Testing overnight

How do those of you without CGMs test overnight?

I have a problem where I set my alarm, but it doesn't really wake me up. Last night I went to bed with high BG and ketones after a site change (I changed at night because the old one was EXTREMELY itchy and irritated). I couldn't tell if the site was bad or not (I often go high after site changes), so did a big correction and was going to test overnight to see if I needed to change. My BG at the time was 16.1 (290) and my ketones were 0.7 mmol/L (normal 0.0-0.5). An hour and a half earlier they had been a BG of 17.3 (311) and ketones of 0.8. (Maybe most people would have changed their site here, but this really happens to me a LOT in the few hours after I change a site. It's like the new site takes a few hours start absorbing insulin properly or something.)

So I had an alarm set for midnight. And I remember the alarm going off and getting out of bed. I remember standing there wondering how to turn it off (this was my iPhone) but don't remember touching my phone to turn it off. I had my glucose and ketone meter right next to my phone so that I'd remember to test, but I didn't even notice them and the thought didn't even cross my mind. I got back into bed with the phone still on (at least the screen was) but don't remember if the alarm was going off, and then I fell back asleep.

I woke up this morning at 4.1 (73) which seems like a massive drop, although clearly my new site has started working properly. I've had the above happen a few times, and of course I could just be half asleep, but I always worry that I'm actually low when that happens. Other times my alarm goes off and I'm wide awake and go and test ... but I never manage to catch any lows that way. I also have mornings where I wake up with my PJs soaked in sweat, which makes me nervous. Again, could just be hot overnight (and my bed does get hot sometimes), but it makes me worry I'm having lows.

My alarm is already across my room so I have to get up to go to it. Any other strategies people can think of?!

That's a good idea, thanks! I do keep low supplies in my bedside table, but having them out where I might notice them could help.

I find if I drink a lot of anything before I go to bed I always have to get up to pee at some point in the night, usually at a couple of points in the night. I have my glucometer, strips, etc on a shelf in the bathroom. I turn on the night light sit down and test. On my bedside table I always have a couple of glucose tabs. But I do understand the semi-conscious response to lows. And I'm not sure if there is an easy fix to that.
Considering the drop from 290 to 73 you more than likely went below 73 and then your liver kicked in to bring you up. But because you had some of the big correction still on board your liver couldn't act appropriately enough.
Since you have seen this happen routinely with site changes, is there any way to pre-bolus for a site change or check with the CDE or endo how to better control it ?

When I told my CDE about it I told her I tend to try and deal with it by doing a 0.5 unit bolus, which she agreed with. It doesn't happen every time, so doing a bigger bolus would make me nervous. My CDE also suggested leaving old sites in for four hours after a site change, which I do if the site isn't super irritated like the one last night was. I'll probably ask my endocrinologist about it at our next appointment, which is in early January.

Too funny because I just wrote a blog post on this topic.

One thing I do is to try and never change out a site before going to bed. I've had sites fail before and it was horrible because I didn't wake up in time. I always try to change my sites so that I have at least three hours before falling asleep to make sure it's working. I prefer to just stay awake if necessary and wait to fall asleep, rather than falling asleep and having to wake up in the middle of the night.

It does sound like you went severely low, but your liver kicked in a bit and brought you back up. My understanding is that lows in your sleep, while scary, are not as dangerous as we sometimes think. In most cases, your liver is going to kick in. From what I've been told by two endos now, dead-in-bed syndrome (what we probably all fear most) is more likely to be the result of some form of autonomic neuropathy, rather than a severe low. I don't know how true this is, but that's what I was told by two different endos now. I guess the verdict is still out.

I like the suggestion of keeping a meter in the bathroom and then drinking some liquids before bed. I also find that if I have to do a correction before going to sleep, eating a small, high-protein, high-fat snack with some carbs helps keep me from dropping too low/fast.

Eric has an alarm clock that is embedded within a camp light. You can set the alarm to turn on just the sound, or to turn on the light dimly, or to turn it on brightly. Or, if you want, it can do two of the three. I don't usually have the light go on because I don't need it, I use a flashlight instead so I won't wake Eric. Maybe what you need is a light that goes on at the same time as your alarm to really wake you up? They say that light is the trigger that gets the brain into "daytime" mode.

I've been waking up drenched in sweat a few times a week. My fasting BS has been relatively high (6-8). Once I'm asleep there's absolutely no chance of me waking up, so I haven't been testing overnight.

I'm only on Metformin, which I take a dose of several hours before bed. Do you guys think I'm going low?

I actually did change my site at 8:00, which was about two hours before I went to bed. The problem is it takes me more time before a site seems to settle in. I usually try not to change sites before bed, but in this case my old site was extremely irritated (actually more irritated than I've ever seen a site!).

