Late Night with Hypoglycemia

Have you ever found yourself in this situation? It’s late; you’re either studying hard for an exam or working up to the last minute on an important assignment. You’ve quickly burned through the midnight oil, filled with anxiety of the impending deadline, and all of the sudden your blood sugar is plummeting! As if you didn’t have enough to worry about, now you have to take precious time (that you can’t really afford to waste) to correct this pressing issue.

Studying for my medical licensing boards was really the first time I found myself in these situations with enough frequency to finally recognize this problem. After two years in school of specific, contained body systems learning, all of the sudden I was being tested on what appeared to be every bit of science I had learned over the years in both my graduate and undergraduate studies combined. So every night in the days leading up to my exam, I found myself studying with an intensity I had never experienced before, and over a longer duration of time. My blood sugars certainly reflected this change. It seemed that without fail, I would be studying late in to the night with an even blood glucose trend, until I would feel abnormally exhausted or have a splitting headache. I would check my blood sugar, and find that I was low seemingly out of nowhere!

So why did this keep happening?

Diabetics are often in tune with the idea of making adjustments for physical activities and exercise, but how often do we account for all the mental activities an exercises going on between our ears?

Suddenly, the need for the phrase “Brain Food” is better contextualized when we remember our brains are our most energy-demanding organs, using up to one-half of all the free sugar energy available in the body2. Just as we think about fueling our muscles for different types exercise, we need to similarly fuel our minds differently when we need high-powered brain output for longer time periods than usual.

Our abilities to problem-solve, recall, and learn new information are closely related to our blood glucose levels.

Anyone with Diabetes can attest to the cloudy, impaired thinking that comes with high blood sugars, as well as the anxious, jittery feelings that come with low ones.

As it would turn out, the science behind our brain function tells a more concerning story. When there is not an adequate amount of glucose available to the brain, communication between neurons break down and the proper signaling through neurotransmitters are not sent. Without that communication, your total cognitive function falls and you can no longer remember concepts you committed to memory or solve problems you would normally figure out.

Diving further, studies have used Magnetic Resonance Imaging (MRI) to see specifically the areas of the brain where neuronal firing is impacted by hypoglycemia, and three specific deficiencies were found1,3:

  • Autonomic Activation: the part of the nervous system responsible for control of the bodily functions not consciously directed, such as breathing, the heartbeat, and digestive processes
  • Hypothalamic Function: which controls body temperature, hunger, personality, thirst, fatigue and circadian rhythms
  • Cortical Function: The ability to control body movements, feel sensations, as well as responding to reaction time.

So it’s easy to say that we aren’t ourselves when these effects take place, and the effects of our low blood sugars greatly impact our ability to function when just at a moderately low blood glucose level. There’s of course the risk of coma if it ever were to drop to a level too severe.

On the other side, stuffing our faces with too many carbs and becoming hyperglycemic is, of course, not the answer either.

Excess glucose consumption by our brains can lead to their own memory and cognitive deficiencies.

High blood glucose levels can actually lead to brain atrophy, or shrinking, over a long period of time. As for the blood vessels supplying nutrients to the brain? They can become atherosclerotic, or thickened to where blood flow is severely restricted.

So how can we avoid these horrible outcomes, but still stay up late and get our work done?

It starts with thinking of our brains as we do the muscles in our body. We need our blood sugars to maintain a level high enough to not drop into dangerous zones but not so high as to lead to cloudy and impaired thinking.

As with anything specific to diabetes and your body’s reaction, you should speak with your physician before making any drastic changes to your regimen, but what we hope to offer you here is a few helpful tips to consider:

Lower Basals: Pump users should experiment with slightly lower basal rates for long nights of study or work. For me, lowering my basal settings by about 15-20% for the duration of my extended study time past 11 PM has been especially helpful in avoiding nighttime lows when I am working late.

Snack Smart: “Brain Food” is a necessity to staying awake and focused on the tasks ahead. The dangers arise when you indulge on high carb or glucose concentrated foods. If you snack like I do, it’s not so much one meal and nothing in between, but rather a slow sampling of a variety of foods over a period of time. Continually bolusing insulin over and over again will lead to insulin-stacking, where a lot of insulin will seemingly hit your body all at once and cause your blood sugar levels to plummet at a time much later than you anticipated. Try high-protein and natural fatty foods, which will slow release and lessen your need for high bolus amounts at one time.

