Prevent Low Blood Sugars
For better blood sugars and fewer lows, test often and review your readings once a week for patterns of lows or highs (or both). Identify problems first, then consider their causes and how to correct them. Make one change at a time and correct lows first. If you need any advice at all about how to correct a problem, be sure to call your physician or nurse educator right away. Do not let control problems linger as they usually turn into larger problems. When trying to prevent low blood sugars, it helps to understand their most common causes. The table below outlines the most triggers for lows. If your are currently experiencing either frequent or severe reactions, look carefully at this list to see what might be causing them. Once you identify a cause, decide upon a correction. Remember: when low blood sugars are frequent or severe, it is almost always necessary to reduce current insulin doses. If lows blood sugars happen infrequently, try to identify the trigger so you can make adjustments when you encounter that situation again. Common Triggers and Corrections Cause Correction too much insulin less insulin skipped meals eat regularly or reduce fast-acting insulin for that meal light meal less insulin or more eating lost weight less insulin or more eating more active less insulin or more eating vacation less insulin or more eating How to Prevent Lows: Eat the meals and snacks for which you've taken insulin. Test your blood sugars often. Count the carbohydrates in each meal. Match your pre meal Humalog, NovoLog or Regular to the amount of carbohydrate and to the current blood sugar. Learn to use your test results to adjust your insulin and food. For example, if low blood sugars happen in the afternoon, an afternoon snack or less insulin in the morning or at lunch can hel Continue reading >>
Avoiding Nighttime Lows
Nighttime hypoglycemia can be the result of a number of factors in people with diabetes, according to Howard Wolpert, M.D., Director of the Joslin Diabetes Center Insulin Pump Program. It’s important to learn what causes low blood glucose reactions, so you can figure out how to prevent them from happening. Causes of Nighttime Hypoglycemia Having an active day or exercising close to bedtime with diabetes can decrease your blood glucose and cause a hypoglycemic reaction during sleep. Consuming alcohol in the evening can also put you at risk for a lower blood glucose level. This is a result of your liver clearing the alcohol from your blood, instead of producing glucose. In addition, some people forget that their bolus/fast-acting insulin lasts for up to five to six hours. If you have a late dinner and go to sleep a couple hours later, your blood glucose may be normal before going to bed. However, since the insulin you took for dinner is still acting in your body, your blood glucose could drop during the night. Signs of Nighttime Hypoglycemia Signs that you’ve experienced nighttime hypoglycemia can include: Sweating: waking up with damp clothes/sheets Waking up with a headache Having nightmares You may also wake up with a higher blood glucose reading, which is a result of your body rebounding from the overnight low. Experiencing a fast heartbeat and anxiety before bed may be an indication of approaching hypoglycemia. Ways to Avoid Nighttime Hypoglycemia Your target blood glucose reading before bed should be at least 140 mg/dl, Wolpert says. Before you go to bed, consider all of the causes of nighttime hypoglycemia, and if you think you’re at risk, have a snack before heading to sleep. If you use an insulin pump, one option is to reduce your basal rate. If you find yo Continue reading >>
Night Sweats And Diabetes – Nocturnal Hypoglycemia
Do you find yourself waking at night drenched in sweat and feeling hot and clammy – even when the room is cold? You’re not alone. Night sweats are a common symptom of nocturnal hypoglycemia – the night-time low blood sugar episodes experienced by some diabetics. What causes night sweats in diabetics? The main cause of night sweats in diabetics is low blood sugar at night (hypogylcemia). When blood sugar levels drop, this can cause a number of sleep-disturbing symptoms, including headaches and excessive sweating. While night sweats can occur across the whole body, in people experiencing nocturnal hypoglycemia, the neck often becomes noticeably sweaty, making this a key sign to look out for. So what causes diabetes and night sweats? Essentially, this is anything that could cause glucose levels to drop overnight. Some of the most