Hypos in the night

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AlicePalace

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Hi does anyone find that as they get older and have had diabetes for a long time that their hypo awareness changes?
 
Most of us have found that our symptoms change slightly - but we still know, just that we don't get so much of X but more of Y - so have to ensure that we definitely test when we feel Y especially when we are alone, to make sure we can treat it ourselves rather than having to dial 999 !
 
Yea. I would have tested last night but I didn't wake up the hypo was 3.6 but I slept through
 
It clearly wasn't registering hypo enough to waken you hence the glucose hadn't actually dropped that low and your actual BLOOD glucose wasn't that low. The blood glucose naturally drops in the middle of the night - it is simply what happens to normal human beings whether they happen to have diabetes or not!
 
AlicePalace said:
Yea. I would have tested last night but I didn't wake up the hypo was 3.6 but I slept through
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Are you sure it wasn’t a compression low @AlicePalace ? You can usually tell by looking at your CGM graph. Do you feel hypos during the day?

Yes, hypo signs can change over time and after a number of years they can dull unless you do a bit of work to keep them sharp. This work is trying to ensure you don’t drop below 5 or around there. This helps keeps hypo signs sharp even in those that have had Type 1 a long time.
 
Your title of this thread "Hypos in the night" suggests that you are talking about nocturnal hypos and my hypo awareness signs are much less obvious/different when I am lying down in bed asleep than they are when I am awake and active.
For instance, one of my first hypo awareness signs is my peripheral vision going slightly blurry and obviously I can't be aware of that when my eyes are shut. Another warning is my legs going like jelly but this doesn't happen when I am lying down because the muscles are not under any strain. Sometimes I wake up when I am hypo and I don't feel anything obvious at all, just a slightly unsettled feeling.
I am quite prone to nocturnal hypos if I have been particularly active or done lots of exercise the previous day so I have to adjust my evening Levemir on a very regular basis to try to prevent them, but I am not always successful. Generally they are very mild ones though and it is not unusual for non diabetics to drop into the red a little during the depths of the night, so whilst I do my best to prevent them, they do still happen.

It is also important to know that Libre and other CGMs can suffer from what we call compression lows where, if you lie on the sensor for any length of time (usually more than about 20 mins) it starts to give a false low reading and you should double check any low alarms during the night with a finger prick before treating, unless you feel obviously hypo. You should also check your recovery 15 mins later with a finger prick as the CGM will almost always suggest that your levels have continued to drop whereas a finger prick will usually show you are recovering, so if you just go by the CGM you are likely to overtreat almost every hypo and end up too high.
 
I should explain that I started my post much earlier when you hadn't clarified the situation about having a 3.5 last night and not waking up. Got a parcel delivery (on a Sunday!!) and then got distracted by phone calls so by the time I got back to this thread and finished posting it there was more info.
 
I do have a dexcom g6 I wasn't laying on it though last night I was laying on the other side. I have my sensor on one arm and my cannual on the other.
 
Can you really be so sure that you didn't roll onto that side at sometime during your sleep.

Can you post a photo of your CGM graph from last night? Generally a genuine nocturnal hypo will be a low and steady descent whereas a compression low is often more of a sharp dip and then rebound when you roll back off it and the pressure is released.

That said, if it was genuine, not waking at 3.5 during the night is not particularly worrying because you are not conscious to detect the early warning sensory signs. Another thing to consider is that CGMs often give consistently lower readings than a finger prick for many people, especially at low levels, so for me Libre usually reads about 1mmol lower than my BG at that level, so in reality, a 3.5 is more likely a 4.5 if I had woken up and double checked it with a finger prick. This is not the same for everyone but knowing how your CGM works for you compared to your BG meter is important so that you don't worry yourself unnecessarily.
 
trophywench said:
It clearly wasn't registering hypo enough to waken you hence the glucose hadn't actually dropped that low and your actual BLOOD glucose wasn't that low.
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I’m not so sure TW, in my experience you can’t rely on your body always waking you up for a hypo. The more hypos one has (even just ‘mild’ ones during the daytime) the body and brain physically changes - it adapts to ‘perform better’ next time. And that can mean it doesn’t want to splash out with all those disruptive, and expensive counterregulatory hormones.

Prof A who I worked with on the NICE thing is a bit of a specialist in the area and I saw a conference presentation that touched on the mechanics involved.

The more years you live with T1D statistically the less likely your liver is to help you out to raise levels, and the less likely you are to be woken overnight.

If you’ve still got both of those things firing, you should feel very proud of yourself 🙂

Maybe it’s my own painful experience of mangling my warning signs with years of extended overnight hypos (thanks Lantus!), and the careful painstaking coaxing and cajoling over a decade or more of repair, restoration, and maintenance?
 
AlicePalace said:
I didn't realize that could happen.
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It’s nothing to panic about. But it’s worth bearing in mind the longer you live with diabetes.

Keeping your number of minutes below 4.0 as reasonable as you can (some hypos are pretty much inevitable after all!) will go a long way towards keeping hold of your warning signs as clearly as possible. And thankfully these days we have sensors overnight for an extra safety blanket 🙂
 
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