Risk Of Nocturnal Hypoglycemia
Nocturnal hypoglycemia is most dangerous for people who take insulin, but it can also happen to people with type 2 diabetes who take oral diabetes medications. You could be at risk if you:
- Skip dinner or have too little to eat before bedtime
- Exercise before bedtime
- Take NPH insulin, which has its peak affect in about 6 to 8 hours
- Have recently changed your insulin medication
Early morning wake-up calls often are simply one of many low blood sugar symptoms.
What Causes High Blood Sugar Levels In The Morning
Commonly known reasons why your blood sugar may be high in the morning include high-carb bedtime snacks and not enough diabetes medications.
Yet two lesser-known reasons may be causing your morning blood sugar woes: the dawn phenomenon and the Somogyi effect. These causes of high morning blood sugar levels are a result of body changes and reactions that happen while you are sleeping.
The 3 Am Blood Sugar Phenomenon
We all want a good night sleep of 8 hours to wake up fresh and energetic in the morning. If youre a diabetic, sometimes you just wake up at 3:00 am not because of some noise but because your body wakes you up suddenly.
You wake up with some uneasiness or excessive sweating and might not be able to go back to sleep. You check your blood sugar levels and it is < 100 mg/ dL. As per your doctors advice, you eat something sweet and after some time, everythings normal.
Now that its solved, you go back to completing your sleep but when you wake up, your fasting blood sugar is high which might surprise you.
Sometimes, you might just wake up at 3:00 am with no or very few symptoms. Since there are no symptoms, you wont check blood sugar and wont eat anything but still get high fasting blood sugar.
When such things happen, you have a lot of questions Why does blood sugar drop at night? or why is my blood sugar high in the morning or how can I prevent low blood sugar at night etc
With the ongoing diabetes treatment, no doubt that prevention is very important to maintain blood sugar within the normal range. Let me tell you the science behind it.
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Why Does Blood Sugar Go Up At Night
There are many factors that can cause your blood sugar to increase at night. For example: what food you ate during the day, how much and when you exercised, whether you ate snacks before bed, the timing of your insulin doses, and your stress level. You can experience different patterns of high blood sugar at night. You may start with high glucose when you go to bed, start the night in range but go high several hours later, or spend most of the night in range until the hours just before you wake up. By identifying your bodys patterns, you can figure out what is causing your high blood sugar and how to address it.
Common causes of a glucose increase at night include:
Ways To Avoid Nighttime Hypoglycemia
Check your glucose before going to bed. This could be either with your glucose meter or your continuous glucose monitoring device. Aim for a target of 90-150mg/dl. Know the signs and symptoms of nighttime hypoglycemia. Before you go to bed, consider all of the causes of nighttime hypoglycemia, and if you think youre at risk, have a snack before heading to bed. Try to be consistent with your meals and/or snacks skipping dinner or snacks you usually have can put you at risk. Eat a meal or snack when consuming alcohol.You may need to reduce your predinner or evening/bedtime basal insulin following exercise. Be prepared, have rapid-acting carbohydrates like glucose tablets, juice or soda at your bedside. If you find yourself experiencing frequent nighttime hypoglycemia you may need to adjust your insulin doses. Speak to your diabetes care team about adjusting your insulin regimen or things that you can do to avoid hypoglycemia whether it be overnight or anytime during the day.
Although this content is reviewed by Joslin Diabetes Center healthcare professionals, it is not intended to replace the medical advice of your doctor or healthcare provider. Please consult your healthcare provider for advice about a specific medical condition.
To make an appointment with a Joslin provider or diabetes care and education specialist please call 309-2440.
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How To Get Relief From Diabetic Night Sweats
- Keep your bedroom cool: Turn heating off or down to an absolute minimum in the hours before bed. You can also try leaving a window open or keeping a fan running to improve ventilation.
- Choose natural nightwear: Sleep in natural fibers such as cotton, wool or silk. These materials are more breathable and more effective at absorbing moisture than synthetic alternatives such as polyester. So, you can stay cool and avoid that clammy feeling.
- Sleep in natural bedding: As with nightwear, bedding made from natural fibers is more effective at regulating temperature and absorbing moisture. For maximum benefit try wool bedding as this natural fiber is more absorbent than feather/down alternatives. Partner a wool duvet, pillows and protector with cotton sheets and covers for best performance.
A Low Blood Sugar Level And Driving
You may still be allowed to drive if you have diabetes or you’re at risk of a low blood sugar level for another reason, but you’ll need to do things to reduce the chance of this happening while you’re driving.
You also need to tell the Driver and Vehicle Licensing Agency and your car insurance company about your condition.
For more information, see:
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What Should Your Blood Sugar Be When You Wake Up
The goal of diabetes management is to keep your blood sugar levels as stable as possible. This means that when you wake up, you want your glucose to be in range and to stay in range throughout the day.
For many people with diabetes, the overall target glucose range is between 70 mg/dL to 180 mg/dL . To start the day strong, the American Diabetes Association recommends that you aim to wake up with glucose levels between 80 to 130 mg/dL. Talk with your healthcare team about your glucose targets.
How To Treat A Low Blood Sugar Level Yourself
Follow these steps if your blood sugar level is less than 4mmol/L or you have hypo symptoms:
You do not usually need to get medical help once you’re feeling better if you only have a few hypos.
But tell your diabetes team if you keep having hypos or if you stop having symptoms when your blood sugar level is low.