common causes include: Insulin use: Hypoglycemia is more common in diabetics who use insulin to manage their condition. Exercise: Being more active means you’ll have used more glucose during the day. In particular, exercising in the hours before bed increases the chances of low blood sugar at night. Alcohol: Drinking alcohol in the hours before bed can decrease your liver’s ability to produce glucose overnight. Dealing with low blood sugar and night sweats For the most part, dealing with diabetic night sweats means making sure that you manage your condition to reduce the risk of experiencing hypoglycemia at night. The following tips can help: Test your glucose levels before bed: If levels are already on the low side, you can take preventative action before going to sleep. Watch what you eat in the evening: Avoid wine, beer or other alcoholic drinks in the hours before bed Increase snacking if you’ve been more physically active during t Continue reading >>
Blood Sugar And Sleep Problems: How Blood Sugar Levels Impact Sleep
November is National Diabetes Month and Alaska Sleep Clinic is dedicating this month’s blog posts to raising awareness for diabetic complications and how they correlate with sleep disorders and overall tiredness. SLEEP PROBLEMS AND SNORING MAY PREDICT DIABETES Studies have shown that individuals who consistently have a bad night's sleep are more likely to develop conditions linked to diabetes and heart disease. Loud snoring sleepers (many of whom may have sleep apnea), compared to quiet sleepers, double (2x) their risks of developing certain types of metabolic syndrome(s); including diabetes, obesity, and high blood pressure. This likelihood also increased dramatically to 80% in those who found it difficult to fall asleep and to 70% for those who woke up feeling not as refreshed. Blood Sugar and Sleep Problems Sleep can affect your blood sugar levels, and your blood glucose control can also affect your sleep. It’s a vicious cycle. As the amount of sleep decreases, blood sugar increases, escalating the issue. Lack of sleep has been shown to increase blood sugar levels and the risk of diabetic issues. Higher blood sugar means less long-lasting fat metabolism in the night and even less sleep. Researchers at Boston University School of Medicine found that people who slept less than 6 hours a night had more blood sugar complications compared to those who received 8 hours of sleep. HIGH BLOOD SUGAR - HYPERGLYCEMIA Sleepless and restless nights hurt more than your mood and energy; it is a form of chronic stress on the body. When there is added stress on your body this results in having higher blood sugar levels. When researchers restricted people with type-1 diabetes to just 4 hours of sleep, their sensitivity to insulin was reduced by 20% compared to that after a full nig Continue reading >>
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- Poor Sleep And Diabetes: The Worse You Sleep, The Higher Your Type 2 Diabetes Risk
Hypoglycemia (low Blood Sugar) In Type 1 Diabetes
I was diagnosed with type 1 diabetes in 1968, at the age of 8 years old. At the time, there were no fingerstick blood sugars available for use. One had to regulate diabetes by measuring urine sugars, a very imprecise way to monitor blood sugar control. I recently obtained copies of my medical records from that 12-day stay, and found the following comment in the discharge summary: “He had one mild episode of shocking without loss of consciousness or convulsion.” I remember that episode. I could not have known that it was to be the first of hundreds of low blood sugar reactions that I would experience over the next 46 years. Though a hypoglycemia episode is always disruptive and never a pleasant experience, most were mild, ones that I could treat myself. But occasionally they were severe, requiring assistance from family or co-workers, or 911 calls. I was driven to achieve ‘tight control’ and prevent the long-term complications of diabetes, which I have managed to do. But there was a high price. I felt like I was playing a game of Russian roulette with hypoglycemia. I could no longer tell when I was low. Hypoglycemia unawareness had developed. I was fortunate enough to have developed T1D at a time when treatment for it has steadily improved. I started on an insulin pump in January 1982, and that helped me to reduce my frequency of hypoglycemia. The availability of insulin glargine (Lantus) and insulin detemir (Levemir) were great advances over older basal insulins (NPH, lente, ultralente) that had more intense and less predictable peaks, a very real problem at night. While I have not used them, because they became available after I started on a pump, better basal insulins have helped many T1Ds reduce night time hypoglycemia. Faster insulins (insulin lispro/Humalog Continue reading >>
