There was a post the other day on a Facebook group I belong to that’s for type 1 diabetics. Someone had posed the question, “Do you try to get above a certain number before going to sleep to prevent lows in the middle of the night?”
There was a wide range of answers, but based on most of the people’s answers, this fear of blood sugars dropping off during sleep is a common one. A lot of people feel comfortable and safe going to sleep with a blood sugar of 150, or even 200 to avoid the possibility of a dangerous low.
This USED to be the way I felt. I used to have a ritual of eating a “just before bed” snack to get my blood sugar up to about 150 so that it wouldn’t crash during the night. It often still went low anyway. And I would wake up sweaty and confused, and have to find my way to some kind of carbohydrate in the kitchen. And even if I didn’t go low during the night, I was definitely low most mornings when I first woke up. And whether I was hungry or not, I had to eat something fast, as soon as I rolled out of bed. And honestly, for me at least, that is NOT the fun or best way to start a day.
But gradually (very gradually!), since I started using a CGM (continuous glucose monitor) and am aware of my middle-of-the-night blood sugars, I’ve adjusted a couple of things and they’ve made all the difference in the world for keeping a stable blood sugar during the night. Now I’m very comfortable going to sleep with my blood sugar around 80-100mg/dL, because it stays pretty consistent during the 8 hours (give or take) of sleeping. And I’d much rather have 8 hours of my blood sugar around 100, than around 200!
First of all, I realized, I was taking far too much long acting insulin. My blood sugars used to steadily fall throughout the night. If you’re taking the correct amount of long acting insulin, that really should not be the case. A huge benefit to using a CGM (like Dexcom, for example) is being able to look at the trend line during the night. Your Dexcom (or whatever CGM you use) should have a fairly straight, horizontal line during the night, showing a steady blood sugar all night long. None of my endocrinologists ever told me this, but I learned this from reading Dr. Stephen Ponders book Sugar Surfing, which I highly recommend. I gradually cut back on my Tresiba until I started to see a consistent horizontal line during the hours I sleep. If my trend line goes up, I’m not taking enough; if my trend line goes down, I’m taking too much. The slightest adjustment can make a difference… Which is why I did it gradually.
I’ve found that the other big component to steady blood sugars during the night is to make sure I don’t have any short acting insulin on board when I go to bed. Therefore, I eat my meals fairly early (at least 4 hours before bedtime), so that my fast insulin has time to do it’s job, and then clears out of my system. I know for me, my short acting insulin seems to peak at about 1.5-2 hours after injection, and is pretty much done within 3-3.5 hours. This varies, but for me, I’ve tracked it for a long time, and I know how it generally works for me. (Notice, “for me” is in italics. Your body is not my body, and things may be different for you.)
I think these consistent blood sugars during the night is a big reason why my A1C is where I want it to be. There’s very little guess work during those 8 hours since I’m neither eating, taking insulin or working out, which are the 3 things that effect my blood sugars the most. And the less lows I’m having to treat, the less I have that whole “roller coaster” of highs and lows that nobody likes.
As I’ve mentioned a lot on this website, I’m certainly not a doctor or a nurse. I only know what works for MYT1Diabetes. And I’m just sharing that information. Definitely discuss any changes you want to make with your team of health care providers. 🙂