugar levels are common among people with diabetes. Authors of a study published in June 2013 in Quality of Life Research noted that people with diabetes type 1 or type 2 experience low blood sugar during sleep more frequently than many doctors realize.
Nighttime hypoglycemia can be caused by a number of different factors, from exercising too close to bedtime to drinking alcohol in the evening. If untreated, low overnight blood sugar levels can lead to headaches and loss of sleep and in extreme cases, seizures or even death. The good news is that preventing low blood sugar while you sleep can be achieved with a few simple steps:
Just Ate Too Much The Night Before
If you had a late night high carb snack, then it is possible that your fasting blood glucose is high simply due to poor food choices in the presence of insulin resistance. As well, a large late night dinner high in fat can delay digestion and absorption of the carb content of the meal enough so that your post-meal rise in BG is going like gangbusters around the time the Dawn Phenomenon is kicking in.
Need help controlling carbs at meals? You can start with a typical goal of 30-45 grams of total carbs/meal if you are an adult woman or 45-60 grams/meal if you are an adult man. Try limiting your bedtime snack to 11- 20 grams total carbs. Discuss personalized meal and snack goals with your healthcare provider. If you have diabetes, ask your doctor for a referral to a Certified Diabetes Educator . This type of specialist is trained to help patients manage all aspects of their diabetes care including how to lower morning blood sugar.
Originally published on Dec 4, 2012,Updated: Updated: Jan 17, 2020
What Are The Warning Signs Of Early Morning Hypoglycemia
Whenever you experience low blood sugar levels at 3:00 am, your body will show symptoms that are not always the same for everyone. These symptoms include:
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Symptoms Of A Low Blood Sugar Level
A low blood sugar level can affect everyone differently. You’ll learn how it makes you feel, although your symptoms may change over time.
Early signs of a low blood sugar level include:
- a fast or pounding heartbeat
- becoming easily irritated, tearful, anxious or moody
If a low blood sugar level is not treated, you may get other symptoms, such as:
- unusual behaviour, slurred speech or clumsiness
- seizures or fits
- collapsing or passing out
A low blood sugar level, or hypo, can also happen while you’re sleeping. This may cause you to wake up during the night or cause headaches, tiredness or damp sheets in the morning.
High Blood Sugar When Waking Up
Diabetes Forum The Global Diabetes Community Find support, ask questions and share your experiences. Join the community I have a problem with my long acting levemir doses… Waking up in the morning my blood sugar is usually above 12 mmols, I take 60 units of levemir after my evening meal. I’m wondering why I’m not achieving a good reading in the morning using such a large dosage. Any ideas?? Also going to ask my GP about and insulin pump next time i’m seeing her what do you guys think about the pump?? I have a problem with my long acting levemir doses… Waking up in the morning my blood sugar is usually above 12 mmols, I take 60 units of levemir after my evening meal. I’m wondering why I’m not achieving a good reading in the morning using such a large dosage. Any ideas?? Also going to ask my GP about and insulin pump next time i’m seeing her what do you guys think about the pump?? It could be that such a large dose of long acting insulin could be making you go hypo in your sleep then you body is correcting it itself by ‘liver dumping’ so your waking up with high BG’s! Try waking yourself up at 2am then 4am to test and see how your BG’s are doing over night. What are your BG’s like before you go to bed? if your long acting is correct you should be waking up quite close to how you go to bed. Another reason could be the ‘dawn phenomenon’ where you body releases hormones dContinue reading > >
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How To Differentiate Between The Two Effects If You Suspect High Fasting Blood Sugar
If your sugar level shoots up every morning after you wake up, then always check your 3:00 am sugar.
If sugar at that time comes low then this is a Somogyi effect. You should always consult your doctor as root cause analysis of hypoglycemia is required. There may be a need for drug dose reduction but it all depends on clinical judgment.
But if your 3:00 am sugar comes out to be normal or on the higher side, then its a dawn effect. It requires clinical judgment, your dose may need to be increased or changed.
Hypoglycemia or low blood sugar levels should be managed at priority since low sugar causes our body to get deprived of energy and causes symptoms such as tiredness, weakness, fatigue, lethargy, shivering, and extreme hunger.
If sugar levels are not managed at this stage, it can further lead to unconsciousness or coma. Unawareness of hypoglycemia phases could be dangerous due to the same reason and hence must be looked for!
On the other hand, hyperglycemia or high blood sugar levels are also important to be managed as it can further lead to complications. Constant high blood sugar levels can impact kidneys, eyes, nerves, heart and brain.
You must work on managing your blood sugar levels within the normal range in order to live a healthy and happy life. Do improve your lifestyle by eating timely, exercising daily, going for doctor follow-ups and taking insulin or medicines on time. For more information, read this blog.
Preventing A Low Blood Sugar Level
If you have diabetes, you can reduce your chance of getting a low blood sugar level if you:
- Check your blood sugar level regularly and be aware of the symptoms of a low blood sugar level so you can treat it quickly.