Correcting Morning Blood Sugar Highs — Know The Causes Of These Spikes And Ways To Treat Them
Today’s Dietitian Vol. 14 No. 11 P. 18 Jill is frustrated. Her type 1 diabetes seems out of control, and she comes to your office at her wits’ end. She says she’s doing everything right: counting carbs, taking her insulin as prescribed, monitoring her blood glucose levels four times per day. A look at Jill’s testing logs and most recent blood work confirms there’s a problem. She has a hemoglobin A1c of 9.2, and her blood glucose levels are all over the map. Her numbers generally are fine before she goes to bed but incredibly high in the morning. Recently, her physician increased her nighttime basal insulin dose to counteract the morning highs, but things seem worse now than ever. Her breakfast bolus doesn’t seem to be effective, and her high blood glucose levels persist into the afternoon. “Fluctuating blood sugars can be very frustrating,” says Eileen M. Sturner, RD, LDN, CDE, BC-ADM. “RDs can play an important role in helping patients get to the bottom of problems such as morning highs. Working with patients to gather the appropriate data and facilitating the sharing of those data with the healthcare provider that’s managing their diabetes can have life-changing results.” Hyperglycemia In type 1 diabetes, the pancreas can no longer provide either the steady drip of basal insulin that keeps blood sugar levels stable between meals or the bolus release of insulin that directs the uptake of glucose after eating. Patients must take basal insulin to keep their fasting blood sugar levels steady and bolus insulin to match their carbohydrate intake and correct highs. The primary cause of hyperglycemia in type 1 diabetes is carbohydrate intake that isn’t matched with bolus insulin dosing. Perhaps Jill is underreporting her carbohydrate intake, administer Continue reading >>
Can You Have Low Blood Sugar With Type 2 Diabetes?
back to Overview Know-how Type 2 A tag-team approach on low blood sugar with type 2 diabetes. Markus recently wrote an article on our German language blog talking about low blood sugar with type 2 diabetes. The question (“can I have low blood sugar with type 2 diabetes?”) is very common, and it’s easy to see why it’s of concern. So I’ve helped Markus bring his German post to life here in English. I hope it helps! Here’s Markus: Low blood sugar In 2014, results from the DAWN2 study were announced. It was the largest study of its kind (15,000 participants) on the “fears & needs of people with diabetes and their families.” One result stood out: The gravest fears are related to low blood sugars, especially at night. Up to 69% of the participants share this fear! So! Can you have low blood sugar with type 2 diabetes? Yes! Of course! But let’s think about who exactly is at risk – and why. It’s common to think: Type 1 diabetes = at risk for lows Type 2 diabetes = not at risk for lows But that isn’t correct at all, so we should wipe it from our mind. So… what do I need to know? Maybe it’s more accurate to say that people with type 2 diabetes who take certain types of medication are more at risk for lows. We’re getting closer! But to get to the truth, we should take a look at someone without diabetes. Is it possible for them to have lows, too? Theoretically yes, especially if doing long-lasting physical activities without proper food intake. Additionally, extreme stress and binge drinking are also common causes of low blood sugar for people without diabetes. However, it’s pretty rare because as soon as BG’s drop below 80 mg/dl (4.4 mmol/L), the natural counterregulatory system kicks in, raising blood sugar back to normal levels. I’ve never exp Continue reading >>
Why Blood Sugar Levels Rise Overnight
