Dealing with Overnight Low Blood Sugars.
Quick confirmation: Yes, you are reading this on the Internet. No, this website is not written by a doctor. Or a medical professional of any kind. (Or a professional of any kind.) This is not medical advice. I have been living with type 1 diabetes for over 30 years and this is just how I do it.
Such a good song.
Anyway, overnight low blood sugars are gross. During the day, am I struck by the urge – need? – to consume 10 times more carbohydrates than I need to correct a low blood sugar? Nope. I don’t eat glucose tabs by the fistful at 11 am. But in the middle of the night I am able to consume 1400 calories without blinking twice thanks to the panic and chaos of middle of the night low blood sugars.
Over-treating lows has been a tricky trap for the last three decades, but there are a few strategies I use to hit back against hypos.
No IOB before BED.
I try to keep my snacks very low-carb after 8 pm in order to keep my boluses at bay. While I’d love to dive head first into a bowl of rotini before bed, I feel safest going to bed without insulin on board. Sometimes it’s hard to avoid a bolus here and there, but on the whole, a big fat zero on my IOB brings better sleep for me.
This is a tricky one because my schedule changes every day, but I do my best to exercise before 4 pm on most days to mitigate midnight lows. If I exercise in the evening, the chances of bottoming out overnight are high, so if I’m able to get things done before dinner, I feel safer. (This does not always work out for my workouts because of kid 1, kid 2, work stuff, family schedule, etc. but I try.)
What do you mean, eating two nutella and peanut butter sandwiches to treat a 54 mg/dL at 3 am isn’t a good idea? If I wake up low, I want to inhale the fridge. Sometimes I over do it so hard that I’m bolusing while low to compensate for the carb overload. This usually results in a high blood sugar. And also bigger pants. Keeping my low blood sugar treatments pre-carb counted helps a lot. This means using glucose tabs or a juice box instead of a bag of candy that I can take too much of or a bottle of juice that I can drink too much of.
Bedside Snack Table.
I need to keep snacks on the bedside table instead of daring my low legs to make it down the stairs. My bedside table is almost always armed with a jar of glucose tabs or a juice box. This is easiest because it keeps me from taking field trips while low.
Continuous Glucose Monitor.
THIS. This thing is the best battle tool against nighttime hypos because I can set my threshold to 80 mg/dL which, in turn, alarms and wakes me before I actually end up low. In the last ten years, since starting on a CGM, my overnight hypos have decreased significantly simply because I catch them before they become disasters. Of course lows sneak in here and there, but they are fewer in number thanks to this technology.
My next goal is to figure out how to stop the cleaning fits while low … although they are terribly productive …