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What Are The Symptoms Of Hypoglycemia
Symptoms of hypoglycemia can start quickly, with people experiencing them in different ways. The signs of hypoglycemia are unpleasant. But they provide good warnings that you should take action before blood sugar drops more. The signs include:
- Shaking or trembling.
- Tingling or numbness in the face or mouth.
During a severe hypoglycemic event, a person may:
- Be unable to eat or drink.
- Have a seizure or convulsions .
- Lose consciousness.
- Slip into a coma or die .
Sleep Impacts Sympathetic Nervous System Activity
Sleep deprivation, or broken sleep, can lead to an increase in sympathetic nervous system activity. In stressful or dangerous situations, the sympathetic nervous system is what controls your âfight or flightâ? response. Lack of sleep can cause your âfight or flightâ? mode to kick in during the day and night, releasing stress hormones like cortisol.
When your sympathetic nervous system is overly active, it can reduce insulin secretion and promote insulin resistance. Both of these can lead to chronically raised blood sugar levels.
When blood sugar levels become raised, it can cause lifelong chronic conditions such as pre-diabetes, diabetes, or metabolic syndrome.
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Avoid Blood Sugar Dropping Rapidly
Keep testing, testing, testing . To be aware of the state of your blood sugar levels, its necessary to check what your blood sugar levels are. Only then can you take steps to stop low blood sugar.
And those variable factors that play a role in hypoglycemia can be tracked with the assistance of Hedia and its diabetes tracker.
Perhaps most importantly in this case, Hedia has an idea of the active insulin in your body. This makes all subsequent calculations for avoiding hypoglycemia more accurate.
The reason for low blood sugar insulin may be basic, but controlling it often is not. Let Hedia take care of that by downloading the app from or the App Store!
What Are Some Tips To Prevent Nighttime Blood Sugar Level Dips
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How Is Hypoglycemia Diagnosed
The only way to know if you have hypoglycemia is to check your blood sugar with a blood glucose meter. Its a small machine that measures blood sugar. Most of these devices use a tiny prick of the finger to take a small amount of blood.
People with hypoglycemia unawareness may need a continuous glucose monitor. These wearable devices measure glucose every few minutes, day and night. An alarm sounds if blood sugar drops too low.
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.
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What Should You Do If This Happens
If you experience any of the symptoms mentioned above at late night around 3:00 am, you have to be quick and follow these steps:
What Should Blood Sugar Be At : 00 Am And How To Maintain It
It is important to maintain a 3:00 am blood sugar level between 100180 mg/ dL and prevent it from dropping. Make sure that you are following these guidelines:
How to manage low blood sugar? Know it all from our expert Dr Arpit.
Now that you know why you are waking up in the middle of the night with low blood sugar, lets discuss another phenomenon that diabetics experiences, called high fasting blood sugar.
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Treating Night Time Hypos
The treatment for night time hypos is the same as the general advice for treating hypos
That is to take 10 to 15g of a quick acting sugary food and some slower acting carbohydrate such as a slice of bread to prevent a further hypo taking place.
Have some quick acting carbohydrate next to your bed so that if a hypo occurs, you can treat it as quickly as possible.
Why Are My Blood Sugars High In The Morning
Heres a simple plan for diagnosing the source of high blood sugars in the morning.
It takes a little bit of effort, but you probably only need to do it a few times to diagnose the issue.
The Somogyi Effect is less common than dawn phenomenon. To diagnose either of these phenomena, scientists recommend checking blood sugar levels for several nights, specifically between 3 a.m and 5 a.m.
Compare these three glucose values and find the pattern:
- If your blood sugar stayed steady overnight, but rose in the morning, you are likely experiencing dawn phenomenon.
- If your blood sugar rose steadily throughout the night, your morning glucose highs may be the result of your diet or exercise choices , or a sign that you may want to adjust your insulin and glucose-lowering medication regimen.
- If your blood sugar dipped low in the middle of the night, you may be experiencing Somogyi effect.
The best option is to use a continuous glucose monitoring system . This will give you an entire nights worth of blood sugar values, making it easy to identify what direction your blood sugar moved while you slept.
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Easy Before Bed Routines For People With Diabetes
Managing diabetes whether you have type 1 or type 2 is a full-time job. Your condition doesnt clock out at 5 p.m. when youre ready to take a break. You have to maintain your blood sugar checks, medication, exercise, and eating habits all day to keep your disease under control.
In fact, you should be mindful of your diabetes all the way until bedtime. Before you set the alarm and settle in under the covers each night, here are a few bedtime to-dos that will help you get more control over your diabetes and sleep more soundly.
What Should I Do If This Happens
People and their partners or roommates should learn to recognize the signs of nighttime hypoglycemia. Be prepared! Ask your doctor for an emergency glucagon kit. This kit contains a fast-acting medication that can be injected if the person cant be woken up. Store the kit in a bedside drawer for easy access.
DO NOT PUT ANYTHING INTO A PERSON’S MOUTH IF THEY ARE ASLEEP OR CANNOT SIT UP.
If the person cannot be woken: If there is no emergency glucagon kit, call 911. If the person has a glucagon kit, the partner or roommate should follow the instructions to fill the syringe and inject the medicine. Once fully awake, he/she should eat a meal and check their blood glucose every few hours using a home test kit. After giving the injection, the persons doctor should be notified.
If the person can be woken up and sit without support: They should be given a fast-acting glucose source. Good options include hard candy, fruit juice or glucose paste or tablets, which can be purchased at most pharmacies. Once the person is fully awake, they should eat a meal and check their blood glucose every few hours using a home test kit.
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