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night time hypos

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bev

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When people have had diabetes for a while the counter regulatory system isimpaired. Also sleep dampens the responses. Continuous glucose monitoring hasnot found evidence of the so called Somogyi phenomenon. Unfortunately somehospitals are still repeating this myth http://www.ncbi.nlm.nih.gov/sites/entrez?db=pubmed&cmd=Retrieve&dopt=Abstract&list_uids=17652003 Nocturnal hypoglycaemias in type 1 diabetic patients: what can we learn withcontinuous glucose monitoring? Guillod L, Comte-Perret S, Monbaron D, Gaillard RC, Ruiz J. Service of Endocrinology, Diabetology and Metabolism,Centre HospitalierUniversitaire Vaudois, 1011, Lausanne, Switzerland. AIM: In type 1 diabetic patients (T1DM), nocturnal hypoglycaemias (NH) are aserious complication of T1DM treatment; self-monitoring of blood glucose (SMBG)is recommended to detect them. However, the majority of NH remains undetected onan occasional SMBG done during the night. An alternative strategy is theContinuous glucose monitoring (CGMS), which retrospectively shows the glycaemicprofile. The aims of this retrospective study were to evaluate the trueincidence of NH in T1DM, the best SMBG time to predict NH, the relationshipbetween morning hyperglycaemia and NH (Somogyi phenomenon) and the utility ofCGMS to reduce NH. METHODS: Eighty-eight T1DM who underwent a CGMS exam wereincluded. Indications for CGMS evaluation, hypoglycaemias and correlation withmorning hyperglycaemias were recorded. The efficiency of CGMS to reduce thesuspected NH was evaluated after 6-9 months. RESULTS: The prevalence of NH was67% (32% of them unsuspected). A measured hypoglycaemia at bedtime (22-24 h) hada sensitivity of 37% to detect NH (OR=2.37, P=0.001), while a single measure <or =4 mmol/l at 3-hour had a sensitivity of 43% (OR=4.60, P<0.001). NH were notassociated with morning hyperglycaemias but with morning hypoglycaemias(OR=3.95, P<0.001). After 6-9 months, suspicions of NH decreased from 60 to 14%(P<0.001). CONCLUSION: NH were highly prevalent and often undetected. SMBG atbedtime, which detected hypoglycaemia had sensitivity almost equal to that of3-hour and should be preferred because it is easier to perform. Somogyiphenomenon was not observed. CGMS is useful to reduce the risk of NH in 75% ofpatients. Defective Awakening Response to Nocturnal Hypoglycemia in Patients with Type 1Diabetes Mellitus http://medicine.plosjournals.org/perlserv/?request=get-document&doi=10.1371/journal.pmed.0040069 We tested two groups of 16 T1DM patients and 16 healthy control participants,respectively, with comparable distributions of gender, age, and body mass index.In one night, a linear fall in plasma glucose to nadir levels of 2.2 mmol/l wasinduced by infusing insulin over a 1-h period starting as soon aspolysomnographic recordings indicated that stage 2 sleep had been reached. Inanother night (control), euglycemia was maintained. Only one of the 16 T1DM patients, as compared to ten healthy controlparticipants, awakened upon hypoglycemia (p = 0.001). In the control nights,none of the study participants in either of the two groups awakened during thecorresponding time. Awakening during hypoglycemia was associated with increasedhormonal counterregulation. In all the study participants (from both groups) whowoke up, and in five of the study participants who did not awaken (three T1DMpatients and two healthy control participants), plasma epinephrine concentrationincreased with hypoglycemia by at least 100% (p < 0.001). A temporal pattern wasrevealed such that increases in epinephrine in all participants who awakenedstarted always before polysomnographic signs of wakefulness (mean ? standarderror of the mean: 7.5 ? 1.6 min).


