Sleep issues?

Does anyone get woken up in the middle of the night? Either by your body thinking your low, or your pump alarming?

The other night, I went to bed at 9pm, but I woke up at 11pm, midnight, 1am, and I finally got out of bed at 2am. This seems to happen about once a week or so. Before it was happening almost everyday, my Endo lowered my overnight basal and it seemed to help. However, now when it happens, I’m not always low. I’ve never slept very well, and maybe that is just compounding on top of the diabetes…

Thank you folks for any insight you can provide!

In the past month I have really decided to get back on track after the loss of a good friend to T1 at the age of 28. I have been running at an A1c of 10.5 for a few years now so have had little experience with hypos. Now that I’m “buckling” down I am consistantly getting woken up out of my sleep to stumble to the kitchen frantically trying to get a boost.

It has been dropping to 35-45 at least 4 nights a week. I have tried lowering my basal, switching my ratio, increasing my carbs, sweets before bed. Everything. But I’m am still dropping in my sleep. On the nights that I don’t experience lows I have still waking up with hypo feelings.

Last night I was so fed up with this. I woke up at 1:00 am with a reading of 41. Out of frustration I completely over corrected. Today I was completely bed ridden. I did not go to work I did not even get out of bed. Side note: I NEVER miss work. But I could not gather the energy to even call my boss to inform him of the situation.

I feel so discouraged. I’ve made a dedicated decision to get things “under control” and it has been nothing but negative. Idk what to do anymore :frowning: I feel completely helpless, hopeless, and defeated.

hey! are you having a bedtime snack? that might help. What are you running at before bed? lastly, keep a juice beside your bed so you do not walk into your kitchen and over eat. Sorry about the hypo hangover. they really suck. :frowning:

@Gj562, that sounds horrible! When I was daignosed my A1C was 11.7 or something around that, I spent 3 days in the hospital (2 of which were in the ICU). I don’t usually have readings down in the 30s or 40s, but my average is around 90 or so, and I swing anywhere from 65 to 180. My last A1C was 5.2, the Doc said it was too low.

@cunninghamnicole, I usually have a small meal (between 10 and 40g of carbs) about an hour before I go to bed. I try to keep my daily carb intake below 200g, 150 if possible. Before the work week, I make meals around 30g each, and take an apple or some sort of fruit to have with the meal. Meal prepping has really helped me, but you never know what will come up throughout the day that will throw your numbers off…

@marshallmac, when you drop low your body releases “fight or flight” hormones (adrenalin mostly) and it is designed to wake you up so you don’t die of a low overnight. your body has a lot of refelexes like that, for example, if you fall asleep and cut off the circulation in your arm, you wake up as well.

@Gj562, and all, dropping low is one or all of the following - too much basal, too much bolus, too much exercise. A meal shot or mealtime pump bolus can hang out for 4-6 hours, dropping blood sugar the whole time. basal insulin (in shot form) churns away for hours, sometimes greater than 24 hours, exercise can affect blood sugar for 8 hours after you stop.

tricks: eat an earlier dinner or one that is not mixed (fats + carbs) so you won’t be correcting for a high right before going to bed. when I am eating late I try to shoot for no carbs. basal insulin in shot form may not absorb just like they say, switching to 2 basal shots or swinging the shot around to the early morning if you find consistent lows. if you have not eaten dinner, and have no bolus insulin in 4 hours, and your blood sugar is dropping THEN -> your basal is too high.

if messing with dinner exercise and basal insulin does not help, then try to add one of those mixed carb snacks… really anything will do but peanut butter is a fav because it is high fat and with a few crackers, the carbs will take 6 hours to absorb. not so fun if you are trying to lose weight…but…could help stabilize overnight sugars.

also @Gj562, I get it. I have been in and out of depression due to diabetes for decades. you try to get your a1c down and you are faced with feeling even worse. my opinion here is “too much too fast” you can’t fix it all tomorrow. took me a year to slowly bring down a high a1c after years of neglect. you need time to adjust, small changes. patience, and please reach out if you are having trouble with the never-ending BS with t1d.

ps I could never get a single shot of basal insulin to work - that’s the main reason I went to a pump. not for everybody granted but, it is programmed to give me the basal i need at the time I need it and not the “shotgun” approach that a shot uses. just saying.

I feel so discouraged. I’ve made a dedicated decision to get things “under control” and it has been nothing but negative. Idk what to do anymore :( I feel completely helpless, hopeless, and defeated.

So, pretty much your “average” T1 then, eh, @Gj562? :wink:

I realize that a CGM (Continuous Glucose Monitor) is in many (most?) cases still not an accessible option for most people, so I’m not going to blithely suggest you can start using one (unless of course you can). But one of the things which became clearer to me when I started using one is that there actually are what I tend to refer to as “WTF? BGs”.

