I hear and read a lot about overnight lows, and the endo quizzed my son about whether he wakes up for overnight lows and what symptoms he experiences. To our knowledge, he’s never had an overnight low. Periodically, we test his through the night - sick days, changes in routine days, days with lows, days with highs, etc. - but we don’t do a 2-3 am check daily. On a routine basis, he tests himself at bedtime and never goes to bed below 100, then whichever parent is up latest checks before they go to bed (anywhere between 11:00 - 1:00), then he tests when he first wakes up (5:30 on school days). He has never been low when tested, and there hasn’t ever been evidence of a rebound high or some of the other signs I’ve read about - sweating, sheets twisted, etc.
The endo almost acted as though she didn’t believe us. So, are overnight lows an inevitable part of type 1?
Since your son is on shots it’s not possible to maintain a perfectly stable basal rate like it is on a pump. But that doesn’t mean that lows are inevitable. If you have tested periodically and see no signs of lows as you describe, then I wouldn’t really worry about it as long as he is 100 when he goes to bed. Doesn’t mean he won’t go low, but if he does he’ll come back up or wake up from the discomfort. If he does start having regular lows (I know things change even more rapidly with kids) then you might want to look at lowering his basal shot by a unit or two or splitting the dose if you don’t already. Ditto if he starts being high in the am or between meals.
I think overnight lows are a common part of type 1, but not inevitable. The only inevitability about type 1 diabetes is that we pretty much all have different experiences. If his basal rates/dose are working, he shouldn’t have overnight lows. I tend to be a bit more prone to overnight lows, especially on days when I’ve done a lot of hard exercise, but I’ve heard from people who rarely have them. I think it just varies from person to person.
Thanks. My son is not on shots - he’s been on the pump for about 4 months, and we feel like his overnight basal is about as close as we can get given the increments we can use to adjust. He always goes to bed at 100 or has a small snack to get there if he’s under due to activity or miscalculation at dinner, and he consistently wakes up around 100-115 or so. On shots, he was closer to the low 90s when waking, but turning his basal up by the smallest possible increment lowered him by too much for his and my comfort, so, for now, we’ve settled where we were.
I just thought the endo’s reaction was funny when she asked about overnight lows and he said he hadn’t had any, so he didn’t know what his symptoms would be or whether he would wake up. She turned and looked at me with raised eyebrows as though he’d just told her he could fly or something!
Is it typical to wake up when going low overnight? Given where his basal is set and that I can’t sleep until I know his bolus insulin has finished acting, I would think if he experienced an overnight low, it would be a mild one. At least that’s what I tell myself so I can sleep at night.
in my opinion, the reason high and low blood sugar is common is because the “normal range” of blood sugar amounts to the equivalent sugar of 4 “skittles”. Mix in little schedule irregularities, account for a touch of bs meter inaccuracy, and allow for the inaccuracies in the reported “carb content” on food packaging, adjust for daily changes in stress levels, how well a particular infusion site is absorbing, and for slight differences in exercise, and as time passes you will find that blood sugar control is an art, an art with bruises and blemishes and a few whoops moments. no worries, highs and lows happen, they’ve happened to me many tines in the last 30+ years with it.
most people have an adrenalin reaction with low blood sugar, if you don’t take insulin these lows feel like panic attacks. They’re designed to wake you up. I always wake up with overnight lows, and I think a lot of people do but I understant your anxiety, the worst is when you wake up really low and with confusion - which can happen. Within the last year I can recall one instance of finding myself standing up at 3AM, and wondering why I was not sleeping, before realizing I was low. keep doing the things you are doing, if your endo is hard to talk to ask for a CDE, and keep up the conversation ton TuD, there are a lot of us here =)
Ah, sorry, your profile said “shots” - must need updating!
I’ve woken up during the night, felt off, tested and was low. I’ve also woken up in the morning and tested and was 60 or lower, but don’t know how long I was low. Accurate basal rates help, but things change and unfortunately there are no guarantees. I think you are doing all the right things. It does seem like some people are more prone to serious lows overnight than others. I’ve only had one bad low and that was when I first started on insulin and was on too high a dose (misdiagnosed as type 2). Even then I was able to treat it myself. Since then everything has been treatable. I don’t know how old your son is, but he sounds like he is old enough to start to recognize his own personal symptoms of lows. If you are really concerned getting a cgm which will alarm you is an option, but for me, since I haven’t suffered severe lows, I’d much rather sleep! Eating and bolusing in time to have the bolus action completed before bed is also a good safety measure.
Thanks, Zoe. Yes, my profile did need updating. I had totally forgotten what my profile said - I set it up when I first got on tudiabetes and never changed it.
