Death in Bed

“The most serious complication of hypoglycemia is death.”

This under-stated yet profound truth can be found in the book “Pumping Insulin” by John Walsh and Ruth Roberts, under a section entitled “Avoid Death in Bed”. For me, death in bed was nearly my fate last night and being naturally pessimistic (realistic I’d argue) I can foresee death in bed as being the most likely contender for introducing me to the Grim Reaper. During last night’s hypo, I had just enough consciousness to feel the terror of knowing I was slipping way – fading in and out from a dazed state, knowing I needed help, but being unable to help myself. Alone, frightened, and helpless: that is the death which awaits me.

The circumstances which caused this episode of hypoglycemia are a mystery. Although I began insulin pump therapy last week, the only difference last night, as compared to the previous nine nights, was that I had eaten some popcorn before going to sleep, an act which conventional wisdom would lead one to believe should have resulted in me having elevated concentrations of blood glucose throughout the night, rather than to have experienced a prolonged hypoglycemia.

However, hypoglycemia is something for which I plan. My glucose meter, glucose tablets, and a gigantic bag of Skittles are always by my side while I sleep. Upon being awoken by the first signs of hypoglycemia, in my stupor, I managed to eat a handful of Skittles, before succumbing to unconsciousness. This process was repeated for about six hours throughout the night and early morning, as I would come around long enough to ingest some sugar, but never being able to reach a level of consciousness that provided me with enough awareness to test my blood sugar or take more radical action to help myself.

Therein lies the rub with treating severe episodes of hypoglycemia when one lives alone.

I'm really happy this happened to you; I know it is truly frightening. But death from hypoglycemia is not inevitable. Even for those of us who live alone; there are things we can do to keep us safe. You don't mention if you bolused for that popcorn? If so, that could have been the cause of your hypoglycemia during the night.Did you have any insulin on board?

You say you are very new to the pump. Have you done basal testing? When you are on a pump it's critical to make sure your overnight basal rates aren't too high, causing lows while you sleep. I strongly encourage you to test your basals. Did you suspend or remove your pump when you started experiencing lows. If you are able to eat the Skittles this should also be something you do.

How often do you test? Do you always test before bedtime? Have you considered getting a CGM which would alert you to falling blood sugars during the night? Many people swear by them. Also if you are subject to many unexpected lows a diabetes alert dog is a possibility.

But first I would say: Test more, don't eat right before bed, test your basals ASAP and make sure they aren't too high overnight. I'm glad you got through this crisis, but now's the time to be proactive to make sure it doesn't happen again.

Glad you made it out alive! Death in bed is actually a rare rare occurrence and studies have found that it is not the hypo that caused death. Our bodies do eventually resolve the hypo and the stress and hormone did their job for you by continuing to 'alert' you in your stupor. I am glad you were home because the truth is that "most serious complication of hypoglycemia is” if you were not in bed but driving a car, operating a chain saw, riding your bike in the city, pushing your baby in the stroller, mowing the lawn,- and so on.

Death in bed is sort caused by hypos, or at least it's triggered by them. In certain people a prolonged hypo results in the heart going into an arrhythmia, and it's the arrhythmia (triggered by the hypo) that causes death. I read once that 6% of Type 1s below age 50 (I think) die from "dead in bed" syndrome. So while it's definitely not common, it's not all that rare, either. I don't know if there is any way of determining ahead of time whether any particular individual's heart will go into an arrhythmia from a prolonged hypo.

To the OP - I have had severe lows like what you describe (though not so prolonged) and it's definitely scary! Glad you are okay. Are you testing overnight? When I first went on the pump I had to wake up twice each night to test for the first two weeks. It was annoying, but it's what allowed us to get my basal settings correct. I also agree with Zoe - eating and bolusing before bed is iffy and can cause nasty lows. The only time I eat prior to bed is if I need to boost my blood sugar a bit and eat without a bolus.

I second Zoe's suggestion to test your basal rates. It's a bit of a nuisance but the benefits are tremendous. The biggest one to me is confidently sleeping through the night. I live alone, too, and completely understand "alone, frightened, and helpless."

But this need not be. I'm a big fan of CGMs particularly for their ability to wake me when my BG heads south. While love my pump, if I had to choose between the pump or the CGM, the CGM would win. I also live with a hypoglycemia alert dog. He's saved my bacon more the a few times. I can't remember when I last had a mind-numbing spot-seeing nasty overnight low. I used to have them fairly regularly.

My best and even overnight BGs occur when I don't snack or dose insulin after dinner. It takes a little discipline but you can stack the odds in your favor.

Whatever you do, don't give up. There are plenty of things you can do. Your brain, persistence, and curiosity are your biggest allies. This is a realistic fear. Act on it, don't give in to it!

Yikes, I just realized I said above: "I'm really happy this happened to you!" I'm so sorry, that was a typo - I meant to type "I'm really sorry this happened to you. I wouldn't wish a serious low on anyone! And I repeat...yikes!

Hi: I am so sorry about what happened to you, what a scare! Something that comes to mind immediately is that you are new to insulin pump therapy. When I started on the pump, I had a lot of hypos at the beginning, because I used the same number of units (TDD total daily dose) as I had when on MDI (multiple daily injections). However, my TDD went down about 25% on the pump, and I know many others who have that common experience. So I would suggest doing some careful basal testing and possibly lowering your TDD.

what were your blood sugars? do you wear a CGM? glad you're OK! I too would suggest adjusting your basal. pumping is very different.

Hi policebox, what an awful experience. Both my basal and bolus needs are reduced in the summer and go up in the winter. Maybe, who knows? you reached a point when you need a reduction in basal due to the season.

I just started on a pump ~2weeks ago. One thing my CDE and Doc both emphasized was to set my alarm clock for the middle of the night (middle is relative to when you got to bed)and test my BG manually even though my pump is also a CGM. The reasoning was that going from Lantus to a Humalog for my basal is a night and day change, which can most definitely cause nightly lows if the calculations are off. It sounds like until you can talk to your doc about this episode, I'd recommend the same for you.
I only had one night(the first) of lows, with the minor CGM data generated my doc was able to change my basal and prevent the nightly lows completely.

I don't know that it has to be an either or situation. You had a very scary incident and are understandably shaken, but you absolutely have to figure out a way to test your BG through these incidents.

You said that, at one point, you had the capacity to do a basal adjustment on your pump through one of these incidents. At this point, testing has to be an automatic response to give you the information you need for better control.

Readjust your basal, set an alarm, test. Whether you readjust it up to a setting that gives you unacceptable highs, or a setting that puts you in the sweet spot, the procedure is the same.

Best of luck!

Po-Po,

When you are low, do you ever eat carbs or fiber with your skittles/glucose tabs? That would help with keeping your sugar up rather than it going back down once the fast acting sugar is gone. I agree with FHS, that you should try setting an alarm when you're low to test again in 15 minutes. Sometimes, when I wake up with a scary low where my mind is foggy and I can barely walk, I'll cram something in my mouth before I test because I'm too anxious/nervous to not eat ASAP. I also try to make myself sit up until I feel like I can think clearly. And then once I'm thinking clearly..I'll retest just to make sure I'm going up/staying up. I used to get night lows, all the time. I have learned that I can't bolus right before I go to bed unless I eat A LOT. In that case, I cut my bolus in half.

Just a couple months ago I had to cut my nighttime basal down 1.5 units, and it has worked wonders. I haven't woken up with a low since.

I think it's worth playing around with. Good luck and if you need any tips or have any questions, holla atcha girrrrrl. :)

Hope this was helpful!