- Use a continuous glucose monitor or flash monitor to see how your blood sugar levels are changing. Ask your diabetes care team about getting a monitor if you do not already have one.
- Always carry a sugary snack or drink with you, such as glucose tablets, a carton of fruit juice or some sweets. If you have a glucagon injection kit, always keep it with you.
- Do not skip meals.
- Be careful when drinking alcohol. Do not drink large amounts, check your blood sugar level regularly, and eat a carbohydrate snack afterwards.
- Be careful when exercising eating a carbohydrate snack before exercise can help to reduce the risk of a hypo. If you take some types of diabetes medicine, your doctor may recommend you take a lower dose before or after doing intense exercise.
- Have a carbohydrate snack, such as toast, if your blood sugar level drops too low while you’re asleep .
If you keep getting a low blood sugar level, talk to your diabetes care team about things you can do to help prevent it.
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People With Diabetes Generally Take 2 Types Of Insulin:
- Short-acting insulin and
- Long-acting insulin.
Short-acting insulin such as APIDRA or NOVORAPID or HUMALOG reaches the bloodstream within 30 minutes after injection and peaks anywhere from 23 hours.
However, long-acting insulin such as LANTUS is peakless insulin that works in the background and lasts more than 24 hours.
The effect of these two insulins gets combined and the peak of short-acting insulin shifts to early morning hours. This increases the risk of hypoglycemia around 3:00 am.
When To Seek Care
Its essential that you get immediate medical attention if your blood sugar drops and you have severe symptoms, like seizures or loss of consciousness.
If you have diabetes and your blood sugar drops, and the usual quick-fix treatments dont help raise your blood sugar above 70 mg/dL, its also important to get medical care as soon as possible. This happens more commonly with taking too much long-acting insulin or sulfonylurea diabetes pills.
Also, be sure to get medical care if you dont have diabetes but have symptoms of hypoglycemia that dont go away or get worse after youve eaten at least 15 grams of carbohydrates.
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Are There Any Newer Technologies To Prevent Hypoglycemia
We are lucky that in this day and age, we can predict hypoglycemia and prevent it through technology like continuous glucose monitors, explains Dr. Shah. Additionally, he notes that there are newer insulins available to help decrease episodes of hypoglycemia.
One of our roles as your doctor is to educate every patient about the self-management of diabetes and to create a personalized care plan, explains Dr. Shah. By self-managing your condition you will really feel empowered enough to take control of your health.
How Do You Treat Hypoglycemia
Treatment for hypoglycemia involves both the immediate steps needed to raise your blood sugar level in addition with the later treatment or medication dose adjustment to prevent recurrence.
To immediately raise your blood sugar level, Dr. Shah advocates the rule of 15eating 15 grams of carbohydrates and then checking your blood sugar level 15 minutes later. Fast-acting carbohydrates include:
- 4 glucose tablets
- 4 ounces of fruit juices
Keep repeating these steps every 15 minutes until your blood sugar reaches above 70 mg/dL, he explains. Once your level has stabilized, its important to then eat a snack or even a full meal to maintain that balance, Dr. Shah adds.
If your symptoms are more severe and/or a person is unable to swallow, you may need an injection of glucagon, he says.
To prevent episodes of hypoglycemia in the future, Dr. Shah says that treatment may involve the changing of prescribed regimens and dosages or adjusting your meal plans.
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Exercise Food And Alcohol
For people with type 1 diabetes, maintaining the correct blood glucose level involves balancing how much insulin you inject, the amount of food you eat, and how much energy you burn during exercise.
Hypoglycaemia may occur if you’ve taken your dose of insulin as usual, but your carbohydrate intake is lower than normal or has been used up more quickly. This may happen if you delay or miss a meal or snack, don’t eat enough carbohydrate, or exercise more than usual.
People with diabetes who’ve drunk too much alcohol, or drank alcohol on an empty stomach, can also get hypoglycaemia.
However, it’s not always possible to identify why a particular episode of hypoglycaemia has occurred, and sometimes it happens for no obvious reason.
Signs You Are Experiencing Diabetic Ketoacidosis
If you are in DKA, its likely that you are nauseous or vomiting. Your breath may have a fruity or acetone odor as your body tries to offload ketones through your breathing. Its likely that you will be dehydrated with very high BG levels and excessive urination. You might have aches and pains, and perhaps blurred vision. Not fun!
DKA is serious, and can be life-threatening. Because of dehydration and excessive ketone production, the blood becomes acidic. This is caused by a lack of working insulin. Most cells preferentially burn glucose for fuel. Many cells can also burn fat in small amounts. While glucose burns cleanly, fat produces waste products called ketones. Ketones are acid and upset the pH balance, essentially polluting the atmosphere in our bodies.
We dont tend to burn much fat at a time, so small amounts of ketones can usually be broken down and burned off along with glucose. Its necessary to have enough glucose in the body cells so there is a fuel source, and we also need to have insulin to move the glucose into the cells, where it can be used for energy. If there is no insulin, the glucose cant get inside the cells. The cells are then forced to burn fat as an energy source, and this causes large amounts of ketones to be produced.
