How to prevent low blood sugar in the morning?

Contents

6 Ways to Prevent Low Blood Sugar at Night

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 sugar reading that results from the body’s response to an overnight low. However, some people experience what’s referred to as “hypoglycemia unawareness,” which means that they don’t feel the symptoms of low blood sugar.

Talk with your doctor about ways to recognize nighttime hypoglycemia, especially if you think you may have difficulty detecting it. “It’s a dangerous condition because people can’t tell when their blood sugar has dropped, since they may not have symptoms,” Dr. Rodbard says. “The body can get desensitized to it.” People with hypoglycemia unawareness are also less likely to wake up as a result of nighttime dips in their blood sugar.

3. Don’t Skip Dinner

Skipping dinner or having only a light supper is one of the most common causes of nighttime dips in blood sugar, Rodbard says. Eat a healthy, well-balanced dinner every night and pay attention to portion sizes.

4. Avoid Excessive Exercise Late at Night

Regular exercise is recommended, but strenuous exercise right before bedtime isn’t because it can cause blood glucose to drop overnight. This means you should avoid exercising in the two hours before bedtime. If your blood sugar level is less than 100 mg/dl at bedtime after exercise, double your regular bedtime snack to prevent an unwanted dip while you sleep.

5. Limit Alcohol at Night

Alcohol consumption can also increase the risk for nighttime hypoglycemia, so avoid regular consumption of alcohol. On special occasions, drink only in moderation — no more than one drink a day for women and two drinks a day for men — and don’t wait to indulge with a before-bed nightcap. If you do have a drink in the evening, enjoying it with food can minimize the chance of low blood sugar while you sleep.

6. Be Prepared

If you frequently wake up with symptoms of low blood sugar, have something available at your bedside, such as a soda or some juice, so you can react immediately without having to get out of bed to treat it.

If low blood sugar at night is a common problem for you, talk to your doctor about changing your diabetes treatment plan to better control your nighttime glucose levels.

Low Blood Glucose (Hypoglycemia)

On this page:

  • What is hypoglycemia?
  • What are the symptoms of hypoglycemia?
  • What causes hypoglycemia in diabetes?
  • What other factors contribute to hypoglycemia in diabetes?
  • How can I prevent hypoglycemia if I have diabetes?
  • How do I treat hypoglycemia?
  • What if I have severe hypoglycemia and can’t treat myself?

What is hypoglycemia?

Hypoglycemia, also called low blood glucose or low blood sugar, occurs when the level of glucose in your blood drops below normal. For many people with diabetes, that means a level of 70 milligrams per deciliter (mg/dL) or less. Your numbers might be different, so check with your health care provider to find out what level is too low for you.

What are the symptoms of hypoglycemia?

Symptoms of hypoglycemia tend to come on quickly and can vary from person to person. You may have one or more mild-to-moderate symptoms listed in the table below. Sometimes people don’t feel any symptoms.

Severe hypoglycemia is when your blood glucose level becomes so low that you’re unable to treat yourself and need help from another person. Severe hypoglycemia is dangerous and needs to be treated right away. This condition is more common in people with type 1 diabetes.

Hypoglycemia Symptoms
Mild-to-Moderate Severe
  • Shaky or jittery
  • Sweaty
  • Hungry
  • Headachy
  • Blurred vision
  • Sleepy or tired
  • Dizzy or lightheaded
  • Confused or disoriented
  • Pale
  • Uncoordinated
  • Irritable or nervous
  • Argumentative or combative
  • Changed behavior or personality
  • Trouble concentrating
  • Weak
  • Fast or irregular heart beat
  • Unable to eat or drink
  • Seizures or convulsions (jerky movements)
  • Unconsciousness

Some symptoms of hypoglycemia during sleep are

  • crying out or having nightmares
  • sweating enough to make your pajamas or sheets damp
  • feeling tired, irritable, or confused after waking up

What causes hypoglycemia in diabetes?

Hypoglycemia can be a side effect of insulin or other types of diabetes medicines that help your body make more insulin. Two types of diabetes pills can cause hypoglycemia: sulfonylureas and meglitinides. Ask your health care team if your diabetes medicine can cause hypoglycemia.

Although other diabetes medicines don’t cause hypoglycemia by themselves, they can increase the chances of hypoglycemia if you also take insulin, a sulfonylurea, or a meglitinide.

If you take insulin or some other diabetes medicines, your blood glucose level can drop too low.

What other factors contribute to hypoglycemia in diabetes?

