Each night, sometime between 1am and 4am, Nicole will wake up naturally (or unnaturally). Sliding a test strip into her glucometer its digital display illuminates the room with a soft glow. Pricking her finger, she uses a flashlight to get the blood on the test strip.
If the blood sugar is above 5.2 mmol/L, she heads to the kitchen. Opening the fridge, she pulls out a pen full of Humalog and dials in a correction dose.
If her blood sugar is below 4.2 mmol/L then she’ll take the appropriate amount of Glucolifts and a swig of water.
Either way, she still makes a trip to the fridge for a long-acting dose of Levemir. We’ve found that if she breaks up her night-time dose of Levemir, she avoids going low in the middle of the night. So that’s 4 units at 9pm, and then another 1 units whenever she wakes up in the night.
So each night she awakes to correct her blood sugar (if needed) and take some Levemir and goes back to bed.
This early morning blood sugar check is critical to keeping her HgA1C down. If she waits until she gets up in the morning the blood sugar can end up being dramatically off course. We learned this approach from Dr. Bernstein’s Diabetes Solution. It seems type-1 diabetics can’t enjoy the luxury of sleeping the whole night through. Non-diabetics pancreas’ don’t take a break at night, after all.
Why Not Set An Alarm?
Nicole used to set her alarm clock for 1am. This was really the most ideal time to check her blood sugar. It allowed enough time for her dinner insulin to do its magic. Because of her gastroparesis she often can’t take her dinner insulin until 8pm or 9pm (even though she ate at 6pm). Fast-acting insulin tapers off after five hours (see chapter 19 in Dr. Berstein’s Diabetes Solution for a graph). So she could take a correction as early as 1am without risking an overlap.
The only problem with getting up to an alarm clock at 1am was that she wouldn’t go back to sleep. She’d end up losing several hours of sleep each night and feel awful in the morning. On the flip side, she’s never been one to sleep the entire night anyways. After much experimentation, she’s found it’s better to wait until she wakes up in the middle of the night on her own. For whatever reasons, when she does it this way, she can usually fall back asleep without too much trouble. It certainly saves money on melatonin supplementation.
Better Blood Sugars Versus Better Sleep
The improved sleep outweighs the benefits of slightly better blood sugar control. That said, her HgA1C has remained at 5.2% despite her lack of noctornal vigilance. It’s one of those holistic decisions, where she felt she had to weigh the pros of better blood sugars, with the negative side effects of less sleep.
Of course, they overlap, don’t they? Sleep deprivation seems to lead to higher and more erratic blood sugars. I assume losing sleep puts the body in a stress response. This would result in more sugar being released by the liver into the bloodstream. The primal mind assumes that a tiger must be clawing at the cave’s door. What other reason would cause you to interrupt your nighttime rest?
So, possibly, avoiding the rigid 1am call to finger pricking helps preserve the sacred A1C.
What About Sleeping Through a Low Blood Sugar?
Nicole eats low-carb meals which require little insulin. There isn’t much risk of her overdosing and going seriously hypoglycemic in the middle of the night.
Her lower carb diet also seems to afford her a much higher tolerance for a low blood sugar. She no longer becomes a quivering, irrational and plant-throwing lunactic when her blood sugar goes below 3.9 mmol/L (70 mg/dL).
Also, often the discomfort caused by slightly lower or higher blood sugars wakes her in the middle of the night at the most opportune time to make a correction.
The 4am Deadline
As along as Nicole wakes up by 4am she’ll have 5 hours before she breakfast at 9am. This way, if she does requires a dose of Humalog (to correct a high blood sugar) she can still take another correction before breakfast.
If by some miracle of anti-insomnia Nicole actually slept the whole night, she would only take a correction at 7am. She then skip doing a correction before breakfast, two hours later.
But 98% of the time, Nicole will awake by 4am. Usually hours earlier.
Or, sometimes, our 7-year old son will wake her. One night, he lost his eye-mask, rolling around in bed. So he started screaming. This is obviously something worth screaming about. How can you expect a blind body living in the country (where there are no street lights) to sleep without his eye mask? As it happened, that night Nicole’s blood sugar had dropped to 3.0 mmol/L (54 mg/dL). So the timing was excellent.
Nicole uses Glucolifts to correct low blood sugars. To read a humourous and critical letter to the founder of Glucolifts please read Mugwort-Garlic Flavoured Glucose Tablets. To order your own Glucolifts, and support this blog, please click here. To learn more about using Dr. Bernstein’s methods for normalizing blood sugars please read Unconventional Type-1 Diabetic Wisdom: Review of Dr. Bernstein’s Diabetes Solution.