No Rest for the Worried
Managing blood sugar during sleep can be a shot in the dark.
Bedtime is often a part of the day that people look forward to. It's a time of day when you can look back on your day and feel good about your accomplishments; a time when you can wind down, relax, and prepare for a recharging night of restful sleep.
Bedtime for me, however, is often a time full of questions, trepidation, and apprehension. Did I eat enough? Did I eat too much? How about my bolus? Was it enough? Was it too much? How about my insulin on board? Where is my blood sugar? How long ago did I eat? The list of questions goes on and on.
When you consider a good night's sleep to be somewhere around 8 hours, that is a very small maintenance window of time yet it makes up one-third of your day. There is usually no eating and no bolusing; no variables to deal with like we have to during our waking hours. So if I can be at target (or near target) for those 8 hours, I've just successfully negotiated 1/3 of my entire 24-hour day. But the target can be a difficult one to successfully hit day in and day out, even for the most diligent of us.
On the one hand, I am concerned about running high for such a long period of our twenty-four hour day. To do so is damaging to the body so it makes a lot of sense to keep your blood sugar as close to target as you can through the night just for that reason. I haven't been through one of those periods for a few months.
On the other hand, I am most plagued by low blood sugar during the night when I am at my most vulnerable – when I'm not awake to notice the normal warning signs that tell me my blood sugar is low. The lows are more frequent because when you run close to target, as I try to do, there is so much less room for error. The range is tighter.
Nighttime is a period of time where it's a real pain in the butt to collect any real useful data. It is hard to wake up and test – even if it is only once or twice through the night. Then there are those, for fear of having lows go undetected at night, who do test every night.
I also have a particularly hard time controlling my urges to over treat the low when I've been woken up in the middle of the night. It's like I can't use the logical part of my brain that tells me to use the 15/15 rule (eat 15 grams of fast-acting carbs, wait 15 minutes, and test again). I just start eating whatever is in front of me and I continue eating until I feel better, which more often than not, leaves me feeling worse and running very high the next morning.
When I was a young boy, I recall it was during the night that I would have seizures, seizures from low blood sugars. Mom and dad would treat me with a glucagon shot and I'd wake up hours later with a terrible headache. I usually would have no recollection of what had happened, just a painful reminder in the form of a headache so bad I had to have total darkness, complete silence, and a cool rag over my eyes.
I'm thankful that it has been many years since I've gone through that. These days if I have a low blood sugar at night I will wake up – covered in sweat and ravenously hungry.
If I can gather my senses, I'll do a test and try my best to treat the reaction rationally. Most times I will head downstairs and hover in the kitchen until I feel better. When I come back upstairs and go to bed, I have to remember to flip my wet pillow before resting my head and drifting back to sleep.
dLife's Daily Living columnists are not all medical experts, but everyday people living with diabetes and sharing their personal experiences. While their method of diabetes management may work for them, everyone is different. Please consult with your diabetes care team to find out what will work best for you.
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