If you take insulin or diabetes medicines that increase the amount of insulin your body makes—but don’t match your medications with your food or physical activity—you could develop hypoglycemia. The following factors can make hypoglycemia more likely:

Not eating enough carbohydrates (carbs)

When you eat foods containing carbohydrates, your digestive system breaks down the sugars and starches into glucose. Glucose then enters your bloodstream and raises your blood glucose level. If you don’t eat enough carbohydrates to match your medication, your blood glucose could drop too low.

Skipping or delaying a meal

If you skip or delay a meal, your blood glucose could drop too low. Hypoglycemia also can occur when you are asleep and haven’t eaten for several hours.

Increasing physical activity

Increasing your physical activity level beyond your normal routine can lower your blood glucose level for up to 24 hours after the activity.

Drinking too much alcohol without enough food

Alcohol makes it harder for your body to keep your blood glucose level steady, especially if you haven’t eaten in a while. The effects of alcohol can also keep you from feeling the symptoms of hypoglycemia, which may lead to severe hypoglycemia.

Being sick

When you’re sick, you may not be able to eat as much or keep food down, which can cause low blood glucose. Learn more about taking care of your diabetes when you’re sick.

How can I prevent hypoglycemia if I have diabetes?

If you are taking insulin, a sulfonylurea, or a meglitinide, using your diabetes management plan and working with your health care team to adjust your plan as needed can help you prevent hypoglycemia. The following actions can also help prevent hypoglycemia:

Check blood glucose levels

Knowing your blood glucose level can help you decide how much medicine to take, what food to eat, and how physically active to be. To find out your blood glucose level, check yourself with a blood glucose meter as often as your doctor advises.

Hypoglycemia unawareness. Sometimes people with diabetes don’t feel or recognize the symptoms of hypoglycemia, a problem called hypoglycemia unawareness. If you have had hypoglycemia without feeling any symptoms, you may need to check your blood glucose more often so you know when you need to treat your hypoglycemia or take steps to prevent it. Be sure to check your blood glucose before you drive.

If you have hypoglycemia unawareness or have hypoglycemia often, ask your health care provider about a continuous glucose monitor (CGM). A CGM checks your blood glucose level at regular times throughout the day and night. CGMs can tell you if your blood glucose is falling quickly and sound an alarm if your blood glucose falls too low. CGM alarms can wake you up if you have hypoglycemia during sleep.

Eat regular meals and snacks

Your meal plan is key to preventing hypoglycemia. Eat regular meals and snacks with the correct amount of carbohydrates to help keep your blood glucose level from going too low. Also, if you drink alcoholic beverages, it’s best to eat some food at the same time.

Be physically active safely

Physical activity can lower your blood glucose during the activity and for hours afterward. To help prevent hypoglycemia, you may need to check your blood glucose before, during, and after physical activity and adjust your medicine or carbohydrate intake. For example, you might eat a snack before being physically active or decrease your insulin dose as directed by your health care provider to keep your blood glucose from dropping too low.

Work with your health care team

Tell your health care team if you have had hypoglycemia. Your health care team may adjust your diabetes medicines or other aspects of your management plan. Learn about balancing your medicines, eating plan, and physical activity to prevent hypoglycemia. Ask if you should have a glucagon emergency kit to carry with you at all times.

You can help prevent hypoglycemia by working with your health care team.

How do I treat hypoglycemia?

If you begin to feel one or more hypoglycemia symptoms, check your blood glucose. If your blood glucose level is below your target or less than 70, eat or drink 15 grams of carbohydrates right away. Examples include

  • four glucose tablets or one tube of glucose gel
  • 1/2 cup (4 ounces) of fruit juice—not low-calorie or reduced sugar*
  • 1/2 can (4 to 6 ounces) of soda—not low-calorie or reduced sugar
  • 1 tablespoon of sugar, honey, or corn syrup
  • 2 tablespoons of raisins

Wait 15 minutes and check your blood glucose again. If your glucose level is still low, eat or drink another 15 grams of glucose or carbohydrates. Check your blood glucose again after another 15 minutes. Repeat these steps until your glucose level is back to normal.

If your next meal is more than 1 hour away, have a snack to keep your blood glucose level in your target range. Try crackers or a piece of fruit.

*People who have kidney disease shouldn’t drink orange juice for their 15 grams of carbohydrates because it contains a lot of potassium. Apple, grape, or cranberry juice are good options.

If your blood glucose is below your target, take 15 grams of glucose or carbohydrates right away.

Treating hypoglycemia if you take acarbose or miglitol

If you take acarbose or miglitol along with diabetes medicines that can cause hypoglycemia, you will need to take glucose tablets or glucose gel if your blood glucose level is too low. Eating or drinking other sources of carbohydrates won’t raise your blood glucose level quickly enough.

What if I have severe hypoglycemia and can’t treat myself?