I got this from another forum and found it interesting so thought you may like to read it too. Bev
 
bev said:
When people have had diabetes for a while the counter regulatory system isimpaired. Also sleep dampens the responses. Continuous glucose monitoring hasnot found evidence of the so called Somogyi phenomenon. Unfortunately somehospitals are still repeating this myth http://www.ncbi.nlm.nih.gov/sites/entrez?db=pubmed&cmd=Retrieve&dopt=Abstract&list_uids=17652003 Nocturnal hypoglycaemias in type 1 diabetic patients: what can we learn withcontinuous glucose monitoring? Guillod L, Comte-Perret S, Monbaron D, Gaillard RC, Ruiz J. Service of Endocrinology, Diabetology and Metabolism,Centre HospitalierUniversitaire Vaudois, 1011, Lausanne, Switzerland. AIM: In type 1 diabetic patients (T1DM), nocturnal hypoglycaemias (NH) are aserious complication of T1DM treatment; self-monitoring of blood glucose (SMBG)is recommended to detect them. However, the majority of NH remains undetected onan occasional SMBG done during the night. An alternative strategy is theContinuous glucose monitoring (CGMS), which retrospectively shows the glycaemicprofile. The aims of this retrospective study were to evaluate the trueincidence of NH in T1DM, the best SMBG time to predict NH, the relationshipbetween morning hyperglycaemia and NH (Somogyi phenomenon) and the utility ofCGMS to reduce NH. METHODS: Eighty-eight T1DM who underwent a CGMS exam wereincluded. Indications for CGMS evaluation, hypoglycaemias and correlation withmorning hyperglycaemias were recorded. The efficiency of CGMS to reduce thesuspected NH was evaluated after 6-9 months. RESULTS: The prevalence of NH was67% (32% of them unsuspected). A measured hypoglycaemia at bedtime (22-24 h) hada sensitivity of 37% to detect NH (OR=2.37, P=0.001), while a single measure <or =4 mmol/l at 3-hour had a sensitivity of 43% (OR=4.60, P<0.001). NH were notassociated with morning hyperglycaemias but with morning hypoglycaemias(OR=3.95, P<0.001). After 6-9 months, suspicions of NH decreased from 60 to 14%(P<0.001). CONCLUSION: NH were highly prevalent and often undetected. SMBG atbedtime, which detected hypoglycaemia had sensitivity almost equal to that of3-hour and should be preferred because it is easier to perform. Somogyiphenomenon was not observed. CGMS is useful to reduce the risk of NH in 75% ofpatients. Defective Awakening Response to Nocturnal Hypoglycemia in Patients with Type 1Diabetes Mellitus http://medicine.plosjournals.org/perlserv/?request=get-document&doi=10.1371/journal.pmed.0040069 We tested two groups of 16 T1DM patients and 16 healthy control participants,respectively, with comparable distributions of gender, age, and body mass index.In one night, a linear fall in plasma glucose to nadir levels of 2.2 mmol/l wasinduced by infusing insulin over a 1-h period starting as soon aspolysomnographic recordings indicated that stage 2 sleep had been reached. Inanother night (control), euglycemia was maintained. Only one of the 16 T1DM patients, as compared to ten healthy controlparticipants, awakened upon hypoglycemia (p = 0.001). In the control nights,none of the study participants in either of the two groups awakened during thecorresponding time. Awakening during hypoglycemia was associated with increasedhormonal counterregulation. In all the study participants (from both groups) whowoke up, and in five of the study participants who did not awaken (three T1DMpatients and two healthy control participants), plasma epinephrine concentrationincreased with hypoglycemia by at least 100% (p < 0.001). A temporal pattern wasrevealed such that increases in epinephrine in all participants who awakenedstarted always before polysomnographic signs of wakefulness (mean ? standarderror of the mean: 7.5 ? 1.6 min).


I got this from another forum and found it interesting so thought you may like to read it too. Bev
Click to expand...

thanks Bev, but to be honest found it hard going half way through and gave up,:D sorry.

perhaps you could condense it into a few simple sentences, ive had a hard day:eek:
 
Ooops!!!!!!!!

I missed a critical bit out! :D
Basically, the phenomenon that we are being told by medics that the liver kicks in and dumps a load of glucose through the night (if going hypo)does not exist! So more for me to worry about - as if i dont lie awake worrying enough about Alex! Sorry it read like gobbledygook!:DBev
 
bev said:
Ooops!!!!!!!!

I missed a critical bit out! :D
Basically, the phenomenon that we are being told by medics that the liver kicks in and dumps a load of glucose through the night (if going hypo)does not exist! So more for me to worry about - as if i dont lie awake worrying enough about Alex! Sorry it read like gobbledygook!:DBev
Click to expand...

We will let you off this once! Is it an official study Bev, have they proved this beyond doubt? Or is it one study showing this? why then do we sometimes wake with high bs and suspect we had a night hypo without waking, with all the "hangover" symptoms?

