Glucagon is available by prescription and is either injected or administered or puffed into the nostril. For those who are familiar with injectable glucagon, there are now two injectable glucagon products on the market—one that comes in a kit and one that is pre-mixed and ready to use.

Speak with your doctor about whether you should buy a glucagon product, and how and when to use it. The people you are in frequent contact with for example, friends, family members, and coworkers should be instructed on how to give you glucagon to treat severe hypoglycemia.

If you have needed glucagon, let your doctor know so you can discuss ways to prevent severe hypoglycemia in the future. If someone is unconscious and glucagon is not available or someone does not know how to use it, call immediately.

Low blood glucose is common for people with type 1 diabetes and can occur in people with type 2 diabetes taking insulin or certain medications. If you add in lows without symptoms and the ones that happen overnight, the number would likely be higher. Too much insulin is a definite cause of low blood glucose.

Insulin pumps may also reduce the risk for low blood glucose. Accidentally injecting the wrong insulin type, too much insulin, or injecting directly into the muscle instead of just under the skin , can cause low blood glucose.

Exercise has many benefits. The tricky thing for people with type 1 diabetes is that it can lower blood glucose in both the short and long-term. Nearly half of children in a type 1 diabetes study who exercised an hour during the day experienced a low blood glucose reaction overnight.

The intensity, duration, and timing of exercise can all affect the risk for going low. Many people with diabetes, particularly those who use insulin, should have a medical ID with them at all times.

In the event of a severe hypoglycemic episode, a car accident or other emergency, the medical ID can provide critical information about the person's health status, such as the fact that they have diabetes, whether or not they use insulin, whether they have any allergies, etc.

Emergency medical personnel are trained to look for a medical ID when they are caring for someone who can't speak for themselves. Medical IDs are usually worn as a bracelet or a necklace.

Traditional IDs are etched with basic, key health information about the person, and some IDs now include compact USB drives that can carry a person's full medical record for use in an emergency. As unpleasant as they may be, the symptoms of low blood glucose are useful. These symptoms tell you that you your blood glucose is low and you need to take action to bring it back into a safe range.

But, many people have blood glucose readings below this level and feel no symptoms. This is called hypoglycemia unawareness. Hypoglycemia unawareness puts the person at increased risk for severe low blood glucose reactions when they need someone to help them recover.

People with hypoglycemia unawareness are also less likely to be awakened from sleep when hypoglycemia occurs at night. People with hypoglycemia unawareness need to take extra care to check blood glucose frequently.

This is especially important prior to and during critical tasks such as driving. A continuous glucose monitor CGM can sound an alarm when blood glucose levels are low or start to fall. This can be a big help for people with hypoglycemia unawareness.

If you think you have hypoglycemia unawareness, speak with your health care provider. This helps your body re-learn how to react to low blood glucose levels. This may mean increasing your target blood glucose level a new target that needs to be worked out with your diabetes care team.

It may even result in a higher A1C level, but regaining the ability to feel symptoms of lows is worth the temporary rise in blood glucose levels.

This can happen when your blood glucose levels are very high and start to go down quickly. If this is happening, discuss treatment with your diabetes care team.

Your best bet is to practice good diabetes management and learn to detect hypoglycemia so you can treat it early—before it gets worse. Monitoring blood glucose, with either a meter or a CGM, is the tried and true method for preventing hypoglycemia.

Studies consistently show that the more a person checks blood glucose, the lower his or her risk of hypoglycemia. This is because you can see when blood glucose levels are dropping and can treat it before it gets too low. Together, you can review all your data to figure out the cause of the lows.

The more information you can give your health care provider, the better they can work with you to understand what's causing the lows. Your provider may be able to help prevent low blood glucose by adjusting the timing of insulin dosing, exercise, and meals or snacks.

Changing insulin doses or the types of food you eat may also do the trick. Breadcrumb Home Life with Diabetes Get the Right Care for You Hypoglycemia Low Blood Glucose.

Low blood glucose may also be referred to as an insulin reaction, or insulin shock. Signs and symptoms of low blood glucose happen quickly Each person's reaction to low blood glucose is different. Treatment—The " Rule" The rule—have 15 grams of carbohydrate to raise your blood glucose and check it after 15 minutes.

Note: Young children usually need less than 15 grams of carbs to fix a low blood glucose level: Infants may need 6 grams, toddlers may need 8 grams, and small children may need 10 grams. In most cases, a person can manage nocturnal hypoglycemia with certain lifestyle and regimen adjustments.

A person should contact their diabetes care team if they are experiencing regular episodes of nocturnal hypoglycemia. If someone is caring for a person living with diabetes and cannot wake them up or they seem unresponsive, they should contact immediately.

Nocturnal hypoglycemia is a potential complication for individuals managing diabetes with glucose-lowering medications.

It occurs when blood sugar levels drop below suitable ranges during sleep. With proper awareness and management strategies, a person can minimize its potential impact. By ensuring glucose levels are above a suitable range before bed, using continuous glucose monitors, and working with healthcare professionals, individuals can significantly reduce the risk of experiencing nocturnal hypoglycemia.

