1st Intro

[Rocky2atsea]

Good morning everyone,

My name is Robbie. 32, M, and I have recently been given test to confirm if I am suffering from nocturnal hypoglycemia. based on the comments on some of these threads i'm starting to doubt the accuracy of the Libre 2 monitor i have been given to data gather over the first couple of weeks.

Hopefully the wonderful hivemind can help me see the wood through the trees.

 

[helli]

Welcome @Rocky2atsea
What is your concern with your LIbre 2? Do you have a finger prick meter to confirm the Libre readings?
Many of us find Libre to be great but human nature is to complain when things don't work as expected so you may see more complaints than praises.
One thing to remember is that Libre (and other CGM) have limitations. If these are not understood, your experience will not be great.
The big thing to remember if you are testing for nocturnal hypoglycaemia is what is know as "compression lows". When pressure is applied to a sensor, it blocks the flow of interstitial fluid (the stuff a CGM reads to calculate BG levels). As a result, the sensor will report a force low. This is most common at night because you may lie on your "sensored" arm and, this, apply pressure to it.
Often, compression lows can be spotted on graphs because the line will suddenly dip as you roll onto your arm and suddenly rise as you roll off it.

 

[Alan44]

Hi @Rocky2atsea and welcome to the forum

Alan 😉

 

[Rocky2atsea]

Welcome @Rocky2atsea
What is your concern with your LIbre 2? Do you have a finger prick meter to confirm the Libre readings?
Many of us find Libre to be great but human nature is to complain when things don't work as expected so you may see more complaints than praises.
One thing to remember is that Libre (and other CGM) have limitations. If these are not understood, your experience will not be great.
The big thing to remember if you are testing for nocturnal hypoglycaemia is what is know as "compression lows". When pressure is applied to a sensor, it blocks the flow of interstitial fluid (the stuff a CGM reads to calculate BG levels). As a result, the sensor will report a force low. This is most common at night because you may lie on your "sensored" arm and, this, apply pressure to it.
Often, compression lows can be spotted on graphs because the line will suddenly dip as you roll onto your arm and suddenly rise as you roll off it.

Hi Helli,

Thanks for this, I believe I have already encountered a few compression lows and am starting to see the commonality in the sensor readings for these.

I also had a hypo event last night which was detected and reflected on the sensor. At present I do not have a finger prick meter. The plan from my GP was to collate the data over 14 days and then plan accordingly.

Last night however was the first time ive been unable to get up during an event, which obviously panicked my wife.

 

[Leadinglights]

Hi Helli,

Thanks for this, I believe I have already encountered a few compression lows and am starting to see the commonality in the sensor readings for these.

I also had a hypo event last night which was detected and reflected on the sensor. At present I do not have a finger prick meter. The plan from my GP was to collate the data over 14 days and then plan accordingly.

Last night however was the first time ive been unable to get up during an event, which obviously panicked my wife.

Have they also done some blood tests, like an HbA1C for example.
What about you blood pressure and heart rate, has that been checked.
Do you recover from the low level fairly quickly by taking some glucose or naturally with no treatment.

 

[Rocky2atsea]

Have they also done some blood tests, like an HbA1C for example.
What about you blood pressure and heart rate, has that been checked.
Do you recover from the low level fairly quickly by taking some glucose or naturally with no treatment

Hi Leadinglights,

To date no blood test has been conducted. Blood pressure and heart rate were normal during the day.

Last night i recovered naturally but it took close to an hour (in hindsight intervention was required last night)

My last event was aided by glucose tablets and it recovered within 10 minutes.

 

[rebrascora]

Hi Leadinglights,

To date no blood test has been conducted. Blood pressure and heart rate were normal during the day.

Last night i recovered naturally but it took close to an hour (in hindsight intervention was required last night)

My last event was aided by glucose tablets and it recovered within 10 minutes.

Hi and welcome from me too.

Sorry to hear you are experiencing these problems. What prompted your GP to give you the Libre in the first place? What symptoms did you go to the doc with?

Are you assessing recovery from these evens with Libre because it is unreliable in these circumstances, so most of us will find that Libre takes nearly an hour to show recovery from a hypo when a finger prick test 15 mins after treatment will show we have recovered, even though we may still be feeling the signs/effects of the hypo and infect, the adrenaline rush that sometimes comes with a hypo is far worse that the low glucose feelings, but there is a delay on the adrenaline rush so you sometimes end up feeling worse when you are recovering than you did at the depths of the hypo.

