Lows in middle of the night

Had a rough night last night with my CGM waking me up three times. I get up and correct the low. Go back to sleep. Three hours later I am low again. How do you correct a low in the middle of the night so that you don’t drop low again three hours later?

hersheys choc syrup in a bit of milk. seriously. works fast, and lasts a while. don’t expect solid chocolate to help like that.

The basic answer is the same regardless of whether pens/pumps/vials. Too much insulin on board over night. Consider cutting back a couple units to start and see if that does the trick? Obviously run that through your doctor first though

You can certainly add a much higher snack before bed which must have carbs plus fat/protein to lengthen the breakdown of those carbs. Or you could go with straight carbs but that will likely give you cranky readings in the morning likely.

Tweak the insulin and then play with the bedtime snack. Check with your doctor if you’re unclear how much to cut back.

It is extremely unlikely but possible you heavily exercised in the last 24? If extreme is the governing word in that sentence that might, might play a factor perhaps?

Any alteration re your regular dinner? There are a couple ways to achieve repeated lows of which what you ate for dinner might also play a role.

To start cut back our insulin is the typical starting point. Any after 3 days fine tune the change with medical supervision of course

To start - look at the bright side; your CGM woke you so you didn’t have to wake up to a paramedic kneeling on your chest while another pinned your arm down to test your BG… :wink:

On the snack… I always base a snack for a nighttime low on my current BG, how long 'till wake-up, and what my previous day was like. The 15/15 rule alone is NOT applicable here - you want the immediate 15g fast carbs - but add to that more carbs and protein to “cover” you 'till wake-up time. For me… that’s peanut butter and crackers, or a granola bar, or cheese and crackers (after a 6 oz yoo-hoo drink box - 22g carbs, 19 from fructose). The activity level of the previous day will “add” more to my snack - if you’ve depleted your glycogen stores (glycogen is a more complex form of glucose, stored in the liver and long muscles), you’ll need a bit more to replenish them.

If you’re having frequent nighttime lows - the standard recommendation is to reduce insulin, as already noted - but that takes some testing during the nites over a few days, and more detailed tracking of BG levels, to determine that you’re not over-correcting either way. Consider re-calibrating your basal dose - unless it’s evident that your dinnertime bolus is the culprit.


Thanks Wayne, very helpful. This is what I am not doing. I had 15 g of carbs and it would not cover me until wake up time. So one more question–the extra carbs you take in to cover you like peanut butter and crackers–do you bolus for those?

Yes, I’m very grateful I have a CGM. It’s keeping me alive!

And I do not have frequent lows. I think it was a combination of a lot of exercise yesterday and going to bed with a lower BG than usual.

I would also consider a temp basal based on the cgm graph.
We have also found that more than typical exercise during the day carries over into the night.
For us, maybe 85% basal (or 15% reduction - depends on how the pump words that) is often times enough to do the trick.

But sometimes with a low at night, it does seem like 12 carbs is all it will take. But then 1-1/2 ~ 2 hrs later it goes low again. When I see a “second” low in a given night, then I definitely get more aggressive and do the combination carbs and temp basal.

Thanks so much. I did why I didn’t think of reducing my basal, but I didn’t. I will now!

I was having lows very frequently because my glucose was not 100% corrected before bedtime. Often, I would wake up in the early morning severely low. Now what I do is if I plan to go to bed but am not sure if glucose will continue to lower I take enough juice so that I am not below 85-100 and then set my alarm for about 30-45 mins to wake up and check it. Usually this gives me peace of mind because I can either take more juice or feel like things are stabilizing and I don’t end up suffering later. I don’t have a CGM.

Are you taking any short acting insulin at night? Were you sweating profusely when you wake up? I had a few episodes where I woke up with an iv in my arm, and my bed was dripping with sweat. Now, I have a large snack before bed, don’t do any insulin, and keep gatorade g2 by my bedside. When it has happened to me, I usually don’t wake up until my blood sugar is back up to more than 40.

I can really relate to the “severe” nightime LOW’s!! CGM has saved me on several occasions… Going on pump has helped, but even now, I still get that ‘soaked-in-sweat’/where am I??? on occasion. Really hard for me to ‘rebound’ from a SUPER low BG & be ‘productive’ next day… Too many variables in my case to ‘predict’, so as I ‘age’, I’m tending to set the pump to deliver a ‘less than optimal’ delivery rate to help mitigate ‘lows’ at night. Not a ‘perfect’ solution for me, but I “really” hate PM ‘lows’…