First overnight low

Sitting here waiting to check my BG after treating a 66. While it was a very mild, almost-doesn’t-count number, it disturbed me for a couple reasons:

Well, first, not sure why I went low. I only had Afrezza on board tonight except for 1u Novolog dosed at 8pm - almost 6 hours ago! I don’t know my DIA exactly, though…maybe my pancreas just had a way delayed reaction to the sustained high I had all evening.

I didn’t wake up on my own. My husband woke me because my baby was crying, and I didn’t wake up (monitor is right beside my head). I wonder if it would have made me feel bad enough to wake me up if it got lower?

I didn’t really have my typical low symptoms. As I nursed baby back to sleep, I just felt very tired (normal), really hungry (normal), and really hot (not so normal, but it’s warmer tonight than it has been lately). I stayed awake to check my BG because I had a feeling it was probably low, and once I got up to check (yes, I didn’t have my monitor by my bed, nor did I ask hubby to help…impaired judgment), THEN I started feeling shaky, etc.

Usually I feel anything below 70, or feel it sooner if it’s dropping at all quickly. Maybe it just wasn’t bad enough yet to make me feel it, and that’s why I didn’t wake up/feel low? Is that normal?

ETA: Does the whole “eat a snack” thing apply for nighttime lows? I usually end up dosing/then eating a snack or meal after a low during the day. Tonight I just ate a couple jelly beans to start bringing it up, then ate a heaping spoonful of peanut butter. Figured maybe the fat/protein from that would help keep things up til morning?

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I understand and remember my first low at night before I had my CGM - that strange feeling of walking down the stairs all wobbly (not the smartest choice). That’s one reason I alsways have carbs in my purse/ or on the bedside table now.

Can’t say it will get easier, but we can be more prepared. Hope it’s on the up swing now.

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I also keep carbs by my bed for lows, as well as my CGM near my pillow (though I have a bad habit of sleeping through its alarms).

I don’t have great hypo awareness even during the day, and at night I definitely have to be lower to wake up than what I notice in the day. I almost never wake up for lows until they are <2.5 mmol/L (<45 mg/dl), even though during the day I can usually feel (subtle) symptoms of lows once I get to around 3.0 mmol/L (52 mg/dl).

Whenever I wake up for any type of random reason during the night (to use the washroom, etc.) I always check my CGM. Before I had a CGM, I’d use the opportunity to check my BG and make sure it wasn’t low.

If I’m really low overnight, I eat glucose tablets and then follow up with a snack of some sort (such as a cookie), and then I’ll bolus if I start to go high. But for a mild low I just treat with glucose tablets.

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Thank you! Just yesterday I had thought that I needed to replenish my bedside stash - definitely will today! I woke to 79, which is a normal fasting level for me.

Thank you, @Jen. I’ll make sure to start testing - “fortunately” I’m awake anywhere from 2-5 times a night with baby right now, so plenty of opportunities to keep an eye on things.

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It seems probably that you were lowish for a little while then. Some thoughts:

  • DIA can be much longer than people sometimes think. My endo says most kids have DIAs around 3 hours, but I believe that she has no idea of what she is talking about. While the activity of insulin goes down a lot after the third hour, for us there still is activity for another 2.5 hours (total 5.5 hours for him). The residual activity is mild but you can feel it, in particular when you stack.

  • You might well have gone low, say, 4 hours after your injection, but not woken up for a while.

  • As @jen wrote, a mild low is often difficult to feel at night, even when you are not hypo-unaware. My son does not wake up from a deep sleep unless he is really low, and, if you shake him awake because he is low, he has a hard time feeling if he is low until a few minutes have passed (unless he is super low).

I thought you did the right thing.

My guess is that you went low earlier but were asleep and did not wake up then. Your BG might have crept up slowly after your BG nadir, until your husband finally woke you up. Since ONLY insulin can bring you low, the only cause of your low must be this 1U injection, which, alone could not do a lot of damage. If stacked, it could have added up, though.

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For what it’s worth, I have pretty consistent hypo awareness, but a 66 wouldn’t necessarily wake me up even if I’d probably notice it while awake—I usually need to be closer to 50 to wake up. Entirely possible you would have woken up had you continued to drop. Last night I was steady in the upper 60s to 70 for most of the night and slept right through it, which honestly doesn’t really concern me, since I wasn’t dropping further.


That’s very likely. I was 135 when I went to bed; had dropped ~70 in an hour from my last Afrezza dose (but knowing Afrezza’s action was pretty much done at that point, I didn’t think to worry). I also forgot I’d had a small glass of wine, so not sure if the alcohol affected my liver’s ability to handle the mild low.

