Signs and symptoms of nocturnal hypoglycemia

Nocturnal hypoglycemia or night time hypos are common in people who treat their diabetes with insulin. Symptoms are usually only realised once waking up from a hypo.
Due to their nature, you will usually only find out about having a hypo during the night after waking up from a hypo.

Signs and symptoms of nocturnal hypoglycemia:

  • Early signs and symptoms of diabetic hypoglycemia include:
    • Shakiness.
    • Dizziness.
    • Sweating.
    • Hunger.
    • Irritability or moodiness.
    • Anxiety or nervousness.
    • Headache.

Prevention: 

A useful first step towards preventing hypoglycemia is to test your blood glucose levels before bed.
For people on two or more insulin injections per day can help prevent hypos over night keeping blood glucose levels above 6.5 mmol/l before going to bed.
If over night hypos are suspected, carry out a test at 3am. Together with a before bed and first thing in the morning test, this can help to understand how your sugar levels are behaving over night.
If sugar levels are dropping too low over night, you may need to adjust your insulin doses. Speak to your doctor
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  • If your blood sugar is less than 100 mg/dL (discuss a blood glucose target for bedtime with your health care provider) eat at low to moderate glycemic index snack before going to bed
    • Whole wheat bread with peanut butter or whole grain crackers with a slice of cheese
  • If you were more active than usual, consumed alcohol in the evening, or had a low blood glucose during the day, set an alarm to check your blood glucose at 2 a.m. or 3 a.m. in the morning.
  • If you currently take the intermediate-acting insulin, NPH, speak with your health care provider about switching to a long acting insulin such as, Lantus, Levemir, or Tresiba. Long acting insulin has a flat action profile and does not have variable peaks (like NPH does) therefore the risk of nocturnal hypoglycemia is reduced.
  • If you have a history of nocturnal hypoglycemia, hypoglycemia unawareness or have experienced a severe low blood glucose, a continuous glucose monitor (CGM) may be helpful.
    • A CGM may also be beneficial if you live alone or travel alone as you can set an alarm for when your blood glucose drops below a set threshold (i.e. <70 mg/dL).

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