I need advice on an issue I am having with waking up every night from low symptoms. Around 4 or 5 hours after I fall asleep I wake up feeling restless, warm and heart pounding. It’s definitely blood sugar below 70 because I’ve tested and used a CGM which showed it. I’m not rising much higher than 140-150 after dinner, so the only thing I can think of is the Victoza I take since I’m not on insulin. Any suggestion on whether I should try a snack and what type?
I don’t recommend a snack before bed. If this were me (and it was for some time with the only difference being insulin instead of Victoza), I would add a bit of protein or a bit more if you already include it in the dinner. What do you do when the night bg is below 70, and what is your bg in the morning?
I get up and drink some water then go back to bed. My body is already in the process of releasing hormones to bring the blood sugar level up. I usually fall back to sleep but have trouble waking up and feel very tired in the morning. My fasting is usually in the upper 90’s - but below 100. If I have any alcohol at all (even 1 glass of wine) before bed it happens multiple times.
Have you considered using a bolus insulin to cover your meals? Also, what’s the composition of your meals? Alcohol can prevent gluconeogenesis.
Alcohol quite reliably brings my BS down several hours after drinking it.
Are you taking any of the sulfonylurea class of drugs (like Glyburide)? These can cause hypoglycemia just like insulin and Victoza can exasperate that. Also, if you are taking the Victoza before dinner you might find that taking it first thing in the morning reduces it’s effect overnight. And you do need to remember that Victoza may make you more vulnerable to reactive hypoglycemia so that after a meal with carbs you may find 1-3 hours after the meal that you experience lows.
But I also have to tell you that it may just be that having LADA and experience variability in your insulin production you may have these problems and something like Victoza may (but not necessarily) make it worse.
The only thing I take is Victoza and I take it in the morning around 6:00 am. Last night I tried an Activia light yogurt with 10 g carbs and 2g fiber before bed. The symptoms were a little better, but I still went below 70, with disruptive sleep. I’m thinking that the Victoza is making it worse, but I’m not sure that insulin would be any better.
If you’re T1, insulin WILL make it better!
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If you’re now confirmed type 1 you should start insulin. There’s more evidence now that early insulin therapy can help slow down or even stop the autoimmune attack. I think Victoza has a lot of bad side effects?
I don’t know if this will help the lows etc. but you will be on insulin anyway at some point and it could help avoid getting into much worse shape Bg wise. This is going to make your life a lot more liveable in the long run.
I think you said you have hypo-hypothyroidism also? That could also cause the lows.
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Hi Meee! I’ve been on meds since I was tested antibody positive about 3 years ago (was diagnosed pre-diabetic 3 months earlier) so not sure about confirming Type 1. My endo refers to me as early stage LADA and focuses on delaying onset, probably why I think he prescribed the Victoza as off-label use. My A1C is slowly creeping up 5.2, 5.4 and last visit 5.8 despite eating moderate carb (100-130 daily) and on highest dose of the med now. He mentioned either adding another drug if it continues or referring me to a Rheumotoligist who would prescribe an RA drug that has been successful in delaying onset as well. As I’ve posted his articles before he has strong views about using insulin too early.
http://www.schwartzdiabetesdoc.com/newsletters-2016/2016-Argument_for_Minimizing_insulin.doc
http://www.schwartzdiabetesdoc.com/newsletters-2017/2017_liraglutide_use_in_prediabetes.doc
http://www.schwartzdiabetesdoc.com/newsletters-2016/2016-Some_Rheumatoid_drugs_beneficial_in_DM.doc
Hi 
I think your doctor is wrong. I’d find another doctor. A lot of the rheumatology drugs are very dangerous especially the monoclonal antibody drugs. They aren’t going to stop type 1 and they can cause severe problems. If you had antibodies and your a1c is creeping up I think it’s time to try insulin.
Those articles all seem to refer to mostly type2 who are also obese. Not your case. I’m curious to know if he has had any success in the long term in preventing onset of type1 or if he is just testing his theory.
As Flem said below you have antibodies, you’re type 1 and very lucky to have caught it so early. Remember what happened to me- DKA and serious complications etc. damage to my vision and so on. I wish I’d had the chance to preserve some beta cell function with early treatment of low dose insulin. I’ve read several stories here of type 1 whose doctors either misdiagnosed and or didn’t put them on insulin who had bad complications. I don’t want that to happen to you. Clearly the victoza is not working to control your Bg or preventing anything. I agree with a 12g snack overnight to help the lows. I don’t drink alcohol anymore due to the lows and other effects. I had lows long before high Bg so that’s another symptom assuming the victoza isn’t the cause.
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I was diagnosed LADA due to antibody tests four years ago. Like you I was put on Victoza which has been shown to help in early onset T1 according to my doctor. He said the same as yours–to delay the onset. The side effects for me were horrible. i quit and went on insulin.
As far as adding other drugs, I don’t think insulin speeds up full-blown T1. In other words, I don’t think it kills the cells in your pancreas that still make insulin any faster. I would ask your doctor why he is so reluctant to put you on insulin. You would start with a very low dose since you already make some insulin.
LADA is T1–just late onset. You will need insulin eventually. I started only needing long-acting (basal insulin) for a year before adding meal time insulin. If you have the antibodies you are T1, you are lucky it was caught early.
If you are dropping below 70 you need some fast acting carbs to bring it up. Not a lot --just 10-12 grams. You would feel better if you had them. It also sounds like you need to eat more at night, especially to counter the carbs in the alcohol–more protein and fat as was said earlier.
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I’m going to beat the insulin drum too. If you truly are T1/LADA, you’re going to need it eventually anyway. It allows more precise control than anything else, and I mean anything else—Victoza, Byetta, etc., included . . . so why wait and suffer for an indeterminate length of time when the most powerful weapon in the arsenal is sitting there unused?
Caveat: in early stage LADA, variability and unpredictability are often the norm no matter what treatment is employed. But I still stand by my previous comment.
I’d have issues with a doctor that is playing around with drugs that are not proven to do what he is trying to accomplish. You are not his personal guinea pig. You need a different doctor and I also am going to say INSULIN.
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I have been type 1 for 56 years. If you test before going to bed, and your blood sugar is 140-150, and you are using a fast acting insulin, I would take or have a before night time snack. I have done this for 56 years. Your blood sugar could drop lower, and you may not wake up. I always erred on the side of I would rather be safe
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