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It’s possible, but much depends on how quickly or even efficiently your particular liver metabolizes alcohol, and I’d wager that for many people the effects of “small glass” (unless you drink out of Mason jars, let’s say that’s 3 or 4 ounces) would be unnoticeable, especially if you had the wine with a meal. But it’s hard to say, really, given that there are so many variables – IOB, type and size of meal, body size, gender, and more come into play.

I can safely say that for myself, a glass or two of wine (or a cocktail before dinner with no wine) does not have any appreciable effect on overnight BG or even over the next 24 hours. The kinds of cocktails I prefer generally contain some carb anyway, and I never drink on an empty stomach, so that offsets the lowering effect on the BG. Plus I tend not to overdo it.

Michel, I think that deduction is faulty. True: Only insulin can lower BG. False: the only cause of your low must be this 1U injection. She has basal. It could be too much basal for that night; there are many ways this can happen. For example, fewer allergens, more active sleep, previous exercise/exertion, lower stress or other hormone-mediated effects, or a seasonal reduction in basal requirement that is just being noticed.

Normally it does, especially while you retain significant hypo awareness, but maybe not until the low 40s or lower. Without CGM you might not even see a deep low on your glucometer: you could go severely low, your body reacts correctly by dumping adrenaline, and you then wake up covered in sweat but no longer terribly low. Before CGM, I would occasionally wake up with this strange buzzy sensation — not a sound, just my entire body was sort of buzzing or humming. For me that was a sign of BG in the low 40s, so I would immediately take 5 glucose before even measuring, because I wanted to make sure of a self-rescue rather than passing out. Unfortunately, people don’t always wake up from severe hypos overnight, it can be fatal. The “dead in bed” risk motivated me to get CGM, and I fully depend on it to save my life.

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Yeah, I’ve been slowly getting back into drinking at all (6 months postpartum), so that one glass was actually a lot for me lately - not sure if that would have influenced it!

Actually, I’m not on basal yet - fasting levels are still fine; my pancreas just can’t handle anything more than fasting. :slightly_smiling_face:

I’m having a horrible time getting my insurance to cover a CGM (or even to figure out which insurance is supposed to cover it).

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Supposedly, moderate alcohol inhibits the liver from dumping glucose into the bloodstream during the time the alcohol is being metabolized. So I would think that effect should have concluded about an hour after your glass was empty, and not carried over into your sleep.

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@bkh, normally what you write would be correct, but @Pianoplayer7008 is still early into honeymoon and does not use basal yet.

[EDIT] Oops, she mentioned that to you already :slight_smile:

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That would be good - I’d hate to have to worry about a little glass of wine! :wink:

An hour is very common, but two or three hours is not uncommon, and four hours or more is not unheard of. There are so many influences on the rate of ethanol metabolism by the liver – gender, race, amount of body fat, type of meal eaten, speed at which the alcohol is consumed, the rate of gastric emptying, time of day (seriously!), to name just a few of many factors, oh and I forgot to mention taking aspirin, which increases blood alcohol concentrations – that it’s tricky to generalize.

Because I couldn’t drink at all for about a decade – it was the only thing I was allergic to, dagnabbit – I did careful experiments when I did start drinking again, eating the same meal under similar conditions with and without a drink and seeing what effect alcohol had on my blood sugars. As I mentioned above, having a drink or two with a meal appeared to have no discernible effect. However, that was before CGMs existed, and I wasn’t getting up to test every hour throughout the night, so it would be interesting to see what results I’d see now.


@Beacher, @bkh, it is becoming harder to figure out who is who when you look at this thread :slight_smile: Both of you show as B! How about posting icons in your profile? I can describe how if you want!

Interesting. I had only heard the rule of 1 unit per hour. I didn’t realize that this was only a coarse generalization.

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That sort of confusion is one of the key strategies for (partial) anonymity. But I supposed that the “bkh” to the upper right of my symbol was a give-away…


I see, you were referring to the summary. I guess I can’t expect you to remember the red B vs the green one. But wait, you already have to remember that Eric is the glucometer and Doc Slotnick is the dog, and Chris is the beach lifeguard pavilion and Thomas is some kind of unfamiliar vaguely marsupial creature and so on.

I understand your request and will consider it.

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For what it’s worth, this is not true for me—one or two glasses of wine or a cocktail will slightly but noticeably inhibit my liver overnight and could easily push me from 80-90 range to 60s. Anything more than that will have a dramatic effect. So a person would probably need to experiment to discover their own liver sensitivity to alcohol.