A Reminder that Diabetes Never Sleeps

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Drifting off to dreamland isn’t always an easy task when you have diabetes. In fact, it can be downright dangerous, depending on the circumstances.

A recent experience reminded me of how it can be scary to sleep when my blood sugar is off-track. Hours prior to bedtime, I was dancing the night away at a friend’s wedding. I enjoyed a few glasses of wine (in moderation) and the company of people who I don’t get to see often. My blood sugar throughout the reception was slightly higher than usual, but I was okay with that because my activity levels were higher, too. I wanted to wait it out before taking a rage bolus to bring my number down.

I was holding steady at 177 by the time the reception was over and I’d arrived back at my hotel. I was a little hungry, so I gave myself a bolus to account for both my blood sugar and the snacks I planned on eating. So far, nothing about this was strange—I almost always have a snack before bed, and I’m pretty good about accurately predicting how much insulin I’ll need in order to level out (maintain blood sugar between 100 and 150) overnight. An hour later, I started to get ready for bed when I noticed that my blood sugar was hovering in the low 100s. This was good, but the diagonal arrow down made me decide to have a mini snack before brushing my teeth, just to make sure I didn’t have to deal with a future low (oh, if only I knew what I had coming to me). I quickly ate a 10-carb box of yogurt-covered raisins and went about my business. By 12:30 or so, I was in bed and eager to get some rest after the hectic events of the day.

But as much as my body and mind craved sleep, my diabetes seemed to be determined in preventing that from happening. Three times throughout the night (yes, three!), I woke up to the urgent buzzing of my CGM. I was annoyed when it happened the first time at around 2:30 A.M. but took it in stride, guessing that 3 glucose tablets should do the trick. I was wrong, because at 4:00 A.M., my CGM went off again. This time, I got up out of bed to fetch another small box of raisins from my purse to consume. I fell back asleep in no time. What felt like five minutes later, though, my CGM was alerting me to a third low blood sugar. This time it was about 6 A.M. I was beyond tired and the prospect of eating even more blocks of sugar was more than unappealing. I opted to turn off my basal rate insulin for two hours to see if that would kick my blood sugar back up more efficiently than additional carbohydrates.

Except it didn’t—instead of catching some much-needed shut-eye, I was waking up again, less than 30 minutes later, to the frantic “below 55” alarm emitting from my CGM. This time, I knew I should do an actual finger-stick check using my meter rather than trust my CGM. (Side note: I’d been using the CGM sensor for nearly a full week at that point and its readings were pretty spot-on. Normally, I would have checked my blood sugar for every time my CGM went off during the night, but I was burnt out from testing so much earlier in the day. It was easier to rely on my CGM’s accuracy than to waste test strips.) My meter showed that I was 68 mg/dL—not exactly critical levels here, but it warranted another 4 glucose tablets.

I was exasperated and perplexed by the number of lows, but I was so exhausted that I didn’t dwell on it. I managed to squeeze in three hours of sleep before I had to get up and start my day. Yawning, I rolled onto my side and checked my CGM for the umpteenth time in a matter of hours. By that time, I was 144 and relieved that I wouldn’t be forced to eat anything else until I wanted to.

This experience reminded me that it’s important to stay diligent when it comes to overnight lows. As irksome as they can be, they are also frightening when it takes longer than usual for blood sugar levels to come up (or in this case, stay up). Fortunately, nights like these are rare for me, and I do think factors from this particular day (drinking, dancing, and eating at unusual times) played a role in the recurring lows. Regardless, I feel lucky that I have access to technology that ensures I wake up to address low blood sugar—and I hope that one day, all people with diabetes can afford it and use it, too.

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Rick Phillips

Yeah, last night at 4:00 AM I threw int eh towel. Any idea what is on TV at 4 AM? It isn’t good.

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