get the scoop When you go to bed, your blood sugar reading is 110, but when you wake up in the morning, it has shot up to 150. Why does this happen? To understand how blood sugar levels can rise overnight without your eating anything, we have to look at where glucose comes from — and where it goes — while we sleep. During the day, the carbohydrates we eat are digested into glucose and absorbed into the bloodstream. Some of this glucose goes to the liver, where it is stored for later use. At night, while we are asleep, the liver releases glucose into the bloodstream. The liver acts as our glucose warehouse and keeps us supplied until we eat breakfast. The amount of glucose being used is matched by the amount of glucose being released by the liver, so blood sugar levels should remain constant. what is the dawn phenomenon? A rise in blood sugar level between approximately 3 A.M. and the time you wake up is called the “dawn phenomenon.” The liver is supposed to release just enough glucose to replace what is being used, and insulin works as the messenger to tell the liver how much is enough. But if there's not enough insulin (as with type 1 diabetes), or if there's enough insulin but it cannot communicate its message to the liver (as with type 2 diabetes), the liver starts to release glucose much too quickly. In addition, levels of hormones such as cortisol begin to increase in the early morning hours, which can contribute to altered insulin sensitivity. The result? Blood sugar levels rise. This is why blood sugar levels can go up between the time you go to bed and the time you wake up. what can you do about it? You might be able to make changes in the timing of your meals, medications, or insulin injections to help prevent dawn phenomenon. First, keep a detailed rec Continue reading >>
Dead In Bed Syndrome
Twitter recently got in a twit about a statement someone found on the Internet: "One in 20 type 1 diabetics die in their sleep due to a sudden drop in their blood sugar." That’s quite a statistic, and one that raises all sorts of questions. Where did this strange and disturbing statistic come from? Does this mean that of all T1 PWD who die, 1 in 20 (5%) die in their sleep from something relating to dropping blood sugar? Does "sudden drop" mean any kind of drop - for instance, from high to normal, or only if it goes low? What’s the evidence that these deaths are indeed due to low blood sugar? And what can we do to prevent such a death? The "Dead in Bed Syndrome" is quite a problem, both for parents of kids with diabetes, and their physicians. One pediatric endocrinologist said "my patients are totally freaked out about this (as am I). My problem is that we have about 1200 patients in our practice with type 1 dm- does that mean statistically 6 patients in my practice will_ __eventually _drop dead in their sleep." A thorough discussion with multiple references, is on-line at the Children With Diabetes website, at The Dead in Bed Syndrome. It should be noted that different authors have developed different definitions for the Dead in Bed Syndrome (sometimes abbreviated DIB), and partially as a result of the differing definitions, and probably mainly as a result of differing patient populations (e.g., country where the study was done, degree of diabetes control of the patients, age breakdown, etc.) the rate of DIB varies widely. The Dead in Bed Syndrome was first discussed in 1991 when the Professional Advisory Committee of the British Diabetic Association published a report, Unexplained deaths of type 1 diabetic patients. They evaluated 50 autopsied deaths of people with Continue reading >>
Hypoglycemia (low Blood Sugar) In People Without Diabetes - Topic Overview
Hypoglycemia, or low blood sugar, is most common in people who have diabetes. If you have already been diagnosed with diabetes and need more information about low blood sugar, see the topics: You may have briefly felt the effects of low blood sugar when you've gotten really hungry or exercised hard without eating enough. This happens to nearly everyone from time to time. It's easy to correct and usually nothing to worry about. But low blood sugar, or hypoglycemia, can also be an ongoing problem. It occurs when the level of sugar in your blood drops too low to give your body energy. Ongoing problems with low blood sugar can be caused by: Medicines. Metabolic problems. Alcohol use. Symptoms can be different depending on how low your blood sugar level drops. Mild hypoglycemia can make you feel hungry or like you want to vomit. You could also feel jittery or nervous. Your heart may beat fast. You may sweat. Or your skin might turn cold and clammy. Moderate hypoglycemia often makes people feel short-tempered, nervous, afraid, or confused. Your vision may blur. You could also feel unsteady or have trouble walking. Severe hypoglycemia can cause you to pass out. You could have seizures. It could even cause a coma or death. If you've had hypoglycemia during the night, you may wake up tired or with a headache. And you may have nightmares. Or you may sweat so much during the night that your pajamas or sheets are damp when you wake up. To diagnose hypoglycemia, your doctor will do a physical exam and ask you questions about your health and any medicines you take. You will need blood tests to check your blood sugar levels. Some tests might include not eating (fasting) and watching for symptoms. Other tests might involve eating a meal that could cause symptoms of low blood sugar seve Continue reading >>