My fear of overnight lows isn't so much of dying as the possibility of not waking up in the morning. That happened to me several times growing up and is pretty scary for everyone. I live alone, so there is no one to help if I ever didn't wake up (of course, people at work would notice, but that wouldn't be until I didn't show up for an hour or two).

I've been diagnosed with SVT which is a type of rapid heart rate arrhythmia, and while researching it I stumbled across and article about how dead-in-bed syndrome is caused by low blood sugar triggering an arrhythmia which eventually turns fatal. So this does make me a bit more nervous, knowing that I'm already prone to such things.

I do find that in order for me to wake up from a low I have to be very low (like it's rare I wake up from a low at a blood sugar higher than about 2.5/45). I'm not sure if this is just from having T1 for over 20 years or what. During the day I'm better at sensing lows, although as a kid and teenager I was very hypoglycemic unaware even during the day. Yesterday I did have a low of 1.7/30 without noticing, though, which could have predisposed me to subsequent lows without symptoms.

Times like this I really wish I had a CGM so I could see what is going on!

Interesting, I wonder if you can buy alarm clocks like this. Right now I'm using my iPhone which works quite well because I can set multiple alarms and turn them on or off as necessary, but light might help, too, if indeed the problem is that I'm half asleep.

I don't know as much about Type 2 medications, but my understanding is that metformin alone is very unlikely to cause lows. Someone else probably knows more about this than I do, though.

Metformin is very unlikely to cause low bs unless it is taken in combination with a Sulfonylurea type drug. Metformin works by lowering insulin resistant and controlling how the liver dumps glucose. Sulfonylureas work by increasing insulin production in the pancreas and can cause lows especially when taken with other T2 drugs. I'm not sure that it's even possible for metformin to cause a low when taken alone.

Gary

I don't set my alarm. But I usually have a cup of tea at bedtime, so sometime between midnight and 3 a.m. I'm usually up to use the bathroom. I check my blood sugars, on average, 5 nights a week, and I never set my alarm. It's just become part of my nightly routine now.

I would buy a separate alarm clock (they're pretty cheap) and set it for 5 - 15 minutes AFTER your iPhone. Sounds like you have become habituated to the iPhone alarm. Alternatively, set numerous, sequential alarms on your iPhone. Another thing to try is mental suggestion (seriously!) - look at the clock before you go to sleep and tell yourself what time you want to wake up for a test. FWIW, I routinely wake up around 3AM and test - no alarm clock required.

How about putting a sticky note on your phone that says, "TEST!"

Regarding your site "ramp-up" time: You might want to consider using a pen/shots in addition to your pump during site changes. Bolusing into a site that need to be changed is likely to be ineffective (I know it is for me!).

I wake around 3 AM and test ...not that I like it , it happens ...pee time ...I do have a cup of tea at about 10 pm .and I don't wear a Sensor all the time

I drink plenty of fluids most days unless I'm away from our home. So most nights, I wake up at least once to go to the can and I test right after.

On the occasions that I used to wake up in soaked clothes at night or in the a.m., it was usually because I had had a seizure. Afterwards, my liver would help out to raise my blood glucose up some and that allowed me to wake up easier.

Last night I had basically exactly the same thing happen: BG of 17.2 (310) and ketones of 1.8 about an hour an a half after exercise. I corrected twice over a few hours and went to bed with BG of 11.8 (212) and ketones of 0.9, this time set my iPhone to a higher volume and to allow snooze (so the alarm would go off again until I unlocked my phone). I woke up at 3:00 AM (no problems waking up or remembering to test the first time) and tested at 3.6 (65) and corrected with 16g of glucose tablets, and in the morning was 4.3 (77).

So I think if last time played out the same way, I probably was low in the scenario I posted here. I'm still trying to figure out how not to spike so much (both BG and ketones) after swimming, and might be doing another post about that.

I have read somewhere that if you are high to begin with, then exercise will raise you up even higher, before it eventually brings you down. That seems to be what is happening, but since I don't have a pump I can't really help with any of the tech stuff.

I used this tip last night - had a cup of tea before bed, and it worked like a charm. I got up at 3am and tested at 2.9 so it was a good thing I woke up! I'm going to turn this into a nightly routine. Night-time lows scare me, so I think this will help :)

Wow, so many people use the pee technique to wake themselves!


This whole issue is pretty scary for me, too, as I live alone and get lots of dangerous nighttime lows. I've realized that if I wake up and feel even a moment of confusion, I'd better eat something. Luckily, I always wake up when I'm low (although not as soon as I'd like).

It's tried and true Emily, just a cup of tea, or beverage of your choice before bed.