We are encouraged to develop a causal map in our minds. “If I do A, then my BG (Blood Glucose) will do B”. Well, yes, but also no. Sometimes your BG simply does not do what any rational expectation would lead you to expect it would do. I personally believe this is most likely to happen if/when you change quickly from one pattern of behavior, perhaps such as your “A1c of 10.5 for a few years now”, to another pattern.

I realize the above may sound like a bunch a mystical spiritualistic BS, and perhaps it is. My personal perspective is that if one could dig deep enough there would be some rational chain of events to explain what is happening. But in these cases we simply don’t have the ability to know ourselves and our bodies that well. So we just have to cope as best we can with whatever part of the elephant we are able to grab ahold of.

Can you try to approach what is happening one step at a time? The night time lows are probably your first concern. Can you isolate whether they are most likely do to your basal insulin or perhaps from stacking bolus insulin?

Do you track your Insulin On Board? Do you know (have you verified by testing) what your Duration of Insulin Activity is?

In the time back before BG meters even existed I would get lows which seemed completely wrong to me. In hindsight, I wonder if I was stacking my insulin without realizing. At the time I would guess that few, if any, people were even aware of the concept. Certainly none of my MDs ever suggested anything about it.

Does anyone get woken up in the middle of the night? Either by your body thinking your low, or your pump alarming?

It is not really clear to me what you are asking about, @marshallmac. Some folks, especially when they first start on insulin, are sensitive enough to hypos that they will wake up if they go low while sleeping. But as times passes, this can happen less & less. People can develop some degree of “hypoglycemia unawareness” and sleep through their lows without waking up. This, uh, sucks. :frowning:

Do you test your BG when you wake in the night? If so, have the BGs been low?

I’m also not quite sure what you were thinking of when you mentioned a pump alarm. Are you asking about people who use a CGM (Continuous Glucose Monitor)? I can’t think of any reason related to BG other than CGM which would cause a pump to alarm.

@Joe, I remember my diabetic educator mentioning the fight or flight reaction. I realize why it is happening, it is just annoying…

@zjohnnyr, I should have explained the situation more. I use the Medtronic 530g with Enlite CGM. Occasionally, the pump alarms thinking I’m going low, but it turns out that maybe some pressure was being placed on the sensor which can prevent blood from getting to it and then leads to a low alarm. When I do test in the middle of the night, the numbers aren’t usually too low. But then I’m out of bed and my wife is awake.

Last night I slept great! That is until the neighborhood dogs started barking at nothing at 2am! Such is life…

Occasionally, the pump alarms thinking I’m going low, but it turns out that maybe some pressure was being placed on the sensor which can prevent blood from getting to it and then leads to a low alarm.

Not blood, interstitial fluid. But, yes, I’ve heard the theory suggested before. I’m just not sure if I’ve experienced it first hand.

I tend to sleep on my back so there is usually not extra pressure on my Enlites … unless one of my cats decides to sleep on top of that part of me.

My preferred insertion site at the moment is the side/back of my upper arms. Initially I assumed that would be a terrible site as I expected to hit muscle. But that didn’t happen. Instead I get some of the best Calibration Factors & ISIGs I’ve seen with an Enlite. I’m also even less likely to put significant pressure on a sensor inserted there while I sleep. (Maybe that’s just me?)

Of course, the upper arm is not an insertion spot which Medtronic has blessed. Their support line won’t replace a bad sensor if they learn that’s where it was inserted. I’ve heard some folks will actually lie about where the sensor was inserted, but, of course, I would never do that. Because it would be wrong. Terribly wrong!

Besides, so far I haven’t had one on the upper arm go bad on me. (Knock on wood! :slight_smile: ) The last bad sensor I called in actually was inserted on my abdomen. Apparently it was intermittently pistoning. Not a fan of abdomen insertion sites. :frowning:

Johnny, Do you insert the enlite in the back of your arm by yourself? I couldn’t figure out how to make the over tape work for that area. This morning, I moved my sensor to the outside of my right thigh. I’m almost positive it went straight into the muscle, but 12-hrs later it doesn’t seem to be having any issues or bruising. My wife helped me insert it in my back once, but she isn’t always available when I need to change it (like this morning at 4am).

Thanks for the help.

@zjohnnyr,

I successfully inserted my CGM in my upper arm last night. My wife was there to help if I needed it, but I was able to figure it out on my own. So far, so good…

Do you insert the enlite in the back of your arm by yourself? I couldn’t figure out how to make the over tape work for that area.

Yes, I live alone so I have to do the insertion by myself. The overtape is tricky when using only one hand but, as you seem to have figured out, it is sorta, kinda possible. You just have to move slowly and carefully to avoid having the tape stick to itself.

The “trick” I use when inserting on the side/back of an upper arm is to use the back of a chair to roll the back of that arm towards me so I can work with that area more easily. You have to be careful to not “bunch up” the skin. You want the tape to lie flat against your skin after you have taped things down and the site has rolled back to the natural position.