Not disagreeing, just wondering thats all :confused:
 
well i for one know i have some sort of back up in me, ive gone low in the night before (wa 6. odd before bed and woke up at 14.odd!) if that isnt my liver kicking out glucose i dont know what is..

I think ive heard that the response can fade somewhat as time goes on (a bit like people loosing their hypo warning signs)
 
Hi Bev

I know that it doesn't help too much but all of the research over the years that highlights potential problems with diabetes, although important, can make living with diabetes more stressful than it needs to be. When I grew up the message was very clearly given in various media that you would almost certainly have serious complications (kidney failure, blindness etc) within 20-30 years of living with diabetes, that you might lose hypo awareness, shortened lifespan etc etc etc. These complications can happen to people, unfortunately, but just as equally it doesn't mean that they will happen. It has taken me until very recently to stop being affected by these worries. The reason that I've stopped worrying?? I've now had it 38 years and none of these things have happened to me but the worrying about them has not helped.

None of us knows what diabetes will do to us in the long-term but, personally I've now come to the view that I balance my BGs as well as I can whilst enjoying my life and make sure that I have all of the check-ups that I need to have in order to deal with problems that may occur. Worrying about what may go wrong has probably stopped me from doing some of the things that I should that enhance life..................
 
bev said:
We tested two groups of 16 T1DM patients and 16 healthy control participants,respectively
Click to expand...

That doesn't sound like a very large group. Is it really enough for them to decide conclusively that this phenomenon does not exist?
 
I've had hypos in the night, but I don't get the 'bounce' - or at least, I don't bounce very high! My waking level has never been above 7. As Lizzie says, it's a small sample and it's possible they had a lot of people like me!:)
 
well im wondering why I go to bed with a good level and wake up with a higher level now...
 
Hi all!

I am sorry to have caused worry or extra confusion!:eek:

I would love to believe that there is this phenomenon - it would help me sleep at night!:D But, its hard to ignore all the research that can be found - not just on this subject , on every aspect of diabetes! It seems that it depends on who you listen to and what stats you believe.

The site i got it off was a childrens site - its a great site - its full of mums all tryng to do the best by their diabetic children - and you know the lengths a parent will go to for their child!:D

This is where i feel confused - mostly on this site people seem 'chilled' about diabetes , but on the other site people seem 'completely fraught' about it all - possibly because they are all parents (like myself)- and are completely stressed out by it all. It seems that the view of a carer of a diabetic, as opposed to the views of the actual diabetic person - are worlds apart?

I find it very re-assuring when you all tell me that diabetes hasnt caused any long term complications etc as you have all lived with the condition for years. And some of you , who have had it for over 30 years etc didnt have the benefits or the knowledge we have now - or the advice.

Bev
 
bev said:
Hi all!

I am sorry to have caused worry or extra confusion!:eek:

I would love to believe that there is this phenomenon - it would help me sleep at night!:D But, its hard to ignore all the research that can be found - not just on this subject , on every aspect of diabetes! It seems that it depends on who you listen to and what stats you believe.

The site i got it off was a childrens site - its a great site - its full of mums all tryng to do the best by their diabetic children - and you know the lengths a parent will go to for their child!:D

This is where i feel confused - mostly on this site people seem 'chilled' about diabetes , but on the other site people seem 'completely fraught' about it all - possibly because they are all parents (like myself)- and are completely stressed out by it all. It seems that the view of a carer of a diabetic, as opposed to the views of the actual diabetic person - are worlds apart?

I find it very re-assuring when you all tell me that diabetes hasnt caused any long term complications etc as you have all lived with the condition for years. And some of you , who have had it for over 30 years etc didnt have the benefits or the knowledge we have now - or the advice.

Bev
Click to expand...

There's always a danger of researching on the web - you might be missing the reports that counter what you've just found!

There's definitely going to be a difference, I would have thought, between people who have diabetes and those who are caring for someone. The approach taken these days is that the person with diabetes is the 'head' of their care team - not the doctors, nurses, podiatrists etc., they're there to help and advise. So, you have an element of control over your condition. If, however, you are the carer or more particularly, the parent, you are placed in the position of understanding the concept but not how it actually feels. Where the majority of people participating in a forum are carers/parents, I would think it's almost inevitable that there is going to be a higher 'fear factor'.

I know if I'm having a hypo, so I treat it, no big deal. But you don't until your child shows symptoms, it's distressing and you are on constant alert. If you do act 'laid back' you might think others would perceive it as 'not bothered', so there's that pressure too.