It definitely does sound like you have perhaps been having some compression lows but perhaps also some genuine ones. That said it is not unusual for people without diabetes or glucose misregulation to fall below 4 during the depths of the night's sleep and a true hypo is generally considered to be below 3.5 but those of us on insulin try to treat anything below 4 as hypo in order to preserve our hypo awareness, because that is our safety net.

It is also important to know that for many of us Libre over exaggerates lows and highs so for instance last night my Libre said I was 2.9 with a vertical downward arrow and whilst I was hypo it wasn't anywhere near that bad with a finger prick showing 3.4 at the lowest and came back up very quickly with a couple of Jelly Babies whereas Libre said it levelled out at 2.9 5 mins later and then slowly came back up over the next 45 mins.

Having a means of double checking Libre at these times and reliably assessing recovery is really important because Libre simply is not reliable in this circumstance.

Keeping a food diary might be helpful to see if there is any food that might be triggering real hypo events. Generally with Reactive Hypoglycaemia (RH) it will be high carb foods which cause a very high spike and then over production of insulin in response to that spike, bringing levels down too fast and too far. The feeling of BG levels dropping fast from a high can sometimes make you feel hypo even if you don't go below 4. Avoiding those high carb foods which trigger it would be key to managing it, so I food diary can be quite helpful if you suspect RH.

Would you be comfortable posting photos of some of the overnight graphs from Libre where it has recorded overnight lows and indicate which ones you felt were genuine, so that we can see what your levels were doing before the low?

 

[Rocky2atsea]

Hi and welcome from me too.

Sorry to hear you are experiencing these problems. What prompted your GP to give you the Libre in the first place? What symptoms did you go to the doc with?

Are you assessing recovery from these evens with Libre because it is unreliable in these circumstances, so most of us will find that Libre takes nearly an hour to show recovery from a hypo when a finger prick test 15 mins after treatment will show we have recovered, even though we may still be feeling the signs/effects of the hypo and infect, the adrenaline rush that sometimes comes with a hypo is far worse that the low glucose feelings, but there is a delay on the adrenaline rush so you sometimes end up feeling worse when you are recovering than you did at the depths of the hypo.

It definitely does sound like you have perhaps been having some compression lows but perhaps also some genuine ones. That said it is not unusual for people without diabetes or glucose misregulation to fall below 4 during the depths of the night's sleep and a true hypo is generally considered to be below 3.5 but those of us on insulin try to treat anything below 4 as hypo in order to preserve our hypo awareness, because that is our safety net.

It is also important to know that for many of us Libre over exaggerates lows and highs so for instance last night my Libre said I was 2.9 with a vertical downward arrow and whilst I was hypo it wasn't anywhere near that bad with a finger prick showing 3.4 at the lowest and came back up very quickly with a couple of Jelly Babies whereas Libre said it levelled out at 2.9 5 mins later and then slowly came back up over the next 45 mins.

Having a means of double checking Libre at these times and reliably assessing recovery is really important because Libre simply is not reliable in this circumstance.

Keeping a food diary might be helpful to see if there is any food that might be triggering real hypo events. Generally with Reactive Hypoglycaemia (RH) it will be high carb foods which cause a very high spike and then over production of insulin in response to that spike, bringing levels down too fast and too far. The feeling of BG levels dropping fast from a high can sometimes make you feel hypo even if you don't go below 4. Avoiding those high carb foods which trigger it would be key to managing it, so I food diary can be quite helpful if you suspect RH.

Would you be comfortable posting photos of some of the overnight graphs from Libre where it has recorded overnight lows and indicate which ones you felt were genuine, so that we can see what your levels were doing before the low?

Hi,

Thanks for taking the time to post.

This is stage one of my GP trying to ascertain if i have sleep apnea or Nocturnal Hypoglycaemia.

Im very early in the process and at presebt just following their test plan.

Symptoms initially:
Sweaty during the night, Rapid heart rate (recorded by apple watch), lethargy and struggle to wake up/get up some mornings, struggle to retain information the following day.

From your post it does seem like a finger prick monitor will help work out what is actually being shown on the libre. (As mentioned above, hopefully my test results will help the GP)

I have attached a couple of pictures of the recent results ive been seeing.

Rapid drops and recoveries i have put down as compression as ive had no alternate means of testing to date.

Fortunately I also share my results with my brother (Paramedic and Diabetese specialist)

 

[rebrascora]

Those graphs do not look like someone with Blood Glucose (BG) disregulation, so I suspect the cause of your symptoms lies somewhere other than BG related and those overnight dips are perhaps a mixture of compression lows and normal dips into the red that happen, sometimes after alcohol has been consumed the evening before or perhaps after exercise the previous day or maybe a combination of both.