Someone will need to give you a glucagon injection if you have severe hypoglycemia. An injection of glucagon will quickly raise your blood glucose level. Talk with your health care provider about when and how to use a glucagon emergency kit. If you have an emergency kit, check the date on the package to make sure it hasn’t expired.

If you are likely to have severe hypoglycemia, teach your family, friends, and coworkers when and how to give you a glucagon injection. Also, tell your family, friends, and coworkers to call 911 right away after giving you a glucagon injection or if you don’t have a glucagon emergency kit with you.

If you have hypoglycemia often or have had severe hypoglycemia, you should wear a medical alert bracelet or pendant. A medical alert ID tells other people that you have diabetes and need care right away. Getting prompt care can help prevent the serious problems that hypoglycemia can cause.

Alaska Sleep Education Center

Alaska Sleep Clinic is dedicated 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 night of sleep.

When your blood sugar is really high, your kidneys will try to get rid of it by removing it from the body via urination. This most likely causes you to get out of bed and go to the bathroom all night, resulting in inconsistent sleep patterns. It can also wake you up by feelings of thirstiness.

High blood sugar levels also make it less comfortable for you to sleep by feelings of warmness, irritability and unsettledness.

THE DAWN PHENOMENON

The dawn phenomenon occurs when the body releases growth and other hormones around 3 a.m. or 4 a.m. to prepare the body for arousal. Making you wake up to a high blood sugar reading in the morning, even if your number was good when you went to bed the night before.

These hormones make the body less sensitive to insulin, the hormone that lowers blood sugar. In people with diabetes, these changes can lead to a morning blood sugar spike.

LOW BLOOD SUGAR – HYPOGLYCEMIA

On the opposite end of the spectrum, if your blood glucose is too low, hypoglycemia, you may also wake up during the night. Every cell in your body needs sugar to work properly. It’s your body’s main source of energy. When your sugar levels fall too low it can cause a variety of problems within your central nervous system which can include:

  • Hunger
  • Weakness
  • Dizziness
  • Nervousness
  • Anxiousness
  • Irritability
  • Chills
  • Sweating
  • Tingling or numbness of mouth
  • Blurred Vision
  • Headache
  • Confusion
  • Nightmares
  • Sleepwalking
  • Restlessness

The next time you wake up during the night with these symptoms, check your blood glucose. When there is a drop in the blood glucose level, it causes the release of hormones that regulate glucose levels, such as adrenaline, glucagon, cortisol, and growth hormone. These compounds stimulate the brain. They are a natural signal that it is time to eat.

Good bedtime snacks to keep blood sugar levels steady throughout the night are oatmeal and other whole grain cereals, whole grain breads and muffins, and other complex carbohydrates. These foods will not only help maintain blood sugar levels, they actually can help promote sleep by increasing the level of serotonin in the brain.

Severe low blood sugar is sometimes called insulin shock. Untreated, it can be very dangerous, resulting in seizures, loss of consciousness, or death.

TIPS FOR A BETTER NIGHT SLEEP

Getting into a consistent sleep routine will improve your overall health and you may start to see subtle improvements in blood sugar as well. The following tips sleep tips may help to promote better sleep:

  • Check and monitor your blood glucose to keep it under control

  • Establish a regular bedtime routine

  • Ensure your bed is large and comfortable enough

  • Ensure your room is cool and well ventilated

  • Ensure your room is dark and free from noise

  • Incorporating a period of exercise into each day

To stay informed on more information regarding diabetes and sleep issues subscribe to our blog. And remember, you can always contact us here at The Alaska Sleep Clinic for any questions regarding how diabetes can affet your sleep at 855-AKSLEEP (855-257-5337).

Hypoglycemia: Nocturnal

Low blood glucose at night

When blood glucose levels fall below 70 mg/dl while sleeping at night, the person experiences a condition called nocturnal hypoglycemia.
Studies suggest that almost half of all episodes of low blood glucose — and more than half of all severe episodes — occur at night during sleep.

Nocturnal hypoglycemia can be potentially dangerous. The good news is that this condition can be prevented with careful planning and by training roommates and partners to recognize and treat the condition.

Who’s at risk?

Nocturnal hypoglycemia can affect people who:

  • Skip meals, particularly dinner

  • Exercise before bedtime

  • Drink alcohol before bedtime

  • Have infections

People who have previously experienced nocturnal hypoglycemia:

  • Take a type of insulin at dinner known as NPH, which becomes most effective six to eight hours after each dose

What are the warning signs?

