Overnight low BG and hunger?

[Eddy Edson]

So this morning I woke up with a "LO" on the Libre reader:

I got up & when I checked again & fingerpricked things were back in the respectable 4's.

Most likely this was a glitch, but I've had a pattern of BG falling when I'm asleep to a nadir at around the time I wake up (and causing me to wake?) - a couple of times down into the mid 2's according to the Libre, accompanied by what I take to be mild hypo-like sweating and pounding headache.

Eg:

Or less pronounced:

Falling below 3.9 mmol/L or 70 mg/dL seems to be a fairly common thing for non-diabetics. The CGM study I use as a benchmark says it happens with about 40% of non-diabetics, and on avg non-diabetics spend ~2.5% of their time down there. And 5% go briefly below 50 mg/dL = 2.8 mmol/L.

According to the Libre's I've worn over the last couple of months, I'm spending ~2.5% of my time below 3.9 mmol/L, so completely in line with the non-diabetic average. Actually, I think it makes more sense to look at medians than averages, and the median non-diabetic spends no time down there. But whatever, I'm within a "normal" range, even given that I've spent a bit of time belw 2.8, according to the Libre.

I do wonder though whether my general pattern of BG's declining until I wake up (or it wakes me up?) is a normal kind of thing, particularly as there often seems to be a sharp dip down at the end.

This pattern has coincided roughly with me getting a lot hungrier than I've been used to. I thought I'd trained my bod & brain to shut up about hunger pangs, but they seem to have rebelled against that. I haven't been keeping an eye on my weight recently, and was surprised on the w./end to see that I'm up 2kg to 65kg.

It's no big deal - 65kg is probably better for me than 63kg, but it would be a drag if I were now on a slippery slope to no longer being Slim Eddy, just when people were getting used to it & no longer telling me to put on weight 🙂

Anyway, idly wondering if maybe there's connection between the BG stuff and the hunger stuff ...

 

[rebrascora]

I wonder if you have reached a point where you have depleted your liver of stores, so that you have nothing to keep you ticking over in the latter part of the night/early morning before you wake.
Hunger and low BG are linked because your brain registers that your BG is low and triggers the hunger response to encourage you to top things up. It is one of the reasons why people tend to over treat a hypo, because they feel often feel a raging hunger and eat more carbs than they should.
Do you still take Metformin or have you now cut that out. I find that I suffered from hunger pangs after I stopped taking it but your low readings suggest that you need to put a little more fuel in the tank. I would suggest you try a low GI carb or protein snack before bed to keep you going through the night and see if that does the trick.

 

[Eddy Edson]

I wonder if you have reached a point where you have depleted your liver of stores, so that you have nothing to keep you ticking over in the latter part of the night/early morning before you wake.
Hunger and low BG are linked because your brain registers that your BG is low and triggers the hunger response to encourage you to top things up. It is one of the reasons why people tend to over treat a hypo, because they feel often feel a raging hunger and eat more carbs than they should.
Do you still take Metformin or have you now cut that out. I find that I suffered from hunger pangs after I stopped taking it but your low readings suggest that you need to put a little more fuel in the tank. I would suggest you try a low GI carb or protein snack before bed to keep you going through the night and see if that does the trick.

Thanks, Barbara!

I'm wondering more whether it has something to do with gluconeogenesis clunkiness - maybe too much insulin for some reason, so the liver doesn't switch it on; or clunkiness in not responding quickly to low insulin; or maybe something like not enough amino acids and trigs to work with.

With that last guess, I can build a little story about not getting enough protein & maybe the hunger is my bod's inept way of signalling it wants more. (I really don't have any specifically carb craving - more like a craving for nuts and occasionally fish or meat, to the extent it's anything specific.)

I have cut down on protein - eg from having some chicken or fish most days to having some maybe every third day. I thought I was getting enough from soya milk/seeds/nuts, but maybe not. Anyway, the idea's worth a little experiment.

