I am 25 years old and have had type 1 diabetes for 12 years. My last A1c was 6.5% and I have no complications. I wake on my own a few times a year during the night with a low blood sugar; I take my glucose tablets and go back to sleep with no special problems. Recently, someone told me that new research shows that type 1 diabetics will not awake on lows. What is your opinion and what should I do about that?

It is has been shown in clinical studies that the longer you have diabetes, the more likely it is to have unawareness of low blood sugars. This is made even worse if you keep your blood sugars in the low normal range, where you have maintained them. It has been also shown that severe low blood sugars are often preceded by low blood sugars at night. My suggestion to you is to do some monitoring during the night. You can either wake up to an alarm at 2 to 3 a.m. or have one of the 24-hour sensors placed in order to screen for low blood sugars. I would suggest maintenance of glucose levels above 80 mg/dl [4.4 mmol/L] in order to minimize the risk of lows and hypoglycemia unawareness. Adjustments should be made in your basal insulin if lows are found.

JTL

[Editor’s comment: For more information, see Awakening from Sleep and Hypoglycemia in Type 1 Diabetes Mellitus.

BH]