Night time low - untreated

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Stanford

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Type 1
Morning guys. Long time since posting. Noticed this morning that I had low sugars during the night and I can vaguely remember waking up when my Libre alarm went off, but went straight back to sleep without treating. How did my levels climb without treatment and how dangerous is this ?
 

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Could it have been a 'compression low'? If you lie on the sensor and squash it, you cut off the interstitial fluid that it reads, and it can read low, you normally get a steep drop and then a rise as you turn over in bed, similar to the pattern on your graph.
Alternatively, your liver could have released glucose when it realised your BG level was falling.(less likely, I’d say, else Type 1s would never have to treat a hypo, just wait for the liver to help out, and as we all have been told, it normally takes a glucagon injection to get the liver to release.)
 
Robin said:
Could it have been a 'compression low'? If you lie on the sensor and squash it, you cut off the interstitial fluid that it reads, and it can read low, you normally get a steep drop and then a rise as you turn over in bed, similar to the pattern on your graph.
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Thank you for your quick response. I did wonder if that was the case, especially as I feel well this morning.
 
@Stanford , had you any alcohol last night? If not? It looks like a possible rebound from a liver dump when the alarm disturbed sleep. (Which looks a little like a compression low in red. & roll over may have resolved it.) Though it is always wise to wake & test.
 
No alcohol. But I have to say this has happened on numerous occasions and I have left untreated, complacent in the knowledge that I have see it rise without treatment. But I feel this could be dangerous. Would you suggest testing by needle in future before treating or just treat to be safe. Thank you for your response. Only diagnosed 18 months ago with T1.
 
Stanford said:
But I feel this could be dangerous.
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I think it probably is. I remember hearing now and again (over decades) of people with type 1 unexpectedly dying overnight; I suspect a good proportion went low and died. There are also a few cases of people going too low (usually overnight, pre-CGM) and suffering brain damage.

Your graph looks as much like a compression low as anything (looks very much like a compression low to me), and it's normal for non-diabetic people to go pretty low overnight (to 3.5 or so) so I doubt there's that much to panic about, but we have CGMs with alarms so we don't need to risk this. You'll probably be OK (the liver produces glucose continuously so (presuming your insulin isn't badly wrong) you'll probably come up again (and I've recovered OK from really nasty hypos at night which is why I always keep a hypo treatment unopened on the floor next to my bed), but maybe not.
 
Stanford said:
No alcohol. But I have to say this has happened on numerous occasions and I have left untreated, complacent in the knowledge that I have see it rise without treatment. But I feel this could be dangerous. Would you suggest testing by needle in future before treating or just treat to be safe. Thank you for your response. Only diagnosed 18 months ago with T1.
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Hello, not the best practice to ignore. If it was me. Test first & find out what the BGs are doing. Unless I really did feel that hypo. Then I’d hit the treatment & ask questions later.
 
Bruce Stephens said:
I think it probably is. I remember hearing now and again (over decades) of people with type 1 unexpectedly dying overnight; I suspect a good proportion went low and died. There are also a few cases of people going too low (usually overnight, pre-CGM) and suffering brain damage.
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Someone I worked close with went out like that. It was suggested the heart. Though, I suspect hypo unawairness. I could pick the lows up before they did on most occasions & quite often prompt them on eating something.
 
I often get a headache after my liver helps out with an overnight hypo, like a really bad banging headache that won’t go away with painkillers. So if you felt perfectly well it could have been a compression low.
 
To me it looks fairly typical of a compression low because your levels look to be steady at about 5 around midnight and then suddenly drop steeply into the red and then rise back up to 6 and then settle back down to about 5 and then start rising presumably with Dawn Phenomenon.
That sharp dip from relatively stable levels, then rise back up probably after the alarm woke you and you changed position and released the compression, followed by a slight drop back to the original pre drop level is quite typical of a compression low in my experience.

You should double check with a finger prick before treating unless you feel obviously hypo. I make a point of thinking which side I am on when the alarm goes off in the night and I look at the graph to see if my levels were stable and then dropped suddenly. Assuming there was no bolus insulin in my system when I went to bed, I would expect a slow steady descent from my basal insulin into the red if it is a true hypo, not a sudden and dramatic drop like that.

What level do you typically go to bed on and do you often see a rise caused by Dawn Phenomenon. If you don't, then that might be the only thing that might make me a little less confident that it was a compression low.
 
Satan’s little helper said:
Someone I worked close with went out like that. It was suggested the heart. Though, I suspect hypo unawairness. I could pick the lows up before they did on most occasions & quite often prompt them on eating something.
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I worked with somebody like that, could detect the hypo before he obviously did, I wish I knew then what I know now. We used to keep emergency cartons of juice and fruit pastilles to hand. They did not appear to do any testing at all.
Before we knew they were diabetic, the symptoms looked like Parkinson's with very jerky movements.
 
Leadinglights said:
I worked with somebody like that, could detect the hypo before he obviously did, I wish I knew then what I know now. We used to keep emergency cartons of juice and fruit pastilles to hand. They did not appear to do any testing at all.
Before we knew they were diabetic, the symptoms looked like Parkinson's with very jerky movements.
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I used to put my own treatment in-front this person & take a few steps back? I would never tax them with questions like “where’s your stuff.” The early signs I saw was dithery & confusion. lol, sometimes I’d get unwarranted random insults? There was a meter carried. No sensors back then.
 
Satan’s little helper said:
I used to put my own treatment in-front this person & take a few steps back? I would never tax them with questions like “where’s your stuff.” The early signs I saw was dithery & confusion. lol, sometimes I’d get unwarranted random insults? There was a meter carried. No sensors back then.
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It just needed a quiet word sometimes suggesting they put some sugar in their cup of coffee and that usually did the trick.
 
Lucyr said:
I often get a headache after my liver helps out with an overnight hypo, like a really bad banging headache that won’t go away with painkillers.
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Ah the ole ‘hypo hangover’. Those are horrid!
 
Lucyr said:
I often get a headache after my liver helps out with an overnight hypo, like a really bad banging headache that won’t go away with painkillers. So if you felt perfectly well it could have been a compression low.
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Yep same that's how I knew sometimes knew I had gone low overnight without waking up before dexcom. Or sometime even had waken up and treated it I felt pretty grim the next day
 
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