Call your doctor if you or your partner notice the following symptoms at night:

  • Restless, irritable sleep

  • Hot, clammy or sweaty skin

  • Trembling or shaking

  • Changes in breathing (suddenly breathing fast or slowly)

  • Nightmares, sometimes rousing the person from sleep

  • Racing heartbeat

Doctors are most concerned about people who sleep through these symptoms without noticing them.

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 can’t 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 person’s 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.

Always follow up with the doctor

It is very important to call your doctor as soon as possible after experiencing nocturnal hypoglycemia. The patient and doctor should try to figure out what caused the episode and how to prevent it from happening again.
Often the doctor will suggest:

  • Changing the dose or timing of insulin or other medications

  • Setting an alarm for the early morning so that the patient can test their blood glucose levels and determine how often the episodes occur

  • Having the person wear a continuous glucose monitor that checks blood glucose every five minutes with an alarm that wakes the patient from sleep if levels start to drop too low. This option is usually reserved for patients who experience frequent or severe nocturnal hypoglycemia

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.

Definition of Nocturnal Hypoglycemia Nocturnal hypoglycemia is defined as hypoglycemia whilst asleep.

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 of 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 out dinner
  • Following a period of illness if basal insulin was increased

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 (such as sweets or glucose tablets) 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.

Preventing night time hypoglycemia

A useful first step towards preventing hypoglycemia is to test your blood glucose levels before bed.

For people on two or more insulin injections per day can help prevent hypos over night keeping blood glucose levels above 6.5 mmol/l before going to bed.

If over night hypos are suspected, carry out a test at 3am. Together with a before bed and first thing in the morning test, this can help to understand how your sugar levels are behaving over night.

If sugar levels are dropping too low over night, you may need to adjust your insulin doses. Speak to your doctor if you need help with correctly adjusting your insulin

The other way to prevent sugar levels going too low is to take some carbohydrate before bed.

Hypos can also be prevented by:

  • Ensuring you basal insulin dose is not too high
  • Reducing your night time/evening long acting insulin following exercise
  • Taking carbohydrate before bed following an evening/night of drinking
  • Not missing out dinner or any snacks you would usually have

Concerned about hypos? Join the (free) Hypo Awareness Program for a comprehensive guide towards improving hypo awareness ”

If you are regularly getting high sugar levels ( hyperglycemia ) before one particular type of meal, that is either lunch or dinner, or before bed, then a change in your diabetes management is likely to be needed.

This guide sets out the common reason for high sugar levels before meals and lists the action that can be taken to prevent the high patterns from continuing.

Also see the guide on high sugar levels through the day which includes a number of additional reasons as to why blood glucose levels can run too high.

Underestimating meal time insulin at your previous meal

A common reason for high sugar levels before lunch, dinner or bedtime can be taking too little short or rapid acting insulin at your previous meal.

Fig 1: High sugar levels and underestimated insulin

High sugar levels before Underestimated insulin
Lunch Short or rapid acting at breakfast
Dinner Rapid acting at lunch
Bed Short or rapid acting at dinner

Action

Consider increasing the amount of insulin you take at the time of the previous meal. This method works best if you tend to have similar meals at similar times of day. When increasing insulin, do so gradually to reduce the risk of hypos occurring.

If the carbohydrate content of your meals varies from day to day, you may wish to consult your health team before increasing insulin doses to prevent unnecessary hypos. An alternative to increasing your insulin dose is to slightly decrease the amount of carbohydrate at the previous meal time.

Be careful if you are considering increasing insulin
Make sure your health team are happy for you to adjust your own insulin doses and consult them if you are in any doubt. If you increase your insulin, do so gradually to prevent risking severe hypoglycemia from occurring and test your sugar levels regularly to check low sugar levels are not occurring

Underestimating intermediate insulin at breakfast

If you take intermediate insulin and are having high sugar levels before dinner, the reason could be down to taking either too little short acting insulin at lunch or too little intermediate insulin at your breakfast dose.

If you feel it is your intermediate insulin at breakfast that is too small, consider increasing this dose. If you are not sure which dose is best to adjust, contact your health team for advice.

Late previous meal

When reviewing your results, note whether any high sugar levels were caused by a late previous meal If you took your previous meal later than usual, this could mean that the insulin you took for that meal still needs time to work.

As well as contributing to high before meal results, it could also lead to you taking too much insulin to correct the high which could lead to a hypo later.

Where possible, aim to achieve consistent meal times.

Less activity than usual

If you have been less active than usual, this could influence your sugar levels later in the day, causing them to be higher than normal.

Where possible, try to include more physical activity into each day Where this is not possible, you may need to increase one or more of your insulin doses.

The insulin dose to increase will depend on which time of day you are getting the high levels. If you are in doubt about which dose to increase, consult your diabetes health team. If increasing insulin doses, take care not to increase the risk of hypos

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