confusion about night time hypos

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bev

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My son was 8.9 before he went to bed last night. We had eaten a takeaway and tried to carb count as accurately as we could, we worked out it was 80grams so he had 4 novorapid. During the night he was really sweaty and hot and this morning he was 11.9, does anyone know why, or do you think he has had a hypo during the night? We havent had to treat a hypo during the night before so not sure whether this is a sign of one or not? very confused mum. Bev
 
it could have been a hypo, the high in the morning could have been the result of a rebound from a hypo or he may have had delayed absorption from the take away meaning he went low and then caught up!
Treating a night hypo is not really much different from another one, you need to test and then treat as normal. Did he wake up in the night so you could test or did you just realize he'd been hot and sweaty when he woke up this morning?
 
How did he feel in the morning bev? Usually, if I have gone low in the night I know about it mainly because I have a bad headache and feel a bit 'hungover' the following day. I've been testing myself in the middle of the night as I've been waking up feeling very hot and sweaty, but I'm not convinced now that it's because of hypos as my BG isn't always low. If Alex has gone low whilst asleep his brain will have triggered stress hormones that make the liver put out glucose - this may be the cause of his high waking sugars. Alternatively, the food may have taken longer to digest (I think Chinese is known for this), and his BG might just have been steadily rising through the night. You'd really need to test him during the night to find out what was going on, which I can't imagine he'd be too keen on! It must be so much harder to be caring for someone else and not knowing just how they are feeling, rather than being the person with diabetes.

Sorry I can't be more help!
 
Thanks for the replies, he woke when i was going to bed and went to the loo and because i am paranoid about him having a hypo and bumping into something i waited for him and gave him a hug , and it was then i noticed he was really sweaty, but he really wasnt in the mood for me to test him and to be honest it never crossed my mind at the time that it could be a hypo - i only thought of it this morning! He didnt seem any different in himself other than being sleepy but then i would if waking from a deep sleep for a wee! What i dont want to ask - but i know i have to - is - if he had a hypo in the night and he went really low - how bad could it get? I am sorry if i upset anyone reading this who has to put up with hypos all the time - i am just a mum who is desperately worried and need to know facts - even though i dont want to know! Sorry for the negativeness in this thread but i know i have to face it some time! Bev
 
Bev, I dont want to scare you but it can become very serious. the best thing to do is to test him if you suspect a hypo, or you are unsure if his glucose is right or not. he may not like it but it is for his own good. I realise you didnt even think that he may have been having a hypo but thats something you will have to come to think about in those situations.

if he had been having a hypo and went back to bed without any treatment it is possible he could have slipped into a diabetic coma.

one of the symtoms of hypo is sweating. (he may have just been hot in bed- but as you dont know that youve got to test him). you really should speak to your diabeties specialist regarding what can happen with hypos etc, unfortunately theres a lot of information about that could be inaccurate.

TEST TEST TEST!
 
A lot of people can sleep through night time hypos. Once a persons blood sugar has been low for a while their liver will usually kick in and release sugar to bring levels back up. The main exception to this is when alcohol is present which I'd assume isn't an issue with your son at present! A lot of people do find that if they hypo at night their body will wake them up anyway.
Always worth making sure you have a glucagon set hand in case he does have a big hypo, counts in day time too of course but I suppose the risk may be greater at night as he may go lower before having warnings.
Is your son a heavy sleeper? I wonder if you could test his blood while he's sleeping without waking him up, I have heard of other people doing do. Could be worth a go in these early days if you're particularly concerned one night?
Don't know if I've really managed it but what I've been trying to say is while you need to be aware please don't worry too much more about night hypos than those at any other times, it's quite amazing how the body can either wake you up or respond appropriately.
 