8 Ways To Prevent Night Sweats
Do you ever wake up drenched in sweat in the middle of the night—even if the thermostat is turned low? Try these diabetes-friendly ways to prevent night sweats. If you’ve ever awakened a few hours after drifting off to sleep, wrapped in damp sheets and dripping with sweat, you know how disruptive it can be to a good night’s rest. Why might your body’s own thermostat be going haywire? “Night sweats are usually related to hypoglycemia, an episode of low blood sugar,” says L.A.-based diabetes educator Lori Zanini, RD. “Other signs of nighttime hypoglycemia include waking up with a headache and having nightmares,” both caused by fitful sleep. A variety of circumstances can throw your blood sugar off balance, from injecting the incorrect amount of insulin to eating or exercising differently than usual. “Focus on preventing your nighttime lows, rather than reacting to the symptoms caused by the lows,” says Zanini. Here’s how: Eat a bedtime snack. “A protein-rich snack is absorbed and processed by the liver slowly enough to ensure blood sugar remains stable throughout the night,” says Zanini. Opt for one that contains at least 15 to 30 grams of carbohydrates and one to two ounces of protein. Some ideas include: ¾ cup of blueberries and ½ cup low-fat cottage cheese Slice of whole-wheat, high-fiber toast with 1 to 2 tablespoons natural peanut butter One or two servings of string cheese Ask yourself: Have I been more active today? If the answer is “yes,” be sure to adjust for the extra physical activity by snacking or taking less blood sugar-lowering medication to compensate for burning extra sugar. Avoid late-night drinking. Consuming alcohol in the evening can put you at risk for low blood sugar, since your liver is busy clearing the alcohol from Continue reading >>
How Can I Keep My Blood Sugar From Dropping While I Sleep?
Low blood glucose can happen at any time of day. But it may be more likely to happen during sleep, when you go for several hours without eating. It's also more of a risk early in your treatment, as your body adjusts to your new insulin regimen. Here are a few steps you can take to help prevent low blood glucose during the night. Check blood glucose at bedtime. You need to make sure that your blood glucose is high enough to sustain you through the hours you're asleep. Most children and teens should aim for a bedtime blood glucose of over 100 mg/dL. If you hit this bedtime target, you can go to sleep as usual. If bedtime blood glucose is less than 100 mg/dL: Have a nighttime snack. (If a snack is already part of your daily schedule, add some carbohydrate to the snack.) Recheck your blood glucose in one to two hours. You can go to sleep after the snack -- you'll just need to wake up to recheck. Successful diabetes treatment is a balancing act between medications and therapies that lower blood sugar on one hand, and our intake of food on the other hand. Once balanced, it works pretty well, but sometimes getting that balance right is quite a trick. If you are going low in your sleep, we haven’t figured out that magic balance yet (or something has changed—maybe you lost weight or are eating less). Low blood sugar is always dangerous, but especially at night. You need to hook up with your medical team right away. In the meantime, eat a snack at bedtime as anti-low insurance. Half a peanut butter sandwich is a good choice. Unless you don’t like peanut butter. You want something that is somewhat high-carb, but also high in fat so that it lasts a long time. Chocolate is another good choice, except that your spouse will refuse to believe that it’s “medicine.” But an ev Continue reading >>
Blood Sugar: What Causes High Blood Sugar Levels In The Morning
