My biggest challenge when it comes to managing my blood sugars is the overnight hours. I know it is largely due to the fact that I am a nighttime eater, consuming most of my calories after 7 pm. But I have also done some investigating and noticed my blood sugars naturally rise around 9-10 pm, so I am fighting an uphill battle. I started looking for some tips and tactics to try in order to improve my nighttime blood sugar levels.
Here are 10 tips on how to lower your overnight numbers, which will give you a better night’s rest too.
1. Don’t Eat Too Close to Bedtime
Eating at least two hours prior to sleep will give you more time to assess how your blood sugar is trending. If necessary, you’ll have an opportunity to get your blood sugars back in range before you fall asleep. Snacks can have unpredictable effects on your glucose levels – if you need something sweet to eat, try and have it at a time where you can monitor its effect.
If you think you need a bedtime snack to keep your blood sugar from crashing overnight, you probably need to adjust your basal insulin dosing. Skip down to tip #5 and consider doing a basal insulin test!
2. Embrace the CGM
Do you own a continuous glucose monitor (CGM) yet? Nothing is better for tracking and analyzing overnight blood sugar problems. Keep the high and low blood sugar alarms set to numbers that you are comfortable with, and the system will wake you up when it’s time for damage control. You can also share your readings with a caretaker or a loved one who could alert you of dangerous numbers if you are unable to wake from the alarm on your own. Most American health insurers now cover the CGM for people with type 1 and type 2 that require intensive insulin use.
Even better: closed loop systems like Tandem’s Control IQ make overnight adjustments automatically. Blood sugar goes high after bedtime? The system will sense it with a CGM, and the insulin pump will release the right amount of insulin. And you get to happily dream, undisturbed.
3. Try to Relax
It is known that stress can lead to higher blood sugar numbers and contribute to insulin resistance. When stress hormones like cortisol kick in, they can raise blood sugar levels, which is often what you see in the morning with dawn phenomenon. “Hyperglycemia is particularly exaggerated by elevations of cortisol and epinephrine in diabetes as a consequence of an altered response of the liver to these hormones,” scientists summarize.
So, put down your phone, drink some hot tea or read a good book in order to relax and put yourself in the right mindset for both in-range blood sugars and restful sleep.
4. Count Your Carbs. For Real.
If you are taking insulin, you already know you should be doing this on a regular basis. Since I am so picky and stick to the same foods, I really don’t count carbs at all. I already know what works for me. But when it comes to new foods, I use the “WAG” strategy (wild a** guess), which I admit is not exactly the best approach.
Make sure to count your carbs, know your carb-to-insulin ratio, time your dose correctly and keep your fingers crossed. Pumps have calculators built in to help make this easier for you and if you are on shots, you should check out the InPen, which has been a lifesaver for me in regards to getting my doses right and keeping my blood sugars in range.
5. Re-Test Your Basal Insulin Needs
If you have type 1 diabetes, this should come first no matter what blood sugar issues you are having. Without knowing the proper dose of “background” insulin your body needs, in the absence of food, it becomes much more difficult to figure out how to dose for meals, creating a rollercoaster of events. Our article How to Test and Adjust Your Basal Insulin Dose will set you in the right direction.
6. Set Alarms and Stick to a Routine
Bedtime routines are not just for children. Consistency will help you fall asleep faster and sleep better.
If you need to set a few alarms to keep your routine on track, go for it. And don’t forget to set alarms for medications, too. If you take your medication or basal insulin an hour too soon or too late, it could impact your blood sugar levels.
7. Adjust Doses If Necessary
We are often so busy that we forget that many different things can affect both our medication and insulin doses. If you recently lost weight, started exercising, are taking steroids, changed your diet, or have become pregnant, to name just a few, you should check in with yourself and your health care team to make sure you are taking the proper amount of medication. Ensuring that you are will no doubt give you better results at all times, including the hours of rest.
8. Don’t Exercise Too Close to Bedtime
Many of us have busy schedules that only allow for nighttime workouts. Exercise is great, and has incredible benefits for people with diabetes, but it can make blood sugar management a little bit trickier. If you need to work out at night, consider favoring lower-carbohydrate foods for dinner so that you don’t wind up with too much insulin in your system a few hours later when you are trying to fall asleep. And while cardio usually drops your blood sugar, weight training can spike it up. Just as with late night snacking, it’s better to give yourself a couple hours (or more) of buffer time before bed, during which you can respond to any blood sugar surprises. Being awake and alert for a few hours after a workout can only help your blood sugar management.
9. Be Wary of Delayed Blood Sugar Spikes Due to Protein and Fat
There are many times when two hours after dinner I am pleasantly surprised by my blood sugar number. But, I notice it starts to slowly creep up shortly after. Often this happens after protein-heavy meals like steak. Unlike carbs that quickly break down to glucose, protein can trigger a blood glucose rise that takes place slowly over many hours. Fat doesn’t usually have a strong direct effect on blood sugar, but it can significantly slow the absorption of the protein and carbs in your meal. When you combine large amounts of fat and carbs in a single meal, you can get the dreaded “pizza effect.”
If your dinner is fat- or protein-heavy, make sure to be aware that it might rise hours after you’ve stopped eating. We’ve got plenty of ideas for how to troubleshoot the pizza effect here, and we’ve also got advice on how to bolus properly for large amounts of protein.
10. Stay Hydrated
Many people with diabetes believe that proper hydration improves glucose control. In the Diabetes Daily forums and other similar communities, you can find many individuals that swear that a few glasses of water can, for example, help prevent or correct hyperglycemia. And whether or not you see a blood sugar improvement, proper hydration is a worthwhile health goal.
My advice is to make sure you get your water in throughout the day so you’re not paying for it with trips to the bathroom all night!