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OMG! I am now really worried - i should have tested him shouldnt i? He sometimes sleeps with me ( yes he is 10 but we cant help it we worry) and sometimes he is really sweaty during the night! He doesnt show any symptoms in the morning as he is a happy little chap. Thankyou for being honest, i havent asked his DN about these things - i didnt want to know. So if he went into a diabetic coma -what are the dangers of that? be kind i am paranoid enough as it is! Sorry for being pathetic i am a mum. Bev
 
bev said:
OMG! I am now really worried - i should have tested him shouldnt i? He sometimes sleeps with me ( yes he is 10 but we cant help it we worry) and sometimes he is really sweaty during the night! He doesnt show any symptoms in the morning as he is a happy little chap. Thankyou for being honest, i havent asked his DN about these things - i didnt want to know. So if he went into a diabetic coma -what are the dangers of that? be kind i am paranoid enough as it is! Sorry for being pathetic i am a mum. Bev
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bev, please don't beat yourself up over it. Although it could've been worthwhile to test to see what was happening it looks like either he didn't hypo, or if he did his body sorted him out one way or another. Diabetes us a huge learning curve and I can't start to imagine how difficult it must be when you're having to do all the learning for someone in your care. From what I've seen in all your posts you seem to be doing a great job, the best ammunition for getting control of diabetes is knowledge so you've won half the battle just being here.
 
aymes said:
bev, please don't beat yourself up over it. Although it could've been worthwhile to test to see what was happening it looks like either he didn't hypo, or if he did his body sorted him out one way or another. Diabetes us a huge learning curve and I can't start to imagine how difficult it must be when you're having to do all the learning for someone in your care. From what I've seen in all your posts you seem to be doing a great job, the best ammunition for getting control of diabetes is knowledge so you've won half the battle just being here.
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couldnt have put it better myself. the reason i said it like it did was because my parents were in your situation when i was your sons age (well 8 actually), and i appreciate what they did for me back then (even if i didnt know it at the time). trust me in a few years when hes able to understand it all fully he'l be the same and you can think to yourself youve done a good job!
 
Impaired counter regulatory response

aymes said:
A lot of people can sleep through night time hypos. Once a persons blood sugar has been low for a while their liver will usually kick in and release sugar to bring levels back up. The main exception to this is when alcohol is present which I'd assume isn't an issue with your son at present! A lot of people do find that if they hypo at night their body will wake them up anyway.
Always worth making sure you have a glucagon set hand in case he does have a big hypo, counts in day time too of course but I suppose the risk may be greater at night as he may go lower before having warnings.
Is your son a heavy sleeper? I wonder if you could test his blood while he's sleeping without waking him up, I have heard of other people doing do. Could be worth a go in these early days if you're particularly concerned one night?
Don't know if I've really managed it but what I've been trying to say is while you need to be aware please don't worry too much more about night hypos than those at any other times, it's quite amazing how the body can either wake you up or respond appropriately.
Click to expand...


Unfortunately one cannot reply on the counter regulatory response to increase the blood glucose levels. Most people who have had diabetes for a few years lose this response.

Somogyi phenomenon
http://emedicine.medscape.com/article/125432-overview
It is now debated whether there are "rebound highs" from a low blood glucose, now there is GCMS and it can be seen what happens at night for children/patients

This is why its very dangerous for clinics to tell parents that children will wake up when they are low or that a rebound with "rescue" them.

Hypoglycaemia in type 1 diabetes assessed by continuous glucose monitoring
Thomas H?i-Hansen, MD
This PhD dissertation was accepted by the Faculty of health Sience of the University of Copenhagen, and defended on March 8, 2006.

The Somogyi phenomenon - nocturnal hypoglycaemia begetting morning hyperglycaemia -- has previously been rejected in experimental studies on admitted patients but many health-care professionals still believe in its existence. Morning blood glucose is not high after nocturnal hypoglycaemia, but generally low. The existence of the Somogyi-phenomenon is now also rejected by CGMS in patients in daily life.



The Somogyi phenomenon. Sacred cow or bull?

Raskin P.