There are two reasons why your blood sugar levels may be high in the morning – the dawn phenomenon and the Somogyi effect. The dawn phenomenon is the end result of a combination of natural body changes that occur during the sleep cycle and can be explained as follows: Your body has little need for insulin between about midnight and about 3:00 a.m. (a time when your body is sleeping most soundly). Any insulin taken in the evening causes blood sugar levels to drop sharply during this time. Then, between 3:00 a.m. and 8:00 a.m., your body starts churning out stored glucose (sugar) to prepare for the upcoming day as well as releases hormones that reduce the body's sensitivity to insulin. All of these events happen as your bedtime insulin dose is also wearing off. These events, taken together, cause your body's blood sugar levels to rise in the morning (at "dawn"). A second cause of high blood sugar levels in the morning might be due to the Somogyi effect (named after the doctor who first wrote about it). This condition is also called "rebound hyperglycemia." Although the cascade of events and end result – high blood sugar levels in the morning – is the same as in the dawn phenomenon, the cause is more "man-made" (a result of poor diabetes management) in the Somogyi effect. There are two potential causes. In one scenario, your blood sugar may drop too low in the middle of the night and then your body releases hormones to raise the sugar levels. This could happen if you took too much insulin earlier or if you did not have enough of a bedtime snack. The other scenario is when your dose of long-acting insulin at bedtime is not enough and you wake up with a high morning blood sugar. How is it determined if the dawn phenomenon or Somogyi effect is causing the high blood sug Continue reading >>
6 Ways To Prevent Low Blood Sugar At Night
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 (hypoglycemia) 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: 1. Check Your Blood Sugar Before Bed “For everybody with type 1 or type 2 diabetes, it’s absolutely critical that they check their blood sugar before going to bed to make sure they’re not going to have an episode of low blood sugar during the night,” says Helena W. Rodbard, MD, medical director of Endocrine and Metabolic Consultants, a private practice in Rockville, Maryland, and past president of the American College of Endocrinology. If your blood sugar levels are low at bedtime, eat a healthy snack before going to sleep. The size of the snack should be in proportion to the dip in blood sugar. For instance, a small drop in blood sugar requires only a small snack. If you use an insulin pump, consider temporarily reducing the active dose of insulin. 2. Know the Signs of Low Overnight Blood Sugar Symptoms of hypoglycemia usually develop when blood sugar levels drop below 70 milligrams per deciliter (mg/dl). They include shakiness, sweating, confusion, erratic behavior, headache, and lightheadedness. With nighttime hypoglycemia, you may wake up with these symptoms or with a higher blood su Continue reading >>
Nocturnal Hypoglycemia - Night Time Hypo
Tweet Nocturnal hypoglycemia or night time hypos are common in people who treat their diabetes with insulin. Symptoms are usually only realised once waking up from a hypo. Due to their nature, you will usually only find out about having a hypo during the night after waking up from a hypo. Therefore people may not even be aware that they are having night time hypos, so it’s useful to be able to spot the signs and symptoms of when nocturnal hypoglycemia may be taking place. Whilst nocturnal hypoglycemia is most common in insulin users, it can also occur for people who take oral anti-diabetic drugs. Symptoms of night time hypoglycemia Sometimes you may wake during an episode of nocturnal hypoglycemia. However, if you don’t, you may notice one or more of the following indications that hypoglycemia may have occurred whilst you were asleep. Waking with a headache Experiencing seemingly unprovoked sleep disturbance Feeling unusually tired Waking with damp bed clothes and sheets from sweating Having a clammy neck can be a particular indication of night time hypoglycemia. Nocturnal hypoglycemia in children For parents on children with diabetes, nocturnal hypoglycemia can be particularly worrying. Parents of diabetic children may wish to check their child’s neck whilst they are sleeping if they are worried that night time hypoglycemia may be occurring. Causes of nocturnal hypoglycemia The chances of having night time hypos may be increased by the following: Too high a level of basal (background) insulin Physical activity during the day can increase insulin sensitivity which can lead to night time hypoglycemia, particularly for the first night after a sustained session of activity Following alcohol consumption Absence of a night time snack when one is usually taken Missing o Continue reading >>