Should a person adjust their insulin dose before performing exercise? Read on to learn more about how physical activity can impact insulin sensitivity. Experts say more adults who develop type 1 diabetes are being misdiagnosed as having type 2 diabetes.

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Medical News Today. Health Conditions Health Products Discover Tools Connect. Nocturnal hypoglycemia: Causes, symptoms, and management.

Medically reviewed by Kelly Wood, MD — By Louise Morales-Brown on September 22, Definition Causes Symptoms Management When to contact a doctor Summary Nocturnal hypoglycemia refers to low blood glucose levels while a person is sleeping. Definition of nocturnal hypoglycemia.

Causes of nocturnal hypoglycemia. Symptoms of nocturnal hypoglycemia. Management and prevention of nocturnal hypoglycemia. When to contact a doctor. How we reviewed this article: Sources.

Medical News Today has strict sourcing guidelines and draws only from peer-reviewed studies, academic research institutions, and medical journals and associations. We avoid using tertiary references. We link primary sources — including studies, scientific references, and statistics — within each article and also list them in the resources section at the bottom of our articles.

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Related Coverage. Insulin and exercise: What to know Medically reviewed by Angela M. Bell, MD, FACP. Why adults who develop type 1 diabetes are being diagnosed with type 2 diabetes Experts say more adults who develop type 1 diabetes are being misdiagnosed as having type 2 diabetes.

Because this trial was exploratory in nature, no multiplicity control was performed. Sample size was calculated using SAS statistical software version 9. Assuming that the probability of more arousals during the hypoglycemic night than during the normoglycemic night is 0.

A total of 42 patients were screened, and 26 were randomized 18 men and 8 women. Sixteen patients failed the screening, including 6 with sleep apnea and 2 taking excluded concomitant medications.

Mean SD age in the full analysis set was Mean SD BMI was At screening, Other commonly used antidiabetic treatments were GLP-1 receptor agonists and sulfonylureas.

One subject received only diet and exercise as treatment. Twenty subjects completed both nights i. Individual plasma glucose profiles during the hypoglycemic and normoglycemic nights are shown in Supplementary Fig.

The profiles show that the clamp targets were kept within the prespecified limits in all subjects. Because some subjects required additional bolus insulin infusion to reach the glycemic targets on both experimental nights, we examined whether a correlation existed between the insulin concentration and the number of awakenings in the 4—8-h period.

We found no association between these two variables. This difference was statistically significant estimated rate ratio 0. This difference was not statistically significant. The model included type of night and period as fixed effects and subject as a random effect.

The analysis was based on the completers analysis set. Additionally, there was no difference between experimental nights in latency to sleep or in time spent in the various sleep stages. Total sleep time tended to be longer on the hypoglycemic night than on the normoglycemic night mean [SD] However, none of these differences were statistically significant.

The prehypoglycemia levels of the counterregulatory hormones assessed varied among subjects, and the geometric mean and range values for these during time 0—4 h are reported in Supplementary Table 4.

A counterregulatory hormonal response was seen on the hypoglycemic night compared with the normoglycemic night see Fig. Contrary to expectations, noradrenaline concentration was statistically significantly lower on the hypoglycemic night than on the normoglycemic night Supplementary Fig.

C-peptide concentration was also statistically significantly lower on the hypoglycemic night. For IGFBP-1, no statistically significant difference in responses between experimental nights was found. The log-transformed hormonal response profiles were analyzed using a mixed-effects model with type of night hypoglycemic or normoglycemic , period, time, and interaction between type of night and time as fixed effects and subject as a random effect.

To our knowledge, this study is the first patient-blinded, controlled glucose clamp trial investigating the impact of nocturnal hypoglycemia on sleep in type 2 diabetes.

The PG target 2. Severe hypoglycemia has been associated with neuronal death in susceptible brain areas, such as the hippocampus 6. Furthermore, hypoglycemia is associated with seizures, cognitive dysfunction, and an increased risk of cardiovascular events, including stroke and arrhythmias 16 — Therefore, the hypoglycemic episode was restricted in terms of both PG level and duration.

Patients with type 2 diabetes often present with sleep disturbances 19 and subsequent increased daytime sleepiness One of the most common sleep disorders in patients with type 2 diabetes is sleep apnea 21 , which leads to sleep architecture disruptions and nocturnal arousals.

Whether hypoglycemia induces or worsens sleep apnea is not currently known; however, hypoxemia due to sleep apnea in combination with the induction of hypoglycemia would impose a considerable risk on the trial subjects.

Patients with sleep apnea were therefore excluded 6 of the 16 screening failures were due to sleep apnea. Hypoglycemia induction should not inflict unnecessary risk to study subjects; hence, patients with recent manifestations of macrovascular disease were excluded.

In summary, patients eligible for this trial had better physical health than the general type 2 diabetes population. It remains to be established how hypoglycemia affects sleep in patients with obesity, sleep apnea i. During the first 4 h i.

A significant counterregulatory hormonal response was observed following induction of hypoglycemia, including an immediate increase in glucagon and decrease in C-peptide.

