Nighttime Low Blood Sugar Introduction

Having low blood sugar while you are sleeping, or nocturnal hypoglycemia, can be a common occurrence in people with diabetes. The symptoms of low blood sugar are more easily recognizable when you are awake and you are more likely to have access to, and able to consume, a fast-acting carbohydrate to raise low blood sugar. Having low blood sugar at night is both frightening and potentially dangerous, and brings questions about being able to wake up when symptoms occur and having the ability to correct it.

It is important to take steps to avoid low blood sugar at night and be prepared to correct it quickly. First, work with your healthcare professional to understand the causes of nocturnal hypoglycemia and strategize how to minimize the likelihood of low blood sugar while sleeping. Also, be prepared to correct nighttime low blood sugar by keeping glucose liquid, gel or tablets by your bed.

Causes of Nighttime Low Blood Sugar

Nocturnal hypoglycemia, or low blood sugar while sleeping, is a common occurrence for people with diabetes. Symptoms may include nightmares, restlessness, night sweats, convulsions, morning headache and fatigue.

Some common causes of nocturnal hypoglycemia are:

  • Failure to check blood sugar level at bedtime
  • Missed bedtime snacks
  • Extra physical activity earlier in the day
  • Inappropriate medication dosage
  • Alcohol consumption
Prevent Low Blood Sugar While Sleeping

Tips to help prevent nocturnal hypoglycemia:

  1. Don’t forget to check your blood sugar. Check your blood sugar, or your child’s blood sugar, every night before bed. Make any adjustment necessary before getting under the covers, particularly when a snack is needed.
  2. Know your target blood sugar range. Work with your healthcare professional to determine your target bedtime blood sugar range and at what levels you should make a correction.
  3. Manage nighttime carbohydrate intake. Stick with your established diet/bedtime snack routine.
  4. Adjust for changes in physical activity. Intense physical activity earlier in the day may lead to nocturnal hypoglycemia.
  5. Think when you drink. Alcohol can have an effect on blood sugar levels, increasing the risk for nocturnal hypoglycemia.
  6. Discuss medication and blood glucose monitoring options. Consult with your healthcare professional about medications and different options for monitoring blood sugar levels while sleeping.*
  7. Source:

    *Briscoe VJ, Davis SN. Hypoglycemia in Type 1 and Type 2 diabetes: physiology, pathophysiology, and Management. Clin Diabetes 2006;24:115-121.

Be Prepared for Nighttime Low Blood Sugar

Whether you, your child or a loved one experiences nocturnal hypoglycemia, it is different than experiencing it during while awake. It may be dark. It is easy to be groggy. You or your loved one’s thinking and coordination may be off. Therefore, it is wise to think ahead and make correcting low blood sugar as simple as possible. The following are steps you can take to be prepared:

  1. Test before you rest. Test your blood sugar every night before you go to sleep.
  2. Correct with pure glucose. Pure glucose products – tablets, liquids and gels – are preferred for correcting low blood glucose. Keep a container of Dex4 liquid glucose on your nightstand for an easy and convenient way to raise low blood sugar at night.
  3. Be ready for an emergency. In case you experience severe nocturnal hypoglycemia and are unable to eat or drink, keep a glucagon kit next to your bed. Store the kit where it is easily attainable and let others know where it is. Remember that glucagon kits have an expiration date. Check your kit on a regular basis to make sure that it has not expired.
  4. Educate those around you. Make sure that your trusted family and friends know how to recognize the symptoms of severe nighttime low blood sugar. Also, let them know that they might have to seek immediate medical assistance if they are not comfortable using the glucagon kit or they feel you need emergency help.