One Bad Night Shouldn't Cost You Two Days: Night Hypos

Day 43 of my challenge. A bad hypo through the night.

I was too tired for CrossFit in the morning and missed it. It wiped out most of the day. I picked myself up and did kettlebells in the evening, but the night had already taken its toll.

That's the thing about night hypos. They don't just hit at night. They take the next day as well.

Why they matter

Night hypos are what a lot of us fear most. Your blood sugar dropping while you're asleep, with nobody to notice.

I'm not going to scare you, but I'm not going to hide it either. "Dead in bed" syndrome, when a young person with Type 1 dies suddenly overnight, is rare. It's estimated to account for about 6% of deaths in people with Type 1 under 40.

Understanding the risk is the first step to managing it. Most night hypos can be prevented.

Why they happen

1. Over-correcting at bedtime. A big correction dose before bed, then you sleep through the drop.
2. Exercise earlier in the day. Hypo risk stays up for at least 24 hours after exercise, and it's highest overnight after afternoon training.
3. Too much background insulin overnight. Your needs change with activity, weight, even the seasons.
4. Alcohol. If you use insulin, the hypo risk from drinking can last well into the next day.

The signs you went low in the night

You might not wake up. But you might wake up wiped out or with a headache. Feeling very tired or having a headache in the morning can be a sign you went low overnight.

How I set up my nights

During the challenge I set my overnight basal on my pump myself, and it was set quite tight, because my training kept changing what I needed. I always tried to go to bed at about 8 to 9 mmol/L, and I'd usually wake at about 6 to 7. That worked for me.

That's a conversation to have with your diabetes team, not something to guess at. Talk to them before changing your insulin.

Prevention

• CGM alarms. A CGM can warn you about a low at any time of day or night. If a reading doesn't match how you feel, check with a meter.
• Automated insulin delivery. Systems that adjust insulin from your CGM. Ask your team if you're eligible.
• Hard training days. Talk to your team about lowering overnight basal or having a bedtime snack.
• If you drink. A starchy snack before bed, something sugary by the bed, and make sure the people you're with know you have diabetes.
• Let someone see your numbers. Apps like Dexcom Follow let people you trust see your readings on their phone.

When the alarm goes at 3am

Keep your hypo kit by the bed. Diabetes UK's advice:

1. Below 4 mmol/L, have 15 to 20g of fast-acting carbs. Five glucose tablets, four jelly babies, or a small glass of a sugary non-diet drink.
2. Recheck after 10 to 15 minutes. Still below 4? Treat again.

If you're ever too drowsy or confused to treat yourself, someone else has to step in. Ask your team whether you should keep glucagon at home, and make sure the people you live with know what to do.

Your challenge: look at your nights

Pull up your last week of overnight data. Ask yourself:

• Were there any lows?
• What happened the day before? Heavy training? A different evening meal? A late bolus?
• How did you feel the next morning?

Write down any pattern and take it to your diabetes team.

The hypo is part of the deal. Hiding from what's causing it is a choice.