Severe hypoglycemia during sleep


(Kristina1) #1

My son, age 15, has had type 1 for 12 1/2 years. He has been on a pump for 6 1/2 years. This morning he had a severe hypoglycemic reaction. I went in to check his blood sugar when he was asleep (like I always do before work) and he started convulsing. He was able to sit up but was jerking and "out of it".  I was able to get down teaspoons of sugar and juice. He started to feel better but then we just sat there crying. It was very SCARY. As a long time parent of a diabetic it was my worst nightmare that hypoglycemia can and does happen during sleep. His sugar before bed was 170. He did not eat any thing after that. For 13 years this has never happened. Why now? I feel that I will be back again to waking up in the middle of the night to check sugar due to my paranoia. Let me know if anyone else has had this experience.


(Jewels Doskicz) #2

I'm so sorry to hear how heartbroken you are.  Of course you are so worried.  I have had diabetes for 26 years and have 3 seizures over the years and unfortunately 2 of them were while I was asleep. I was alert enough to know I was low and both times made it to the kitchen and had a seizure.  Both times our dog alerted my mom and then my husband (2 different dogs) and wokethem from a deep sleep to find me having a seizure downstairs.  Hormone changes and exercise the day before and diet the day before all play a role.  Sometimes it is hard to pin it down.  His site may have been near a vessel.  It sounds flukey if you haven't experienced it before.  All of mine were related to exercise and diet as I am very athletic.  You have a good mothers instinct, I'm so glad you check when you did.

Jewels


(Kristina1) #3

Thank you for responding. It is helpful to know that throughout your 26 years of this disease you have experienced this and that you are okay. He is also athletic..on a daily basis (high school baseball). I think I am going to start using the medtronic sensors at night.


(Jewels Doskicz) #4

Yes, he will be just fine.  Using the sensors right now may make sense for you. I really disliked that sensor.  It beeps too much and I over manage and get more lows.  It also bothers my skin alot too. Hopefully you have better results. My youngest daughter was diagnosed 2 years ago so I share the same worries as you.  I need to take  even better care of myself to be sure I am able to care for her needs too.

Rest easy,

Jewels


(momkennedy) #5

We use the Dexcom. It works really well - some times. Like all sensors it is a hit or miss.

Night times work sometimes for us sometimes not.

Good luck. It can be a godsend or a nightmere depending on your sensor.

 


(Janmc) #6

Hi, I have a son who is 9 and he has been diabetic for 2 1/2 years.  Sometimes in the morning he may be a little low, around 70 something.  I have found that if he is low, I don't wake him up totally.  I just leave him lying there and wake him enough to just get some juice and food in him.  It seems when he gets up and starts walking he just drops and can start shaking and twitching some.  It is very very scary.  A couple of weeks ago he was in the 70s, got him up and to the bar to eat and while eating, he started shaking and twitching really bad.  I tested again and he had dropped from the 70s to the high 40s in just a couple of minutes.  I always test him when he is still sleeping so that if he is a little low, I can feed him or give him juice and then I retest in a few minutes to make sure he has come up before I get him up to get ready for school.  I like him to wake up around 100 so in case he does drop, he would still be in the 70s or 80s.  It is so hard to figure out what is going on with their bodies.  I never sleep past 2 or 3 hours in the night because I get up to test him.  We have tried the sensor now and it is helping figure out the night stuff.  I can't pinpoint a low all the time, sometimes it is exercise or the food, but sometimes there is no reason that I can think of.  What type of pump does he use?  Luke uses the medtronic pump.  Luke has only been diabetic for 2 1/2 years.  That is awesome that your son has not had that problem in 13 years.  Way to go!!  Please keep in touch.  Jan


(Jessie) #7

Mother of t1 15 year old daughter and woke up early on a Sunday and went in by her. Where I found her unresponsive, foaming at mouth and choking on her tongue. We gave her glucagon and called 911. Took 10 minutes for ambulance and then they said she would just be fed if they brought her to hospital. I insisted they bring her in. I cannot get over the image… The realism of this situation. I don’t want her to leave my side. I’m back to checking her at night. How do you move on from such a tragic event? Is there a device to alert parents? She is on Medtronic 630G. I’m at the point I want to pull pump and go back to injections … maybe this would prevent this?