Posthypoglycemic hyperglycemia (Somogyi phenomenon) occurs infrequently in insulin-treated diabetic patients. When it occurs it is often in children and adolescents, or patients with a short duration of diabetes. Marked hyperglycemia (greater than 12.2 mmols) after hypoglycemia results from a large meal to relieve the symptoms of hypoglycemia. Posthypoglycemic hyperglycemia correlates with falling plasma insulin levels, rather than increasing concentrations of counterregulatory hormones, whose secretion may be defective. Asymptomatic nocturnal hypoglycemia is common but subsequent fasting hyperglycemia is not necessarily the result of "rebound." More likely, fasting hyperglycemia is due to a falling predawn insulin level. Nocturnal hypoglycemia is dealt with by a readjustment in the timing and dose of insulin. The failure of the Somogyi phenomenon to occur puts insulin-dependent diabetic patients at increased risk to potential lethal consequences of nocturnal hypoglycemia.
 
bev said:
My son was 8.9 before he went to bed last night. We had eaten a takeaway and tried to carb count as accurately as we could, we worked out it was 80grams so he had 4 novorapid. During the night he was really sweaty and hot and this morning he was 11.9, does anyone know why, or do you think he has had a hypo during the night? We havent had to treat a hypo during the night before so not sure whether this is a sign of one or not? very confused mum. Bev
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Hi Bev

I dont know how long your son has had diabetes for, but if he has had it for some time, then even if he had a bad hypo its unlikely that he would have had a rebound high. You certainly can't rely on the possibility that this will happen. Now we have continuous glucose monitoring systems it has been shown that rebounds are quite unlikely in patients who have had type 1 diabetes for sometime. the counter regulatory system becomes impaired so one cannot reply on the body recovering by itself from a low blood glucose level.


The most likely senario which caused your son morning high is that as result of having a take away meal and perhaps more carb than you thought or greasy than you thought, this meant higher levels overnight. It would also be worth testing him to see whether is is low when he is hot and sweaty just in case.


My daughter has no night time hypo awareness and has had several severe lows. She doesnt wake when she goes low. The only way we can detect hypos is to test regularly.

Have you thought about coming to the Friends For Life Conference in Windsor?

There will be a lot of children and parents there to meet and talk to.

http://www.childrenwithdiabetes.com/activities/UK2009/
 
Nemo said:
Unfortunately one cannot reply on the counter regulatory response to increase the blood glucose levels. Most people who have had diabetes for a few years lose this response.
QUOTE]

No sorry, perhaps I should clarify. I wasn't trying to suggest that it was something to rely on in the absence of usual precautions so please don't take it as that, was just trying to say it is a possibility and in this example something along those lines happened or there wasn't a hypo.

But again, please don't worry unduly about night hypos, whilst they are something to take seriously I dont feel they are any more or less significant than than every other consideration we have to think about regarding diabetes, just part of the big picture.

Sorry for any confusion....
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aymes said:
bev, please don't beat yourself up over it. Although it could've been worthwhile to test to see what was happening it looks like either he didn't hypo, or if he did his body sorted him out one way or another. Diabetes us a huge learning curve and I can't start to imagine how difficult it must be when you're having to do all the learning for someone in your care. From what I've seen in all your posts you seem to be doing a great job, the best ammunition for getting control of diabetes is knowledge so you've won half the battle just being here.
Click to expand...

Aymes, thank you for that it ws very kind of you to say. Some days i feel as if we have cracked it - then it all goes completely wrong and i wonder whether i am 'good' enough to be responsible for such a huge responsibility! Its only been 8 weeks so i suppose it will take a few years to learn what my son responds best to! But i have to say i dont think i could cope at all without this site - its so lovely to be able to ask a question and someone will always answer it! Bev
 
Hi Nemo, thank you for all the information you have supplied. My son was diagnosed 8 weeks ago - so we are still learning! We have booked a weekend event with diabetes uk at a place in Kent - it sounds very similar to the one you mentioned. We have also applied for a place on the diabetes uk holidays for children which i think will be wonderful for him. How long has your child been diagnosed for? (hope you dont mind me asking) Has he/she been on one of these holidays? Bev
 
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