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, 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
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 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
For a patient experiencing recurrent nighttime hypoglycemia, it’s important to start by re-evaluating your insulin regimen and blood glucose monitoring patterns. Gathering data on blood glucose levels before, during, and after the night can provide insights into whether adjustments in insulin doses or timing might be needed. Consider keeping a detailed log of your blood sugar readings, foods eaten, insulin doses, and any exercise performed in the evening.
Since you’re on a mixed insulin regimen, one potential issue could be the long-acting component of the mixed insulin peaking too late at night, leading to hypoglycemia. Adjusting to a regimen with separate short and long-acting insulins may offer more precise control. Continuous Glucose Monitoring (CGM) could be useful if it’s accessible, as it provides real-time glucose readings throughout the night and may reveal patterns not seen with standard monitoring.
Checking renal function and liver function tests could also be considered since issues in these areas can affect insulin clearance and glucose metabolism. Comprehensive reviews of dietary habits, especially the carbohydrate intake before bedtime, might be helpful. Having a healthcare professional assess possibilities of autonomic neuropathy, including gastroparesis, if relevant, might be warranted. If these steps don’t elucidate the cause, referral to an endocrinologist for a more specialized assessment and possible adjustment of your diabetes management plan could be advisable.
