"How to get rid of recurrent hypoglycemia' - #20341

To identify the cause of recurrent nocturnal hypoglycemia, the most important investigations are:

Night-time glucose monitoring (preferably CGM)

Renal and liver function tests

HbA1c

Thyroid ± cortisol (if indicated)

Once confirmed, management usually involves adjusting insulin type, dose, or timing, rather than adding new medications

Hello dear See it seems medication are not effective or diet control is a failure. Iam suggesting some tests Please share the result with diabetologist or concerned physician only and take medication only after recommendation by concerned physician RBS Hba1 c Insulin therapy evaluation OTT Regards

Hello,

Most common cause: excess evening insulin / insulin peak during sleep

Investigations: 3 AM blood glucose CGM (if available) HbA1c Pre-bedtime glucose monitoring Renal function tests (urea, creatinine) Liver function tests

Other factors to assess: Missed or inadequate dinner Late-evening exercise Insulin timing, dose, and injection technique

Rule out Somogyi effect vs true nocturnal hypoglycemia

Cause is usually treatment-related, not a new disease.

I trust this helps Thank you

Hello Mahmoud Hesham Thanks for sharing the details. For a 50-year-old female with long-standing insulin-dependent diabetes and recurrent nocturnal hypoglycemia, it’s important to figure out why this is happening. Here’s how we usually approach it:

Key Investigations 1. Blood Glucose Monitoring - Frequent Self-Monitoring: Check blood sugar before bed, at midnight, and early morning (3–4 am) for a few days to confirm and time the hypoglycemia. - Continuous Glucose Monitoring (CGM): If available, this gives a detailed pattern of glucose fluctuations overnight. 2. HbA1c - To assess overall glycemic control and risk of hypoglycemia. 3. Renal Function Tests - Serum Creatinine, Blood Urea: Kidney problems can reduce insulin clearance, increasing hypoglycemia risk. 4. Liver Function Tests - Liver issues can affect glucose production overnight. 5. Thyroid Function Tests - Hypothyroidism can sometimes contribute to hypoglycemia. 6. Insulin Dose Review - Check timing, type, and dose of insulin, and any recent changes. 7. Other Relevant Tests - Electrolytes: To rule out metabolic causes. - Urine for Ketones: If hypoglycemia is severe or prolonged.

Additional Points - Review diet, exercise, alcohol intake, and any other medications. - Ask about symptoms before, during, and after hypoglycemia.

Thank you

Hello Mahmoud, thank you for sharing your concern. No investigations are needed to reach the cause as the cause is in front of us - INSULIN.

Consult your diabetes doctor regarding dose adjustment of insulin. It will fix the hypoglycemia issue.

Feel free to reach out again.

Regards, Dr. Nirav Jain MBBS, DNB D.Fam.Medicine