People with diabetes should be on guard against nocturnal hypoglycemia or night time low blood sugar because this can cause coma, seizures, brain damage and death, according to Dr. Richard Elwyn Fernando, a diabetes specialist and president of Diabetes Philippines.

Fernando said that nocturnal hypoglycemia affects up to 50 percent of adults with Type 1 diabetes and over 33 percent of people with Type 2 diabetes – one of the country’s top killers.

At the “Media Briefing on Nocturnal Hypoglycemia” organized by Novo Nordisk Pharmaceuticals (Philippines) Inc. on May 27, 2014 at Annabel’s Restaurant in Quezon City, Fernando said that nocturnal hypoglycemia occurs when blood glucose levels fall below the target physiological level at night time. This may be related to the dose of diabetes medication and the level of activities the patient has done during the day.

Factors that contribute to the development of nocturnal hypoglycemia include not having a night time snack when a person usually has one, imbalance between the diabetes medications a person takes and the timing and frequency of meals, early or delayed meals, increased physical activity in the last 24 hours, alterations in the level of insulin or other blood glucose-lowering medications, high-fat meals, and alcohol consumption.

While nocturnal hypoglycemia can be asymptomatic, some people may experience symptoms like difficulty waking up, night sweats, waking with a headache, waking up tired despite a full night’s sleep, nightmares, and talking during sleep.

Although the majority of people with diabetes experience nocturnal hypoglycemia episodes several times a month, Fernando said these remain underreported and many go unrecognized.

“This is because people with diabetes may not be aware they are having nocturnal hypoglycemic events and, therefore, are unable to treat themselves or to seek assistance,” he explained.

“Following a nocturnal hypoglycemic event, a person may experience physical fatigue and find it difficult to function at work. The person’s mood and well-being may also be adversely affected the next day,” Fernando said.

The problem is also a burden to family members who fear that the patient will become hypoglycemic during the night. This affects other people’s work, finances and various aspects of life.

To prevent nocturnal hypoglycemia, Fernando recommends eating a snack containing slow-acting carbohydrates or food containing a good source of protein before going to bed. These include raw vegetables (e.g. carrot sticks, cucumber, tomatoes), nuts, a small piece of wheat bread with a cut of ham or chicken slices, cheese, and apple slices.

For people with nocturnal hypoglycemic events that can be self-managed, Fernando recommends eating between 10 and 15 grams of fast-acting carbohydrates (like soda, a piece of candy or a small chocolate bar) after an episode occurs to quickly raise blood glucose levels back to normal.

People on insulin or other blood glucose-lowering medication who experience nocturnal hypoglycemic events regularly should talk to their doctor about decreasing their dosages.


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