What would it be like to sleep through an entire night without needing to wake up even once? I can only imagine how good that sleep must be. When living with diabetes, not only do we often need to relieve our bladders multiple times in the middle of the night (either because we are drinking more water throughout the day, or more juice, or because our kidneys aren’t at 100%…), but we also have to worry about being woken up in a cold sweat wondering where we are and why we are soaking wet.
That feeling is like no other. Waking up out of a dead sleep, only to have soaked through your pajama shirt, with your hair sticking to the side of your temple and an unquenchable thirst that comes over you. All you want is something cold, to drink, or to put on your forehead. You also have to pee, but you can’t decide which you should do first; treat the low, or pee. Your body goes on auto-pilot: Juice, food, must-get-to-refrigerator. You start wondering, ‘How low am I? Geez, I would bet I’m at least 30 or lower.’ But as much as you would like to check your blood sugar, wash your face and change your shirt, you can’t do any of that until you get some sugar in your system.
The kitchen is quiet; all you can hear is the wind outside and the heat coming through the vents. You open the fridge, and make a quick decision; juice, or if there is none, then you go for the milk (not fast acting, but will do the trick in the next 10-15 minutes). The next decision is the best part of being awake at some god awful hour: what dessert do I have lingering in the cabinets that I’ve been dying to get my hands on…. Oh, yum, the Pepperidge farm cookies that my husband hid from me… ooh, I’ll take a few of those. If there isn’t anything ‘fun’ to eat, then you settle in for the good old peanut butter crackers and take a trip down memory lane to the lows that you would share with friends at camp on hot summer nights when all they gave you were dry glucose tabs and nabs (peanut butter crackers).
You settle in your seat at the kitchen counter and go to town on your treatment of choice. You can’t get enough juice or milk to quench your thirst. You try to ration the liquid to make sure you have enough for each bite of cookie or cracker. You know you need to stop, stop at some point, or else you WILL over-treat. Some nights your brain is able to tell your hand to stop feeding your mouth, other nights it fails, and your slumber will be interrupted again an hour or two later with a blood sugar of 250 and a different unquenchable thirst… for water.
It doesn’t matter how many juice boxes my husband puts on my nightstand. It wouldn’t even matter if I had a mini-fridge within arms reach of my bed. This is just the journey I take during my 3am adventures. I have tried, through trial and error, to avoid these severe lows. It has been extremely difficult during pregnancy due to my constantly changing insulin needs. A few weeks ago I was having a period of extreme highs in the middle of the night, so I increased my basal rates to take care of that. For whatever reason, my insulin needs have changed again, and now I am experiencing lows in the middle of the night. There is such a delicate balance sometimes, and we just need to communicate with our doctors and adjust the proper pump or insulin settings, a little bit at a time. I have learned increasing or decreasing my basals too drastically usually doesn’t work.
Here are some things to consider when managing early morning lows:
- Review your blood sugars with your Endo or CDE, where a sensor if you can. Note that basal rates usually need to be adjusted at least an hour before you see the pattern of lows.
- Depending on the time of lows, i.e. 11pm, midnight, 2am…. Etc., they may be correlated with what you ate or didn’t eat for dinner. If you eat a very low carb meal one night, and had a low in the middle of the night, and then the next night you ate a very high carb/fat meal, and had a high in the middle of the night, then you can bet you need to adjust your insulin to carb ratio or account for those extra high or low carb meals before you fall asleep with a correction dose or a snack.
- If you take injections, especially if you are on an old school regimen of NPH and fast acting insulin; it is always a good idea to eat a high protein snack before bed. The protein and fat in something like cheese or peanut butter will linger around in your blood stream and help to decrease severe nighttime lows. If you are on a regimen like this, I beg you to challenge your physician on changing you to newer long acting insulin or to consider a pump (if it is appropriate for your type of diabetes).
- Do your very best NOT to over-treat your mid-night lows. As difficult as it is, you will pay a price. Try your darndest to stick to the rule of 15: Treat with 15 grams of fast acting carbs, and wait 15 minutes and then check your blood sugar again to see if it has come up. If not, treat with another 15. This is SO much easier said than done, trust me, I get it. If you are REALLY low, it’s okay to stray a bit from this rule, but it might even be smart to wake up your spouse or someone else in the house to help you. I don’t always do this, but my husband usually rolls over in bed and mumbles every 5 minutes ‘you okay? just to make sure I’m responding.
Also, if you’re like me, and you use these dead of night lows as an excuse to chow on the dessert downstairs, at least sip some juice next to your bedside before you make the sweaty trek into the unknown of the dark kitchen….and make sure you shut the refrigerator door tightly before going back to bed; I didn’t one night and woke up the next morning to a fridge full of warm food that had to be thrown out! So now I get back into bed and my husband mumbles ‘You okay? Did you shut the fridge?’
Be safe, Be smart, and pay attention to patterns with your blood sugars!