Hypoglycemia, or low blood sugar, occurs when blood glucose drops below a healthy range, typically below 70 milligrams per deciliter (mg/dL). When this happens during sleep, it’s called nocturnal hypoglycemia. More than half of all severe low blood glucose episodes, and nearly half of all such episodes, occur at night.
Recognizing Nocturnal Hypoglycemia
Recognizing nocturnal hypoglycemia is challenging as it occurs during sleep. Signs might indicate an episode occurred during the night or upon waking, including restless sleep, excessive sweating, and nightmares. Upon waking, individuals might experience a headache, unusual fatigue, or confusion. Other physical symptoms include trembling or shaking, changes in breathing patterns, and a racing heartbeat.
Key Prevention Strategies
Implementing consistent dietary practices is a primary approach to preventing nocturnal hypoglycemia. Eating regular meals and avoiding skipped meals helps stabilize blood sugar levels throughout the day and into the night. A bedtime snack, combining complex carbohydrates with protein and some fat, can maintain stable blood glucose overnight, especially if pre-bed levels are lower than desired. Suitable snacks include yogurt with granola, half a sandwich with lean protein, or whole-grain crackers with cheese.
Careful management of diabetes medications is another important aspect of prevention. The timing and dosage of insulin or other glucose-lowering medications significantly influence blood sugar levels. Adjustments to medication regimens should always be made under the guidance of a healthcare professional to ensure safety and effectiveness.
Regular blood glucose monitoring provides valuable information for preventing nighttime lows. Checking blood sugar levels before bed helps assess the risk of nocturnal hypoglycemia. Continuous glucose monitoring (CGM) systems can offer real-time alerts if blood sugar levels drop too low during sleep, providing an opportunity for intervention.
Lifestyle factors also play a role in nighttime blood sugar stability. The timing and intensity of physical activity can impact glucose levels, with intense or late-day exercise potentially leading to lower blood sugar overnight. While exercise is beneficial, it may necessitate adjustments in medication or food intake to prevent nocturnal hypoglycemia. Consuming alcohol, especially without food, can interfere with the liver’s ability to release stored glucose, increasing the risk of low blood sugar for several hours after drinking.
Immediate Response to Hypoglycemia
If hypoglycemia occurs despite preventive measures, a rapid response is important to raise blood sugar quickly. The “rule of 15” is a widely recommended protocol: consume 15 grams of a fast-acting carbohydrate, then wait 15 minutes before rechecking blood sugar. If blood sugar remains below 70 mg/dL, repeat the process until it returns to a safe range.
Examples of fast-acting carbohydrates include glucose tablets, fruit juice, or regular (non-diet) soda. Foods containing fat or protein, such as chocolate or candy bars, are not recommended for immediate treatment as they can slow glucose absorption. Once blood sugar levels normalize, a small snack or meal with carbohydrates and protein can help maintain stability.
For severe cases where an individual is unable to swallow or is unconscious, emergency glucagon should be administered. Glucagon is a hormone that signals the liver to release its stored glucose, rapidly increasing blood sugar. It is available by prescription, and individuals at risk for severe lows, along with their family members or caregivers, should be trained on its proper use.
Seeking Professional Guidance
Managing nocturnal hypoglycemia effectively requires personalized strategies developed with a healthcare provider. Regular consultations with your doctor or diabetes care team are important for adjusting medication, fine-tuning dietary plans, and addressing concerns. They can help identify patterns of low blood sugar and recommend specific interventions tailored to your individual needs. Seek medical attention if you experience frequent episodes of nocturnal hypoglycemia, struggle to manage your blood sugar, or have severe symptoms. This information is for general understanding and should not replace professional medical advice.