Nighttime Hypoglycemia - Causes, Symptoms, and Prevention

Introduction

Nighttime hypoglycemia is also called nocturnal hypoglycemia. It is when blood glucose levels fall below the normal range while sleeping at night. This condition is common among type 2 diabetic patients and could be dangerous. Research shows that more than half of the diabetic population globally experiences symptoms of nocturnal hypoglycemia (blood glucose levels fall at night).

What Is Nocturnal Hypoglycemia?

Diabetic patients often experience fluctuations in their blood glucose levels at different times of the day. Nocturnal hypoglycemia or nighttime hypoglycemia is when the blood glucose levels fall below 70 milligrams per deciliter while sleeping. The symptoms are usually experienced when the individual is awake the next morning. Nighttime hypoglycemia is a common type of hypoglycemia in diabetic individuals using insulin. This is very dangerous and seems worrisome for many individuals because the symptoms occur at night while asleep and may often go undetected, leading to unconsciousness or even death. But there are ways it can be managed and prevented.

Is Nocturnal Hypoglycemia Dangerous?

Symptoms of nocturnal hypoglycemia may be ignored or unnoticed as the individual may not regularly check glucose levels in the body. During the nighttime, the symptoms may go unnoticed, and the patient may fall unconscious while asleep. At such times, the person sleeping next to them may not realize the condition as it may be mistaken for sleep. However, the person may be deprived of oxygen, which may eventually lead to death without any noticeable symptoms. This may be very dangerous, leading to the individual's death.

What Are the Signs and Symptoms of Hypoglycemia?

Blood carries glucose to different parts of the body's cells for energy. Hypoglycemia is when these blood-glucose levels fall below 70 milligrams per deciliter. This phenomenon mostly occurs at nighttime in diabetic patients. However, non-diabetic patients may also experience symptoms of hypoglycemia. The following are symptoms of hypoglycemia in mild to moderate cases:

• Irritability and nervousness.

• Concentration difficulties.

• Weakness and fatigue.

• Headaches and frequent migraines.

• Blurry vision.

• Sleepy and drowsy.

• Tiredness and fatigue.

• Confused and disoriented.

• Shaky or jittery.

• Paleness.

• Sweaty and cold, clammy hands.

• Lightheadedness.

• Fluctuations in personality and behavior.

Listed below are the symptoms of hypoglycemia in severe conditions:

• Reduced appetite and inability to drink and eat.

• Seizures and convulsions.

• Unconsciousness.

What Are the Symptoms of Nocturnal Hypoglycemia?

At times, the person suffering from nocturnal hypoglycemia may not experience the symptoms since they are asleep. However, the person sleeping next to them may notice these symptoms. Symptoms of Nocturnal hypoglycemia are slightly different from the symptoms of hypoglycemia.

• Nightmares and sleeptalking.

• Crying and shouting.

• Sweating enough to damn the bedsheets and clothes.

• Feeling tired and confused on waking up.

• Trembling or shaking on waking up from bed.

• Fluctuations in breathing patterns.

• Racing heartbeats (increased pulse rate).

What Are the Causes of Nighttime Hypoglycemia?

The causes of nighttime hypoglycemia are listed below:

• Skipping meals, especially dinner, could be a potential cause for fluctuations in blood glucose levels.

• Drinking alcohol before bedtime may cause blood glucose levels to drop while asleep.

• Exercising before bedtime can make the body deprived of glucose and energy. This drop can cause hypoglycemia at night.

• Having underlying medical conditions like obesity and other disorders could cause hypoglycemia at night.

• Hot and humid weather.

• Feeling sick or extremely ill.

• Too much insulin in the body.

• Too low carbohydrate diet.

• Menstruation.

• Puberty in children with type 1 diabetes.

• Low hemoglobin HbA1c test levels (test for sugar levels in the body).

• Daytime hypoglycemia.

What Are the Risk Factors Associated With Nighttime Hypoglycemia?

The risk factors of nighttime hypoglycemia are listed below:

• Skipping Meals - Skipping meals is one of the significant risk factors for hypoglycemia. The body meets the energy requirements from the food consumed, and skipping meals lowers blood glucose levels leading to hypoglycemia.

• Delaying Meals - The body needs energy on a timely basis. Delaying meals and not having food on time can eventually cause hypoglycemic conditions in the body.

• Over-Exercising - Increased physical activities beyond the regular routine can drain down energy levels in the body. This causes the body to utilize all the glucose available, eventually leading to hypoglycemia.

• Low Carbohydrate Diet - Carbohydrates break down to release glucose. This increases blood glucose levels. A low carbohydrate diet would hence drop the glucose levels in the body.

• Excess Alcohol Consumption - Consuming excess alcohol without proper food intake can cause hypoglycemia.

• Underlying Medical Conditions and Illness - It is another risk factor for hypoglycemic conditions in the body.

How Is Nighttime Hypoglycemia Diagnosed?

Nocturnal hypoglycemia is usually diagnosed based on the signs and symptoms of the patient. Another way to diagnose nighttime hypoglycemia is to monitor the blood glucose levels with a CGM (continuous glucose monitor). This device alerts the individual when the blood glucose levels fall too low. The device is loud enough to alert the individual when asleep if nocturnal hypoglycemia occurs.

How to Avoid Nighttime Hypoglycemia?

Nighttime hypoglycemia can be extremely dangerous. However, one can prevent it from occurring. Nocturnal hypoglycemia can be prevented by:

• Checking the blood sugar levels before bedtime.

• Using a device CGM (continuous glucose monitor) to check blood glucose levels.

• Workout and exercise routine that best suits the individual’s condition.

• Avoid excess alcohol consumption.

• Following a diet recommended by a nutritionist or a dietician.

How Is Nocturnal Hypoglycemia Managed?

Nocturnal hypoglycemia is managed by taking the necessary precautions to avoid low glucose levels at night. Having a quick carbohydrate-rich snack instantly increases blood glucose levels. Continuous blood glucose monitoring should be done to avoid the consequences of nighttime hypoglycemia. If measuring devices are unavailable, one should immediately call for medical assistance if experiencing severe shortness of breath and low pulse rate. Healthcare professionals or nurses inject glucagon injections to relieve symptoms and increase blood glucose levels immediately during nighttime. On waking up the following day, the individuals should eat a carbohydrate-rich diet and test their blood glucose levels again. For long-term prevention of nocturnal hypoglycemia, it is vital for the individual to keep monitoring their glucose levels, stick to regular meals, and adjust insulin doses before bed.

Conclusion

One must seek medical attention as soon as one notices the signs and symptoms of nocturnal hypoglycemia. Doctors and medical professionals may help the individual change the dose, type, and timing of insulin and other medications. Regular monitoring is essential to prevent the consequences of nocturnal hypoglycemia. Doctors help with proper and detailed medication charts to help manage the symptoms of hypoglycemia and nocturnal hypoglycemia.