 

[helli]

Those graphs do not look like someone with Blood Glucose (BG) disregulation, so I suspect the cause of your symptoms lies somewhere other than BG related and those overnight dips are perhaps a mixture of compression lows and normal dips into the red that happen, sometimes after alcohol has been consumed the evening before or perhaps after exercise the previous day or maybe a combination of both.

While I would not be surprised to see those drops for someone with Type 1 diabetes who has not adjusted their basal insulin after exercise and/or alcohol, I would expect someone without diabetes to be able to regulate their insulin production and not produce those lows.
That said, I have no medical training so I may be wrong.
Barbara, do you have some examples or reference to articles/research papers from people without diabetes seeing those kind of lows at night due to exercise and/or alcohol?

 

[rebrascora]

@helli No I don't have any references but I do know that @harbottle who I believe is in remission, experiences such lows and I believe it is part of the circadian rhythm to drop low during the "witching" hours. I also understand that alcohol causes hypos in non diabetic people, which is why we can appear drunk when we are hypo.
I should say that I am absolutely not suggesting that the OP or @harbottle get drunk, but just that alcohol can cause hypos.

 

[Rocky2atsea]

Those graphs do not look like someone with Blood Glucose (BG) disregulation, so I suspect the cause of your symptoms lies somewhere other than BG related and those overnight dips are perhaps a mixture of compression lows and normal dips into the red that happen, sometimes after alcohol has been consumed the evening before or perhaps after exercise the previous day or maybe a combination of both.

Hi Rebrascora,

Thanks for your post, and your view on my graphs. I don’t drink so am able to rule that option out. I understand the compression low likelihood and based on symptoms and fall out from my latest event I am leaning more towards it not being a compression issue.

However i also am not a medical professional, hence why I am here looking for advice and guidance whilst I continue with my Diagnosis.

 

[helli]

I also understand that alcohol causes hypos in non diabetic people, which is why we can appear drunk when we are hypo.

I do not understand it that way - the symptoms of a hypo are similar to the symptoms of someone who has "less control of themselves".
This does not mean that a hypo looks like a drunk person because alcohol causes hypos in someone who does not have diabetes.

Sorry, I am at risk of derailing the thread.

Forgive me @Rocky2atsea. I hope you get to the bottom of your symptoms.

 

[rebrascora]

@helli If alcohol stops the liver from releasing glucose but the pancreas continues to trickle out insulin then to me that is likely to cause a hypo which explains why being drunk is similar to having a hypo and why people have a craving to eat kebabs or whatever after a night out because their BG is low. I am sure this was explained during my DAFNE course.

 

[helli]

@helli If alcohol stops the liver from releasing glucose but the pancreas continues to trickle out insulin then to me that is likely to cause a hypo which explains why being drunk is similar to having a hypo and why people have a craving to eat kebabs or whatever after a night out because their BG is low. I am sure this was explained during my DAFNE course.

The bit about liver stopping glucose was explained but only in terms of the effect on someone with diabetes.
Someone without diabetes is able to regular their insulin trickle so a hypo is less likely although not impossible.

And, not everyone gets the munchies when their BG is low.
I experience the munchies when my body is not getting the energy from the food I have eaten - high BG.

 

[rebrascora]

As I understand it the pancreas continues to release insulin to cover basal needs when drunk even though there is no glucose release from the liver. I am not sure if that is because the pancreas has a baseline release based on circadian rhythm, but I think it comes down to the liver to regulate low BG and if it is busy dealing with removing alcohol, it can't balance the basal need.

I may have that wrong but to me that seems reasonable and logical. So the liver has a built in function to prevent or deal with lows and the pancreas counteracts any highs, but they both have a baseline level release that they chug along at, so they don't ever normally stop release of each component, either glucose from the liver or insulin from the pancreas... unless one or the other is damaged.... or busy dealing with alcohol.

 

[Lucyr]

As I understand it the pancreas continues to release insulin to cover basal needs when drunk even though there is no glucose release from the liver. I am not sure if that is because the pancreas has a baseline release based on circadian rhythm, but I think it comes down to the liver to regulate low BG and if it is busy dealing with removing alcohol, it can't balance the basal need.

I may have that wrong but to me that seems reasonable and logical. So the liver has a built in function to prevent or deal with lows and the pancreas counteracts any highs, but they both have a baseline level release that they chug along at, so they don't ever normally stop release of each component, either glucose from the liver or insulin from the pancreas... unless one or the other is damaged.... or busy dealing with alcohol.

Sounds like you’re talking about why alcohol can make your bg low factually, but then you’re saying “that’s why hypos can appear like you’re drunk” which is not the same thing and would have a different explanation about hypos impairing the brain and being drunk impairing the brain