This post may contain affiliate links. Please read our disclosure.
Having low blood sugar at night is the worst. THE WORST! If you are treating your diabetes with insulin, you know what I’m talking about.
That feeling when you wake up in the middle of the night soaked in sweat and shaking due to low blood sugar.
Your whole body goes into stress mode, and all you can think about is EATING! I absolutely hate it, so I wanted to share my approach on how to treat low blood sugar at night with you guys.
So, how do I treat low blood sugar at night?
What I do is treat it for what it is, a medical emergency. So I test my blood sugar and immediately eat or drink 8-15 grams of carbs in the form of 2 glucose tablets or 125 ml juice.
I then assess whether I need a low-glycemic carb as well. The assessment only involves checking that I didn’t bolus within the last 4 hours. If I did, I might have to cover that with a few rice cakes.
The reason why I say 4 hours is because I bolus with Humalog, which stays active in the body for about 4 hours. If it has been more than 4 hours since I took my bolus, I know that just the sugar or juice will get me through the night.
My recommendation is to be honest with yourself, and if you can’t go into the kitchen and just have those 15 grams of carbs without emptying the fridge every time, then keep your emergency carbs in the bedroom next to your bed (that’s always a good idea anyway).
I also recommend that you don’t treat your hypoglycemia with candy or cake. As I said, it’s a medical emergency and you need a carb that will hit your bloodstream quickly.
Pure sugar or juice is the best for that because the fat in candy or cake will slow down carb absorption. Also, you don’t need a treat in the middle of a low blood sugar. You’re not enjoying it anyway, just stuffing your face.
You can read more about the best and quickest ways to treat low in this post: How to Treat Lows as Quickly as Possible
How to prevent low blood sugar in the future
There is probably no way to completely eliminate low blood sugars at night, but I have learned how to limit them quite a bit.
What I do is pretty simple — I try to learn from my mistakes. If I have a low during the night, I’ll go back and see how my insulin patterns were the day before, what I ate, and what I did.
For example, my last low blood sugar was at 4 am a few nights ago, and when I went back and analyzed the data, this is what I found:
Since it was 4 am and my last snack was at 11 pm, the low couldn’t be due to my last bolus. I also hadn’t changed my basal amount. However, I had moved my workout to later in the evening.
So my conclusion was that to limit future nighttime lows, I should take less basal insulin before I go to bed if I work out later in the evening. That’s a pretty easy fix. I reduced my nightly basal and now I’m sleeping through the night again and waking up with perfect sugars.
For more in-depth tips on how to prevent low blood sugar at night, watch this video where I share exactly what I do:
Do my tactics work every time?
No, I still have nights where I go low and nights where I overeat to treat it, but they are really few and far between.
I’m not perfect, but always analyzing why I had a low and making adjustments going forward has helped a lot in reducing my nighttime lows.
And having the right food and drink easily available has helped me treat my lows in the right way.
I hope this can help some of you and I would love to hear your advice and tricks as well. If you have a smart way of dealing with nighttime lows, please write it in the comments so everyone can learn from it.
Arvinder Batta
I am very thin and want to put on some weight. How can I?
Christel Oerum
Hi Arvinder,
I’d suggest you start with tracking all you eat and have a good honest look at what you find. Knowing your baseline is how you can figure out what needs to change. You’re most likely undereating compared to your activity level and tracking can make you help assess what needs to change
Janet
I’ve only had T1 for less than two yrs and still learning. I have a CGM. What works for me is don’t eat late in the evening thus no insulin on board to worry about while sleeping. I aim for 90-120 bg at bedtime. I’ll eat a couple peanut M&Ms if I’m running lower than 90. If/when I do have a low in the middle of the night I chew 2-3 glucose tabs. I appreciate this post. Thank you for sharing!
Christel Oerum
Hi Janet,
You glucose tab strategy sounds much like mine. Your basal insulin (if not set correctly) can also result in a nighttime low, but having a CGM is a great way of preventing those lows, or catch them before they get really bad
Catherine
I didn’t know I was having nighttime lows until I got a CGM. I do wake up sweaty sometimes at night or restless. Should I be checking it when this happens? Is apple juice a good juice? OJ causes heartburn.
Christel Oerum
If you have a low blood sugar (below 70 mg/dl or 3.9 mmol/l) and you’re treating your diabetes with a blood sugar-lowering drug you need to consume glucose to adjust your blood sugar up. Glucose tablets or juice is excellent sources. It can be any fruit juice
Tanja Baker
Not all ppl will like this, but i promise it works and keeps my low suger up. If you test your suger before going to bed and it is under 5 you can eat bread with a peace of chees and apricot jam on it. ( it’s actually not a bad taste ) you’re suger will not drop during the night and will be about 8 in the morning. I am a tipe 1 diabetic for 24 years now and inject 5 times a day and this really helps.
Josie Wilkins
I always keep a banana on my bedside table! I find that it raises me out of my low to the perfect amount so I’m the morning I’m not left with a nasty sugar spike.
Nadine
I use a shot glass, so as not to turn up the juice container and guzzle; 55-70 bg, 2 shots and below 55, 3 shots. Have been doing this for about 2 years now, and since I’m not on pump, that formula has been consistent for me. I often use the shot glass method before a home workout too. It eliminates the guess work, most of the time ?