(Bill) #8

Hypoglycemia during sleep is a frightening experience for the person who has T1D and their family members (what an understatement!). I can’t count how many times I’ve waked up to find my wife sitting on the side of the bed holding a spent glucagon syringe, an empty glucose gel packet, or an empty glass of juice. Hypoglycemia during sleep is our “shared” biggest fear.

I’ve had T1D for more than 60 years. I did my doctoral dissertation in diabetes management and went on to practice as a neuropsychologist. Despite my experience, education, and training I have not come up with a simple solution for the challenge of monitoring glucose levels at night - my wife continues to wake me when she gets up to go to the bathroom and, if I sound the least bit “sing-songey” (as she calls it) I get up and check my blood glucose level. It is the only sure fire method we have come up with that prevents severe nocturnal hypoglycemia.

I have posted elsewhere that I begin to prepare for sleep by closely monitoring my blood sugar after supper. My goal is to hit a blood glucose level of around 130mg/dl at 10:00 p.m. I don’t want to have any “active” insulin in my system at 10:00 p.m. (I use a pump and consider each bolus of Humalog to remain “active” for about four hours). My nighttime basal is about half of what I use at any time during the day.

When I check my blood glucose at 10:00 p.m. I consider the level of physical activity I have had that day and the days before. If I have spent the day working in the yard I might eat a light snack before I go to bed. The snack will be larger if I experienced low blood glucose levels during the day. Why? Because my glycogen levels will already be depleted. That will leave my brain “unprotected” if my blood glucose should fall during the night.

If I have been physically active for several days in a row I eat a snack before I go to bed even when my blood glucose level looks “perfect” (for me that’s about 130mg/dl at 10:00 p.m.). Why? Because my glycogen stores are certainly low-to-gone after several days of heavy physical activity. That leaves my brain at greater risk of injury from hypoglycemia. On those nights I set alarms on my smartphone for every two or three hours. And I sometimes ease my nighttime basal off about 20%. But that’s just me.

While working on my dissertation I studied the original literature on hypoglycemic episodes people experienced soon after ultralente insulin was developed. That research, and my personal and professional experience led me to the conclusion that “severe” hypoglycemic episodes have the potential to cause injury to the brain; repeated episodes cause obvious injury. I don’t believe anyone is “okay” after experiencing an episode that causes a seizure; there is injury. But, we seem to have adequate “gray matter” to continue to function and perform as we did prior to the episode. But after repeated episodes the “cumulative” injury will be evident (often including such symptoms as fine motor tremor, subtle word-finding difficulties, and problems “multi-tasking”). Severe hypoglycemia is not “innocuous” (IMHO).

My most significant hypoglycemic episodes occurred when I was taking one of the super-long-acting insulins (24 hour insulin). I’ll never take that stuff again. Never!

And I really appreciate the flexibility that my pump affords. When I have to I can slow my nighttime basal to “just a drip” if I’m really, really worried. Heck, I’ll take a high blood glucose reading in the morning rather than a seizure during the night any time I have to make the choice. I can make that choice easier with my pump and a snack.

Hope this helps. And good luck!

Bill


(Dennis J. Dacey, PWD) #9

Hi Jessie @Jwchada, I feel for you finding your daughter like that - and your anxiety. I’ve never had the experience of finding someone passed out from hypoglycemia but my wife has found me unconscious two times; one time I was transported to the hospital, checked over and given 6 oz. orange juice and sent home. The other time [I’ve never had seizure] my BG was >10 I was infused a couple of ampules of D50 in an hour and a half and then fed but didn’t go to hospital [I did visit the endo in the morning].

Your daughter’s pump can be integrated with a CGM and “auto-suspend” activated. The CGM receiver has alarms that could alert you as she begins to drop so corrective actions may be taken BEFORE trouble occurs. The Medtronic software available with the CGM can transmit BG values and alarms to a caregivers phone.


(Abilash) #10

Hi, am Abilash from India am 26 years and been TD 1 for past 13 years . I too had hypoglycemia during my sleep several times during my initial period , due to which I had fluctuation, then I started this small exercise as suggested by my doctor, that to monitor my blood sugars at morning 2.30 , as it gives median blood sugars and will help me from hypoglycemia, further my mom used to keep milk besides my table in case of hypos. This helped me to reduce my doses and with possible hypos . Ps: This was achieved by keeping alarm.