My son is 13, and he does recognize and handle his lows. Since he hasn’t had one at night (that we know of), I don’t know whether he’d wake up. I’m sure it will happen one of these days, then we’ll know.
I do like him to eat and have his bolus complete before bed, but that’s not always possible with his schedule. If he has active bolus, though, his dad or I always test him before we go to bed and after his bolus is finished (or at the tail end, depending on the time).
My son does not want to wear a CGM, and, since he isn’t having a problem, I’m not going to make him. It would be a good option if it becomes an issue. He’d agree with you - he’d much rather sleep.
So, from the responses I’ve received, I’m going to have faith that he’ll wake up of there’s a problem and not worry about our doctor being skeptical. It seems as though my son is not her typical patient. He is compliant, does what he needs to do to take care of himself and understands that, ulitmately, he has to live with the consequences of the decisions he makes regarding taking care of his diabetes, including following certain parameters before going to bed.
Thanks for chiming in. I’m feeling more confident that he’ll wake up if he goes low, and that it’s quite possible that overnight lows don’t necessarily have to come along with this disease.
I disagree with your statement that it is not possible to maintain a perfectly stable basal rate on shots Zoe. I use Levemir and it is very flat for me. I do basal testing to know that it is set correctly. I know other people that have the same experience with Levemir. Unfortunately a lot of people using MDI are not taught the things that they get taught once they go on a pump. I think if more people on MDI were taught that stuff, they could make it work better.
Thanks, Joe. I’m feeling more confident that if my son were having overnight lows, we’d know about it.
Yes, we are learning that bg management is an art! Fortunately, my son is fairly mature (and has matured a lot since being diagnosed), and really understands the importance of taking good care of himself.
I think our endo is probably a decent doctor, but her interpersonal skills could use some work. She is a research physician, and I think she’s very knowledgeable, but I don’t think she’s used to patients who do a lot of their own homework and ask questions about what she says. Fortunately, our CDE is fabulous, and we have the option to see a PA for every other visit, and she’s great, too.
It is rare that I have a low at night and when I do, there is normally an explanation for it - I overshot a correction before going to bed. Usually the nights are my most stable time and that has been verified when I was using a Dexcom.
No, I rarely have overnight lows…I can count them on one hand…I think its probably a common side effect but it all depends on your son chemistry also. I have morning highs no matter what I do before bed, its my hormones apparently…It sounds like you understand your sons body and doctors sometimes question because they have never read that and so it couldnt be…
Since you had a previous post about whether your son is still in his honeymoon period, I wonder if these two posts are related. We also have discussions on this board about whether some of us are more “brittle” than others.
I just know in my world of Type 1, I can’t imagine a world without at least some overnight lows. For me it would be an utter fantasy world. Perfect basals, no overeating, no intense exercising, and no hormones could certainly minimize them. But to have none at all is just not something I can imagine.
We usually discuss the lack of insulin production as the hallmark of Type 1. But what is also there is the lack or diminishment of the counter-regulatory hormones. I don’t know enough about true honeymoon periods to know whether the person also continues to have an appropriate glucagon response to low BG’s.
I am a believer that your son will wake up to lows. That he has never had an overnight low is not the Type 1 diabetes I know. But relish every moment of it.
When I was diagnosed, my doctor scared me witless about overnight lows. I set the alarm for weeks to test in the middle of the night. He also insisted I raise bedtime BG to prevent lows & eat before bed. Nonsense! Doctors could be held liable for the potentially disastrous effects of overnight lows, so they tend to go overboard.
I don’t think overnight lows are inevitable & congrats on your son having the correct basal rate.
I don’t think “inevitable” is the right word. In truth, kids are more prone to overnight lows because of their highly variable activity levels. Their bodies just are not as stable as the adult body. And when they spend a day running around it will have a major impact on their insulin needs for the next day or so. Some kids also get hypos after exercise and these hypos can appear at night.
Are hypos inevitable? No.
Are the likely to affect your son? Probably at some point he will deal with at least some.
ps. Part of your endos concern was that you may have seemed to dismiss the idea of a nighttime low. Your son may not wake with lows and your only clue may be all the sheets all thrown off the bed in a mess in the morning.
I agree with Joe. Add in extras like an aggressive dawn phenomena and a long period of time (20+ years) and I think night time hypos are worth some concern. There are two helping factors that save most diabetics: you either wake up or your liver dumps glycogen. Since your son is more recently diagnosed I would bet he would wake up with any night time hypo. I would highly recomend (if you dont already) that you have hypo treatment at his bedside for a just in case because as others have mentioned, a night time hypo can be confusing and difficult. Night time hypos are also a very real possibility when you add in a few alcoholic drinks.