 

[KARNAK]

HI Eddy of a personal opinion I agree with @rebrascora, stick some more carbs in that gob of yours.😳 You have enough experience to know the score, look at what you have achieved brilliant control. To be perfectly honest I am following your diet regime, although T1 it works for me.🙂 Lots of figures you quote although you still use the Libre and off Diabetic medication as far as I`m aware, most of us dip overnight suck eggs I tell you not. A few more carbs at kip time won`t go amiss. I have just had a real laugh reading your last post.

I'm wondering more whether it has something to do with gluconeogenesis clunkiness - maybe too much insulin for some reason, so the liver doesn't switch it on; or clunkiness in not responding quickly to low insulin; or maybe something like not enough amino acids and trigs to work with.

What are you like, take care mate.🙂

 

[Eddy Edson]

HI Eddy of a personal opinion I agree with @rebrascora, stick some more carbs in that gob of yours.😳 You have enough experience to know the score, look at what you have achieved brilliant control. To be perfectly honest I am following your diet regime, although T1 it works for me.🙂 Lots of figures you quote although you still use the Libre and off Diabetic medication as far as I`m aware, most of us dip overnight suck eggs I tell you not. A few more carbs at kip time won`t go amiss. I have just had a real laugh reading your last post.



What are you like, take care mate.🙂

How are you doing now, Ted? I've been sending you big virtual man-hugs from the other side of the world!

Really don't think I'm low on carbs - doing 150g - 200g per day usually & don't feel the urge for more. Like I say, I suspect it's more to do with gluconeogenesis but who knows?

All best Mr T!

 

[everydayupsanddowns]

For overnight lows with Libre one other consideration worth thinking about is 'compression lows' where you sleep on the same side as the sensor and the increased pressure affects the flow of interstitial fluid, and provides a falsely low reading.

Sometimes they are spottable in the traces because ou can see when you were lying on it and when you rolled over, but it's not always all that easy. If in doubt - assume the lows are real and take small steps to increase overnight BGs a little.

'Feeling a bit hungry' is one of my main early hypo symptoms. Which is a bit annoying really as some times i am just 'a bit hungry' and other times I am late to respond because I just assume I'm peckish 🙄

 

[TheClockworkDodo]

R's Reactive Hypoglycaemia used to mean he woke up starving and had to get up and eat, we presume because he was hypo-ing in the night, and RH is basically a timing issue with the body's own insulin not responding to carbs at the right speed. Eating a yogurt at bedtime has been a big help for him - might be worth a try for you if you think "clunkiness" is to do with your body's timing being a bit off?

 

[Eddy Edson]

For overnight lows with Libre one other consideration worth thinking about is 'compression lows' where you sleep on the same side as the sensor and the increased pressure affects the flow of interstitial fluid, and provides a falsely low reading.

Thanks, Mike. Could be! I guess waking a couple of times with what seemed like mild hypo-ish symptoms made me think that there might be a real signal. And it's maybe a bit interesting the way my BG usually seems to fall overnight until I wake up, even if it doesn't drop into the red.

@TheClockworkDodo - Thanks Juliet. Hate yoghurt, but usually snarf some nuts before bed. Maybe I'll try something more protein-y.

 

[TheClockworkDodo]

I think it was fat which was recommended to R as something to last him through the night, rather than protein. Cheese and a couple of crackers, if nuts are not enough for you?

 

[Eddy Edson]

I think it was fat which was recommended to R as something to last him through the night, rather than protein. Cheese and a couple of crackers, if nuts are not enough for you?

Thanks again, Juliet. Thinking about it, I doubt it's a RH thing, from what I've read - eg lows happen say 6-8 hrs after last eating - and for whatever reason I suspect protein might be an issue, assuming that there's a problem at all.

