How to Detect Hypoglycemia While You Are Sleeping

Abstracted from Dr. Bernstein’s book “Diabetes Solution”
© 2007 by Richard K. Bernstein, M.D.

The signs of hypoglycemia during sleep include cold, clammy skin, especially on the neck, erratic breathing, and restlessness. It certainly helps to have a light sleeper sharing your bed. Parents should check diabetic children at night and should feel their neck.


Review your Glucograf data sheet after all hypoglycemic episodes, even mild ones. It’s important that you reconstruct the events leading up to any episode of low blood sugar, even if it caused no notable symptoms. This is one of the reasons why we recommend (page 76) that most insulin-taking diabetics keep faithful records of data pertinent to their blood sugar levels and why we went into so much detail in Chapter 5 teaching you how to record the information. Since severe hypoglycemia can lead to amnesia for events of the prior hour or so, habitual recording of relevant data can be most valuable for this scenario.

It is certainly helpful to record times of insulin shots, glucose tablets, meals, and exercise, as well as to note if you overate or underate, and so on. Recording blood sugar data alone may not help you to figure out what caused a problem. If you experience a severe hypoglycemic episode or several mild episodes and cannot figure out how to prevent recurrences, read or show your Glucograf data sheet to your physician. Your doctor may be able to think of reasons that did not occur to you.


Keeping Hypoglycemia Supplies

Glucose tablets, glucose gel (Glutose 15), and glucagon can each potentially save your life. They won’t help if they’re not around or are allowed to deteriorate. Here are some basic rules:

  • Place supplies in convenient locations around your house and workplace.
  • Show others where your supplies are kept.
  • Keep glucose tablets in your car, pocket, or purse.
  • When traveling, keep a full set of supplies in your hand luggage and also in your checked luggage—just in case a piece of luggage is lost or stolen.
  • It may be wise to replace glucagon on or before the expiration date on the vial. In an emergency, however, it isn’t necessary for your savior to worry about the expiration date. In the United States, glucagon is usually sold with very short dating. Many people are sold costly emergency kits marked with expiration date only a few months later. Don’t worry. Glucagon is sold as a freeze-dried powder that will probably remain effective for five years after the “expiration” date, unless of course it has been exposed to moisture or extreme heat (as in a closed car in the summertime). It retains its longevity especially if it is refrigerated. Once diluted, however, it is good for only 24 hours.
  • Always replace supplies when some have been used. Never allow your stock to become depleted. Keep plenty of extra glucose tablets and blood sugar test strips on hand.


To make sure you are not caught unprepared by low blood sugars, you should always keep the following supplies on hand at both your home and your workplace:

If You Take OHAs or Even ISAs

  • 1–3 bottles (100 tablets each) Dextrotabs or other glucose tablets; always carry glucose tablets with you

If You Take Insulin and Do Not Live Alone, You Also Need

  • One package of three tubes Glutose 15
  • Glucagon Emergency Kit
  • 4-ounce bottle metoclopramide syrup

Emergency Identification Tags

If you use insulin or OHAs, you should wear an identification tag that displays a recognizable medical emblem, such as a red serpent encircling a red staff. The tag, which may be worn as a bracelet or necklace, should be engraved with a message that relates to the treatment of hypoglycemia. My own bracelet is engraved with the following message: diabetic. if conscious — give candy or sweet drink. if unconscious — to hospital. Since bracelets are more likely to be spotted by emergency personnel, I prefer them to the necklaces.

Most pharmacies and jewelers sell medical ID tags. Prices begin at $5 for stainless steel and go into hundreds of dollars for solid gold. The MedicAlert Foundation, Turlock, CA 95381, will keep a record of your stainless steel ID bracelet or necklace, with their emblem, for $45. Sterling silver or gold-plated IDs cost slightly more. Beautiful 14-carat gold IDs are available at considerably higher cost. They will also engrave the tag diabetic for the same cost. All tags are stamped with your special ID number and with their “call collect” 24-hour telephone number. By phoning this number, a hospital can secure your name and address, contact information for your next of kin and physician, a list of all your medical conditions, and the doses of medications that you take. You can obtain an application form by writing to the above address or by phoning (800) id-alert.

Diabetics who do not take medications that can cause hypoglycemia would also be wise to wear a MedicAlert bracelet, if only to discourage the automatic use of intravenous glucose infusions—a common practice of emergency personnel on victims of motor vehicle accidents, heart attacks, and so on.

Emergency Alarm Service

If you live alone, you may want to consider using an emergency alarm system. These can automatically phone a friend, relative, or emergency squad when you push a button on a necklace. The system can also be activated if you do not “check in” at predetermined time intervals. The least expensive system that I have encountered is supplied by the MedicAlert Foundation. Their “failure to check in” alert unfortunately can only be activated at 24-hour intervals, so you can be unconscious for 24 hours before someone is notified.