I really take my hat off to all parents, I would hope to have had such love and concern had I developed this as a child.
 
Hi Bev,

I have read the article and I think its quite poor. I know its hard not to worry but in every area of medicine there is so much research for and against things. I think what u need to be careful of is that alot of the research readily available on the internet is poor. Alot of the good stuff is published in medical journals which need subscriptions by professionals. The internet can be very useful for info but also very scary as its not always the best stuff.
As u say people on here are quite chilled and dont have horrific complications that you read about. I worked on vascular surgery for 6 months and saw diabetics with complications but u have to remember this is such a small percentage of the population. The majority of us are just fine.
 
I'm not sure if I've ever expereinced this effect myself, I do doubt that I have gone severley low in the night before though as have been awokon by night hypo's. i don't wake up high. My DSN did tell me a long time ago that it does happen. Maybe it doesn't happen in everyone all the time, but I think it does happen. Will be asking some professionals what they think though.

I don't have children but I wonder if feeling very stressed is something all parents expereince or if it's only in the group of parents that would go onto internet sites about diabetes. With us here I would agree that generally we are pretty chilled about it all, but probably less so than a large 5 of the population with diabetes who wouldn't think aboutt heir diabetes enough to even come to a site like this.
 
Northerner said:
There's always a danger of researching on the web - you might be missing the reports that counter what you've just found!

There's definitely going to be a difference, I would have thought, between people who have diabetes and those who are caring for someone. The approach taken these days is that the person with diabetes is the 'head' of their care team - not the doctors, nurses, podiatrists etc., they're there to help and advise. So, you have an element of control over your condition. If, however, you are the carer or more particularly, the parent, you are placed in the position of understanding the concept but not how it actually feels. Where the majority of people participating in a forum are carers/parents, I would think it's almost inevitable that there is going to be a higher 'fear factor'.

I know if I'm having a hypo, so I treat it, no big deal. But you don't until your child shows symptoms, it's distressing and you are on constant alert. If you do act 'laid back' you might think others would perceive it as 'not bothered', so there's that pressure too.

I really take my hat off to all parents, I would hope to have had such love and concern had I developed this as a child.
Click to expand...

Northerner, you are very insiteful!,

I 'pretend' to Alex that i am not worried when he has a 'hypo' - when in fact i am panicking until i see what the metre reading is! I dont want the whole hypo thing to make him feel scared or more importantly make him feel that i am scared - no child wants to see a parent not coping! But, i also have to let him know that whilst i am 'laid back' i am also on alert in case his reading is a very low number etc..I also need to bear in mind that teachers and other carers should be taking it seriously in case other help is required. Its so difficult trying to get the balance right between keeping calm and reacting to an emergency! You are right about researching the net - for every argument for - you will find one against - sometimes i feel like going into a shell and never reading anything again!:confused:Bev

p.s. Thanks for all the supportive words off you all - it really does make a difference! x
 
bev said:
Hi all!

I am sorry to have caused worry or extra confusion!:eek:

I would love to believe that there is this phenomenon - it would help me sleep at night!:D But, its hard to ignore all the research that can be found - not just on this subject , on every aspect of diabetes! It seems that it depends on who you listen to and what stats you believe.

The site i got it off was a childrens site - its a great site - its full of mums all tryng to do the best by their diabetic children - and you know the lengths a parent will go to for their child!:D

This is where i feel confused - mostly on this site people seem 'chilled' about diabetes , but on the other site people seem 'completely fraught' about it all - possibly because they are all parents (like myself)- and are completely stressed out by it all. It seems that the view of a carer of a diabetic, as opposed to the views of the actual diabetic person - are worlds apart?

I find it very re-assuring when you all tell me that diabetes hasnt caused any long term complications etc as you have all lived with the condition for years. And some of you , who have had it for over 30 years etc didnt have the benefits or the knowledge we have now - or the advice.

Bev
Click to expand...

Bev, the point i was trying to make, is that you can really only take this random studies with a pinch of salt unless there is conclusive evidence to the contrary. when i did my degree i had to do a lot of experiments and being psychology there were never any real conclusions. always ended my projects with , FURTHER RESEARCH AND EVIDENCE NEEDED IN THIS AREA TO DRAW ANY REAL CONCLUSIONS, HYPOTHESIS NOT PROVEN. (maybe this was just the easy way out in psychology though ;))
 
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