How to manage nighttime hypoglycemia in a 34-year-old?

Question

Hello doctor,

My 34-year-old colleague, who has had type 1 diabetes for over 15 years, recently started experiencing unexpected nighttime hypoglycemia despite following the same insulin dosage. He uses a CGM, and it has shown his glucose levels dropping below 60 mg/dL multiple times during sleep over the past two weeks. His laboratory results, including HbA1c, were stable at 6.8 percent, but his C-peptide levels were negligible, and his recent kidney function tests were normal. Could these episodes be related to delayed insulin absorption or changes in his basal insulin requirements? Should he consider switching to a different insulin formulation, or would adding a nighttime snack help? Additionally, he has been feeling more tired than usual during the day, which might be linked to poor sleep from the hypoglycemia. Are there any strategies for managing these fluctuations more effectively without compromising his overall control?

Kindly help.

Answer 1

Hello,

Welcome to icliniq.com.

I read your query and understand your concern.

Nighttime hypoglycemia can be frightening and affect the quality of life of an individual. However, to determine the most likely cause, you would need to keep a record of your activities at night, the quantity and timings of meals and insulin at night, and your blood sugar reading. This would help draw out a pattern that could help in getting the possible cause.

For now, confirm that his present insulin is stored properly and has not expired, and also confirm that he has not mistakenly increased his insulin dose recently. This could be the cause of his recurrent nighttime hypoglycemia.

Once you get a two-week pattern, do let me know as it would help in knowing if his basal insulin requirement has changed, if he is having a delayed absorption, or if the time between dinner and night insulin dose is distorted. You can also share it with his physician.

For now, let him take bedtime snacks, and reduce activity at night, this would help reduce the risk of him having nighttime hypoglycemia. Preventing nighttime hypoglycemia would help improve his sleep and his overall physical and mental status.

The probable causes include the following:

1. Distorted time interval between nighttime insulin and meals.

2. Decrease the quantity of nighttime meals.

3. Decrease basal insulin requirement.

4. Defective/expired medication or poor storage of medication.

Treatment plan:

1. Keep a two-week pattern as explained above.

2. Take bedtime snacks.

Regarding follow-up: Keep me updated with patterns.

I hope this helps.

Take care.