Christel Oerum
That’s a great idea, and one I haven’t heard before. Thanks for sharing
Joanne Hamilton
I take a blood sugar right before I go to bed. If it is 100 or below my pump trainer has me do a temp basal of 90% or so for about 3 – 4 hours , I try to get past the usual 4am “bs low” time period. I also may take one or two glucose tabs in addition to the temp basal. I do have the pump that suspends when I am low and sometimes I am sleeping so soundly I do NOT hear the alarm go off. My pump trainer has seen on my uploads where I have been suspended for the two hours and slept through it all. I live alone so there is no one to help me. I have woken up in the 30/40’s and that is when I walk into the kitchen and grab the container of jelly beans, go back to bed and have a sugar feast since the only thing on my mind at the time is to get my blood sugar back up. I realize at the time I am stuffing lots of calories plus sugar in but I just want that awful “low” feeling to go away. I do keep glucose tabs at my bedside. I sometimes eat a low fat cheese stick after the 4 glucose tabs as well. Thanks for the article to help us know we are not alone!!!! <3
Christel Oerum
Hi Joanne,
Sounds like you have your strategies in place. But yeah sometimes the urge to eat everything is too large. It happens.
Thanks for sharing
SANDEEP RAI
Hello there, just experienced this low sugar episode seeing my mom who’s type 2 at 3am she reported 55, we gave her glucose and it came upto 83
My question is how to level up her sugar by best combination
Christel Oerum
I recommend using glucose tablets or a glass of juice if she has a hard time with the tablets. You can also use honey or plain table sugar in water.
The reason I recommend glucose tablets is that Dextrose will increase blood sugars the fastest.
Your approach sounds perfect. Getting her up to 83 mg/dL is ideal. Hope that answered your question?
Kevin Shuster
Beautifully authentic response. It’s important to me because at 4AM no one sees me as the wolf man. It’s surreal, horrible, solitary….. those feelings don’t help me self manage or cope with the days schedule that starts in 3 hours (now on low sleep). Yeah so it’s normalizing to hear that someone else is stashing carbs at bedside and doing math, and pressing buttons in the middle of sleep.
BTW: how does one hear alarms if he should be lucky enough to fall asleep? I use a bluetooth ear bud, wirelessly connected to iPhone. When my sensor wants to talk to me, it pushes to the phone and to my ear…. volume is selectable, unignorable.. My diabetes alert dog sleeps at my side. He is 7 months old, and is self trained on the audibles coming from that ear bud. So he will NOT let me sleep through a hard low.
How I don’t go low at 4AM with brittle diabetes pattern: Bedside: Regular Vernors Ginger Ale (easy to open and understand and do…. all by yourself current can has been there for 6 months. for more durbulant carbs, bottle of diabetic freindly pre made protien shake. These are portable, will sit and wait years if need be open and drain, even if you can’t think you can drink. if things are just “trending” lower than ideal. Have a good supper, you know what to do there.. I might have a tablespoon of Peanut butter, tonight 2300 hrs. bG=121. Oh and I always have water bedside, car, long appointment.
Jen
After glucose or juice is taken I usually grab some small bonbons/tic tac/chewing gum – whatever to put in the mouth and chew/suck it until the crazy food craving goes away. Otherwise I risk to eat an elephant until the shaking stops.
Christel Oerum
That’s actually a brilliant idea. I agree that sometimes it require a great deal of distraction not to overeat. Good tips, thank you
Kathy
I treat my night time lows this way:
(1) test BG to confirm the low
(2) either have 3 glucose tablets or a very small juice (juice box size).
(3) depending on what time it is I may also add a small amount of fat or protein (e.g. 1 TBS peanut butter or 2 oz of turkey). I have found that if my low (usually in the 50s) happens around 2 or 3 am and I only treat with glucose or juice, I will have another low in a couple of hours. If I add fat or protein I can make it to the morning without a second low.
If I don’t have access to a fat or protein and it is several hours before breakfast I will suspend my pump. I’d rather wake up with high blood sugar than risk repeated lows during the night.
I have also noticed a side effect of night time lows…I wake up with a headache! This does not happen with lows at other times of the day….strange….I don’t know if other type 1 diabetics experience this as well.
Christel Oerum
Hi Kathy,
Thanks for your comment.
Your hypo treatment regime sounds really sound. And you are not the first to suggest adding a little PB, definitely something I have to try if needed.
I sometimes get headaches if my sugars are going up really quickly, I wonder if that could be the case for you as well?
Christel
Mary Jane
Yes – I always know I’m low when I wake up with a headache .
rena
almost every time I wake up with a low in the middle of the night I experience a headache which seems to hang on throughout the day. 1/2 cup of orange juice usually gets me in the right direction for the blood sugar level. it only takes 15 minutes to 1/2 hour to recover.
yahor
Nothing new for me but thanks for summarizing. Have you thought about the soft drinks? I feel like carbonated water makes it faster to absorb in your mouth.
And there is a typo. 150 ml not 15=)
Do you know any athlete endocrinologist? I am wondering what should I do if I compete in martial arts? Shall I keep my BG around 200? That doesn’t seem like a good idea.
Christel Oerum
Hi – thanks for the comment. You are right there was a 2 missing, I drink 125 ml (the small juice boxes). It’s fixed, thanks.
I’ve never used soft drinks, it’s worth considering. I try to keep my diet as ‘clean’as possible so that’s why I gravitate to juice.
If you send me an email I’ll send you the name of one endo I know that works with athletes. You can reach me at christel@diabetesstrong.com
Marcia Glaser
I recommend having a box of raisins next to your bed. It’s a natural sugar and works every time for me and you don’t have to get up to go to the refrigerator. If my sugar is at 80 it will raise it enough to get me through the night. If you’re lower than that eat 2 boxes. Typically when I’m at 55 2 boxes will get me back to around 130 or so. I try to stay between 100-120 but I’m a brittle diabetic on a pump with a sensor and it’s a daily challenge.
Christel Oerum
Thanks for the comment Marcia,
I think raisins are a great idea. I sometimes use that as my backup snack when I’m out and about. I don’t eat them at night though, since I find they are a pain to get out of my teeth, and I don’t want to spend too much time flossing in the middle of the night. So that’s mainly me being lazy…