But now my last sensor has run out and to convince myself I'm not obsessive beyond hope of recovery I'm going to wait at least a few weeks before deciding whether to get a couple more 🙂

 

[TheClockworkDodo]

I wasn't suggesting you might have RH, Eddy - just that if it's a timing issue the same sort of treatment might help. But if you think it's a protein issue it might not! Sounds like it's experiment time ...

 

[KARNAK]

Thanks for the man hugs Eddy really appreciated,🙂 you seem to be going a bit low in general, especially overnight. Not an easy one too sort out considering the amount of control you normally have, as Juliet says a bit of time to experiment, what you fink mate?

 

[trophywench]

A T2 I knew used to eat a Nairns Oatcake, one of the very small ones, buttered and with a good bit (for its size) of cheddar on it every night which he ate whilst walking upstairs to bed after locking up the house. Used to solve all his overnight lows and am highs, so he reckoned.

 

[Eddy Edson]

A T2 I knew used to eat a Nairns Oatcake, one of the very small ones, buttered and with a good bit (for its size) of cheddar on it every night which he ate whilst walking upstairs to bed after locking up the house. Used to solve all his overnight lows and am highs, so he reckoned.

Thanks, Jenny - another experiment to try. How are you, BTW?

Another thing which has me wondering: my last HbA1c in May showed a surprising 4.6% / 27. On the conventional translation, that's an avg BG of 4.8. I wasn't tesing very much at that time, but enough to think I could only have been getting that avg if I was going very low overnight. Without any reason to think that I was, I figured it was probably due to changing RBC's, from weight loss, diet change, giving up smoking, whatever.

But maybe I actually was often going low overnight?

My Libre says avg BG of 5.3 - 5.6 depending on period. But since May I've added some grains back into the diet, which do have a noticeable effect on me. So who knows - maybe I need to get a couple more sensors & run some more experiments without grains. Or maybe just forget about it - like I say, even if I'm going a bit low it's within the bounds of "normal". But probably obsessive nerdiness will win out 🙂

 

[KARNAK]

You`ll get there Eddy your too clever by half to let it get the better of you.😎

 

[trophywench]

I think your last sentence says it all - now you've suggested it to yourself and announced something, I've always found it compulsive to actually do it!

I'm fine thanks - just missing for a while cos I was on my hols is all - I don't tend to announce it in the public domain at all (not that I usually did anyway, but …) having answered my husbands phone one day in Portugal only to discover it was the police telling us we'd been burgled!

 

[Eddy Edson]

I think your last sentence says it all - now you've suggested it to yourself and announced something, I've always found it compulsive to actually do it!

I'm fine thanks - just missing for a while cos I was on my hols is all - I don't tend to announce it in the public domain at all (not that I usually did anyway, but …) having answered my husbands phone one day in Portugal only to discover it was the police telling us we'd been burgled!

You're probly right 🙂

Hope you had good hols.

 

[Eddy Edson]

So of course got a couple more Libre sensors. I'm experimenting with going back to my diet from earlier in the year, sans grains. I get results like this:

Still with the BG driving steadily lower until I wake up (very late - working late). I still don't know if that .9 mmol/L thing is real or not. I wake up, eventually remember who I am, where I am, what species I am, my political affiliation etc etc; then do a fingerprick - 4.7, while the Libre is still saying 3.9. But then the Libre starts rising and more or less catches up. So maybe there's just a lag and I really am going low overnight.

I guess the only way I'd really know is if I had somebody I trusted enough and who was willing to fingerprick me while I was asleep. But it doesn't really matter, I suppose. To me the more interesting thing is that steady downward drive, without eg a rise from 3am which I think is what you're "supposed" to see.

My Libre says my 7 day avg, without grains, is 4.9 mmol/L. So maybe my 4.6% / 27 HbA1c back in May actually wasn't an anomaly? Anyway it'll be interesting to see what my next HbA1c says in a few weeks.

 

[everydayupsanddowns]

I’m not getting the image @Eddy Edson, but sounds like you are making progress!

 

[Eddy Edson]

Hmmm .....