But knowledge is power, right?
What is the deal with otherwise healthy type I's dying in their sleep from hypos? I had kind of assumed (or maybe convinced myself) that there had to be more to the story, like drugs or drinking, but I'm losing my resolve. Is it really just a crap shoot to go to sleep every night? Is it a Q of glycogen stores in the liver -- and if so, how does one make sure they're stocked up?
Thats why I wear a cgms RELIGIOUSLY !!!
I am very glad u asked the question because I often wake up hypo at night and sometimes 2-3 times during the night. I always am scared and hope that I wake up to eat something. as of now I can always can tell when im hypo while sleeping...sometimes im even dreaming that I need to go get food lol. but im scared of the one time my body doesn't wake me up for that low!!! it's terrifying to think about. I always eat before I go to bed as my doctor suggested but sometimes that doesn't help.
Eric, I wonder if you'd mind sharing how you have dealt with preventing a repeat of that sort of devastating overnight low? Do you set an alarm to do a routine overnight BG check? Do you wear a CGM?
My son's overnight BG's can make no sense at all at times other than knowing that the activities that he prefers can cause lows many hours or a day and hours later. Kinda hard to predict when you never know if sports one day will cause a low that night, the next night, or not at all. It is very hit and miss.
Eric, I kind of hate to ask about it, because it was such a traumatic experience, but I have a few questions. How long ago did this happen? How much insulin were you taking per day when this happened? How long were you unconscious for? Were you in the hospital for long afterward?
I lost some memories from earlier hypo incidents. Also, some difficulty with memory, but I don't think I am much the worse for it overall.
It still seems like sort of long odds that we'd end up dead or injured like Eric's been good to share with us? I dunno how many of the 22K Tu folks are T1 but probably most of us, and perhaps many of our T2 comrades as well, have run into nighttime lows without suffering death or serious injury?
The best way to hedge your bets is to be precise in setting your numbers and work to maintain them in a state of relative flatness, particularly basal rates but also carb ratios. I think that the inflation of goals for "safety" may lead to more ups and downs or rollercoastering which is where the biggest risk is? I think that this is where the biggest opportunity to help people with diabetes lies and that it's sort of unfortunate that attention to this aspect of the disease is wiped out by "curism".
You know how we say, YMMV? In this case I think it's very true. I've had some significant lows. I will wake in the middle of the night with a significant low that the Dexcom didn't catch. It says I'm 90 and I'm 28. Lately I've found I've been way too lucky for my own good. I'll start to feel a little odd and check and I'm in the 20s. Once I was actually "low" when the meter read and I was still functional at a high level. Though, I'm pretty sure it's the adrenalin that gets me to the glucose. Once I was treating, I got the low symptoms like gangbusters. When I mentioned this to my endo at my last visit, he actually thought they couldn't be accurate readings. I should have been mashed potatoes.
I come from particularly hearty Russian peasant stock. When my dad died and was autopsied, his brain had evidence of a number of major stroke events that should have killed him. We all thought he was napping. I can only hope that I'm a quarter as tough. But as I said, I think this may be a situation of YMMV. It's a little freaksome to think that I've been a likely candidate for "dead in bed" and managed to dodge the bullet. Genetics and good luck are great, but once the luck takes a vacation, . . . does anyone have a spare valium?
I have to say this thread has made me feel a bit better about things. It seems like there are some groups that are at higher risk and also that there are steps one can take other than just trying not to have lows. For one thing, I think being more careful for 48 hours or so after a serious during-sleep low could be very protective. I think I will make it a practice to run a bit high and not do any boluses for a few hours before bed during those times.
I also wanted to share an experience that I had in case anyone is motivated to try it... I could stand to lose a fair amount of weight and haven't been at all successful using normal means (low cal on its own doesn't do anything for me, 20 grams a day of cho doesn't do anything for me, exercise has always been counterproductive) but during a period where I was having a hard time keeping my bs in control, I got frustrated and decided to just cut ALL carb out of my diet for a few days thinking I could bring it back slowly, but then I started losing weight! So of course I kept at it. I managed to do it for close to six months and lost over 40 pounds. But the reason I bring it up is that during that time, I didn't have *any* lows at all. I don't think it was anything magical except that it was Dr. Bernstein's law of small inputs (or whatever he calls it) taken to the extreme. I was doing so little insulin and there was no guestimating at all (I think when I'm eating carbs and doing carb-counting, it's not as exact a science as the professionals make it out to be, carbs are not all equal for me, iykwim -- and my starting bs also makes a big difference to my carb ratio). It was awesome and I felt SO good, lost weight, perfect blood sugars, absolutely no lows. The obvious problem, though, was that it is freaking hard to keep from *ever* eating anything that's not meat or heavy cream. (I also allowed myself 2 oz of cheese a day, though). If I could get back to it, I do think it's insanely healthy and this *dead-in-bed* thing would be a non-issue. I sure wish I didn't enjoy food so!
Maybe try to tighten up the carb counting a bit? I think that's a big thing? I'm not totally precise about it all the time either and eat a fair amount of guesstimating but, when I weigh and measure things, I think I usually end up doing better and getting close. Since I've had the CGM, I go through phases where it seems like a small adjustment to a ratio can make a big difference in numbers which are sort of where my concerns about "rollercoastering"= increased risk (I'm not sure of the amt?) of more severe hypos and that flat is a better goal than low? I also have worked to lose weight, although not so much for a while, and found that if I were eating 42G of say pretzels/ day and cut it back to say 28 or 14G (or, currently, carrots and broccoli...) I will drop a few lbs? I don't totally cut carbs out and am always up 5, down 2, down 3, up 2 sort of situations. I suspect that it's possible to run slightly higher than 20G of carbs/ day and still lose weight? The highest number mentioned in Taubes "Why We Get Fat" is 75G. It might not flip the ketosis "switch" but I think that it's a more reasonable number?
I think people can be pretty different in this regard. I know in terms of dieting that people claim that different things work for different people, and I kinda don't believe that. lol My opinion, based on nothing but my gut feeling, is that there probably really is a best way to eat and that it applies to everyone who is physiologically normal (so I guess that would not be us!). But anyhow, if low carb is that best way, I think we might have different thresholds that we need to be below. I would think that people who have a lot more muscle and use it a lot can probably go higher, and there're probably other factors. But about 12 years ago I went very seriously low carb and ate 20 grams a day for almost two years and at the end of that period I was at my start weight (so, lost a few pounds of water in the first week but gained them back over that time). I was completely meticulous about counting, though. Even though I didn't lose any weight, I was thrilled with my blood sugars and the fact that I was only using 23 units of insulin a day. I was actually having lows then, but I think it was because I was running and also working a super demanding job.
I have read GCBC but not Why We Get Fat. I have been wondering about what his actual diet recommendations would be. Taubes is awesome. :)
I found both of his books pretty interesting but he doesn't actually make recommendations exactly, more talks about the history of ideas and the "low-carb" scientist who studied the highest amount struck me as 75?