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Normal Waking Blood Sugar
After a night of sleep, and without any recently digested food in the system, the bodys glucose level tends to settle down to a healthy, normal level.
In the context of diabetes, this doesnt happen naturally, but it can be achieved with the proper use of insulin and other glucose-lowering medications. Ideally, everyone with diabetes will wake up with blood sugars in the normal range.
However, many people experience what is called the dawn phenomenon. As the body prepares to wake and start moving, it releases stored sugar from the liver into the blood. This can cause a moderate spike in blood sugar. You can read How to Fix High Morning Blood Sugars for tips on how to improve these numbers.
To confirm if this is happening to you, you can wake up in the middle of the night and check your blood sugar. If its in the normal range then, but higher after waking, this is probably the cause. If the spike is small and goes away quickly, then its likely nothing to worry about . The spike from dawn phenomenon is often less pronounced than one you would get from eating a typical meal.
How Common Is Low Blood Glucose
Low blood glucose is common among people with type 1 diabetes and among people with type 2 diabetes who take insulin or some other diabetes medicines. In a large global study of people with diabetes who take insulin, 4 in 5 people with type 1 diabetes and nearly half of those with type 2 diabetes reported a low blood sugar event at least once over a 4-week period.2
Severely low blood glucose, defined as when your blood glucose level drops so low you cant treat it yourself, is less common. Among U.S. adults with diabetes who take insulin or some diabetes medicines that help the pancreas release insulin into the blood, 2 in 100 may develop severely low blood glucose each year.3
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How To Treat Someone Who’s Having A Seizure Or Fit
Follow these steps if someone has a seizure or fit caused by a low blood sugar level:
Tell your diabetes care team if you ever have a severe hypo that caused you to have a seizure or fit.
How Is Hypoglycemia Treated
When blood sugar levels are low, the goal is to get them back up into the healthy range quickly. Here are the basic steps to follow if your child is alert and awake:
- Check blood sugar levels if you can to find out if symptoms are from hypoglycemia. If you can’t, don’t delay treating your child’s symptoms. You can always test after treating your child.
- Give sugar. Offer your child a sugary food or drink that will raise their blood sugar quickly. Regular soda, orange juice, or cake frosting are good choices. Or, give your child a glucose tablet or gel. Follow your childs care plan for the right amount of sugar to give your child. If you are unsure, give 15 grams of simple carbs, such as 4 ozs. of juice. Symptoms usually stop about 10 minutes after your child takes sugar.
- Check blood sugar level again 15 minutes after giving sugar to make sure the level is no longer low.
You can repeat these steps until the blood sugar level is in the healthy range.
If your child cannot keep down juice or food, cant wake up or is having a seizure, give glucagon right away. Then call 911. Do not give anything by mouth until they are awake and alert. After getting glucagon, your child will be more alert and feel better within 15 minutes. When your child is alert enough to eat, give sugary food or drink to help prevent their blood sugar from falling again.
Their diabetes plan may need to be adjusted to help prevent future episodes.
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This Isnt Dawn Phenomenon
Many people would blame this rise in blood sugar on dawn phenomenon , which has a similar endpoint, but a different mechanism. Dawn phenomenon is the result of hormones releasing in the body in the early morning predominantly growth hormone, cortisol, epinephrine, and glucagon which in turn increase insulin resistance. The current basal insulin from the pump or long-acting injections is no longer enough, and blood sugars rise.
That hormonal surge happens around 2 am-6 am, with most of it occurring in the middle of the night. Lets say you woke up at 7:30 am and arent in the DP zone. Its not DP. Then what?
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High Blood Sugar: Hidden Dangers
In the short term, high blood sugar levels can zap your energy, cause excessive thirst and urination, and blur your vision. High blood sugar levels can also lead to dehydration, dry and itchy skin, and infections. Minimizing the time spent above your target blood sugar range can help you feel your best and will help prevent complications and injury to your body.
Over time, high blood sugar affects many parts of the body. Chronic high blood sugar can start to cause noticeable changes, including:
- Memory problems
- Vision problems like blurriness, diabetic retinopathy, and blindness
- Gum disease that leads to tooth loss, which can make eating healthy foods difficult due to problems chewing
- Heart attack and stroke due to increased plaque build-up in the vessels and other vascular issues
- Kidney disease, which can lead to the need for dialysis or a kidney transplant
- Nerve damage that can cause decreased sensation in the feet and legs which increases the risk for wounds to turn into serious infections and even amputation
Nerve damage from high blood sugar can also cause a variety of symptoms including:
- Pain and tingling in the feet and hands
- Difficulty emptying your bladder
- Problems during the digestion process after eating, which can cause food to sit in the stomach too long and lead to nausea, vomiting, and erratic blood sugar levels
Checking your blood sugar frequently and taking immediate action when it is above range can reduce your risk of complications.
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