Likewise, an immediate sympathetic response occurred with an increase in adrenaline, the role of which is to alert the individual of the hypoglycemia so that he or she can compensate behaviorally with an intake of carbohydrates Large increases in growth hormone and cortisol were also seen; these hormones also play a role in counterregulation, although less importantly than glucagon and adrenaline An increase in pancreatic polypeptide confirmed activation of the parasympathetic nervous system Taken together, the hormone profile data demonstrate that the hypoglycemic event PG target 2.

In healthy individuals, nocturnal hypoglycemia causes a counterregulatory hormonal response as described herein, and most wake up upon the hypoglycemic stimulus 13 , In contrast, in patients with type 1 diabetes, the identical stimulus very rarely causes awakening 13 , 27 , and in the great majority of the patients, no clear-cut counterregulatory hormonal response to hypoglycemia is observed In the present trial in type 2 diabetes, a reduction in the awakening response was observed after hypoglycemia, although the effect was not immediate occurring several hours after the hypoglycemic event and the counterregulatory hormonal response was preserved.

It is noteworthy that a reduced awakening response was observed in this population, despite the relatively recent diagnosis mean time since type 2 diagnosis 5.

Although not fully understood, arousals and arousal responses are known to occur in response to certain stressful internal and external stimuli e. For patients experiencing life-threatening physiological changes during sleep, the arousal response can be critical for survival In contrast, the reduced awakening response seen following nocturnal hypoglycemia in this study could potentially be harmful by rendering patients unable to compensate behaviorally i.

An observational study investigating the correlation between hypoglycemia and cardiac arrhythmia in patients with diabetes with established cardiovascular disease showed that hypoglycemic episodes lasted longer at night min than during the day 62 min.

These findings indicate that prolonged, undetected episodes of nocturnal hypoglycemia exacerbated by a reduced awakening response may increase the risk of impaired cardiac autonomic activity and cardiac arrhythmias, which may in turn lead to an increased risk of cardiovascular mortality Hence, a reduction in hypoglycemic episodes, especially during the night, is an important therapeutic goal for future insulin treatment regimens.

Of interest would be an assessment of how sleep responses to nocturnal hypoglycemia are specifically influenced by factors such as current drug regimens e.

In addition, the present findings call for further studies to examine the pathophysiology of hypoglycemia during sleep. Here, we used the gold standard macro sleep evaluation i. However, macro sleep evaluation is not sensitive to discrete physiologic changes. These include micro sleep events e.

Although a major contributory factor is obesity, the contribution of hypoglycemia to sleep apnea remains to be fully elucidated. Clinical trial reg. NCT, clinicaltrials.

The authors thank the trial staff and subjects. They also thank Derk-Jan Dijk, Surrey Sleep Research Centre, Surrey, U. Gillies Watermeadow Medical, Witney, U. for assistance with article preparation. Duality of Interest. No other potential conflicts of interest relevant to this article were reported.

Author Contributions. and S. contributed to the trial concept and design, data collection and interpretation, discussion of the results, and review and editing of the manuscript. was the principal investigator responsible for the sleep assessments, and S.

was the coinvestigator responsible for the clamp assessments. and R. contributed to the trial concept and design, data interpretation, discussion of the results, and review and editing of the manuscript. contributed to the data collection and interpretation, discussion of the results, and review and editing of the manuscript.

performed the statistical analyses and contributed to the data interpretation, discussion of the results, and review and editing of the manuscript. is the guarantor of this work and, as such, had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

Prior Presentation. Parts of this study were presented in abstract form at the 50th European Association for the Study of Diabetes EASD Annual Meeting, Vienna, Austria, 15—19 September Sign In or Create an Account. Search Dropdown Menu.

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Research Design and Methods. Article Information. Article Navigation. The Impact of Nocturnal Hypoglycemia on Sleep in Subjects With Type 2 Diabetes Poul Jennum ; Poul Jennum. Corresponding author: Poul Jennum, poul. jennum regionh.

This Site. Google Scholar. Kirstine Stender-Petersen ; Kirstine Stender-Petersen. Rasmus Rabøl ; Rasmus Rabøl. Niklas Rye Jørgensen ; Niklas Rye Jørgensen. Pei-Ling Chu ; Pei-Ling Chu.

Sten Madsbad Sten Madsbad. Diabetes Care ;38 11 — Article history Received:. Get Permissions. toolbar search Search Dropdown Menu. toolbar search search input Search input auto suggest. Figure 1. View large Download slide. A third hypoglycemic clamp was performed in the morning of day 2 after sleep or sleep deprivation.

Subjective symptoms of hypoglycemia were assessed through a questionnaire. Participants had a dampened neuroendocrine adaptation to recurrent hypoglycemia in the sleep deprivation state compared with regular sleep.

No differences between the first and final clamps were observed for noradrenaline concentrations during either sleep condition. The researchers said more studies should be conducted in other populations to confirm the findings.

Future studies are also needed to identify the mechanisms underlying the effect of sleep deprivation on the adaptation to recurrent hypoglycemia and to single out the contribution of direct effects on counterregulatory processes.

Meyhöfer S, et al. Healio News Endocrinology Diabetes. By Michael Monostra. Read more. June 27, Add topic to email alerts. Receive an email when new articles are posted on.

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