Remember Caffeine: When you’re staying up late, you’re often looking for energy from a source coming from a cup, can, or otherwise. Remember that caffeine not only affects your ability to stay awake, but also significantly increases your body’s metabolism. Ordinarily, your body’s metabolism is low at night, so be wary of how your body’s normal glucose ranges may be affected by the shift in inner processing brought to you courtesy of all the caffeine you intake in order to stay awake.

Diabetes complicates social activities, exercise, recreation, and just about every aspect of our lives. Working late into the night is just another aspect for which we need to account. But, same as all other things, with a little forethought, we can avoid the nasty complications that come with uncontrolled blood glucoses that may stand in the way of all that we set out to accomplish.

So Think Ahead, Work Hard, and Carry On!


  1. Cryer, Philip E. “Hypoglycemia, Functional Brain Failure, and Brain Death.”Journal of Clinical Investigation117.4 (2007): 868–870. PMC. Web. 14 May 2017.
  2. Edwards, Scott. “Sugar on the Brain”. On the Brain: The Harvard Mahoney Neuroscience Institute Letter. Havard school of Medicine. http://neuro.hms.harvard.edu/harvard-mahoney-neuroscience-institute/brain-newsletter/and-brain-series/sugar-and-brain. 2017

3. Rosenthal, J. Miranda; Amiel, Stephanie A.; Yágüez, Lidia; Bullmore, Edward; Hopkins, David; Evans, Mark; Pernet, Andrew; Reid, Helen; Giampietro, Vincent; Andrew, Chris M.; Suckling, John; Simmons, Andrew; Williams, Stephen C.R.; Diabetes. American Diabetes Association, 2001 Jul; 50(7): 1618-1626. https://doi.org/10.2337/diabetes.50.7.1618

“Going Low” An Athlete’s Perspective

It’s the reason you keep juice in the refrigerator, a Gatorade in your gym bag, and candy in your girlfriend’s purse. “Going low” can be described as that strange, empty feeling pitted in the center of your core that leaves you anxious, irritable, and even worse, sweaty.

‘Hypoglycemia’ is simply defined as the condition in which your concentration of blood glucose is lower than normal. For most diabetics, we start to experience symptoms somewhere in the 70’s or lower (mg/dl). While this condition can be experienced for a multitude of reasons, every diabetic is well aware that they are especially at risk during exercise.

For athletes, the fear is not so much worrying about the hazards of going too low. We all know the consequences: if left untreated, low blood sugars can lead to seizures or coma. But while it may sound illogical, incomprehensible, and fairly reckless to non-athletes, these serious dangers associated with our blood sugar dipping too low are not usually our main concerns.

The diabetic athlete just hates being told “No.” It is the desire to avoid sitting out of an activity that usually motivates us to stay above normal blood glucose ranges.

We don’t want to have to stop exercising.

We don’t want to sit out of practice.

And we certainly don’t want to distance ourselves any further from our friends and teammates.

The diabetic take on FOMO (“Fear of Missing Out”) creates an unintended consequence: diabetic athletes often overcompensate with high blood sugars.

In the ultimate case of shortsightedness, we sometimes take the immediate benefits while disregarding long term detriments we tax onto our bodies. I know for sure that if I trend a little higher than I should, I may not feel awesome, but I certainly won’t have to sit out. It was this careless thinking that led to me walking around with an A1C pushing double digits for a stretch in my high school football days. My brash justification for carrying sky-high blood sugar levels was that my team couldn’t possibly afford to have me sitting out for any extended period of time. I completely ignored any long-term effects I was causing myself, let alone the extremely clouded judgment and sensation of nausea I experienced when I was on the field.

Thankfully, I eventually saw the error in my ways. While maintaining a blood sugar level in the 200’s did indeed keep from me from going too low, I was sluggish, disoriented, and often a liability to my teammates. I came to realize that playing sports at a blood sugar level only slightly above my normal resting range actually provided me with more energy and allowed me to perform at my full potential. Meticulous preparation and consistent glucose level testing in order to remain in the proper range instantly became preferable to dumping high amounts of sugar into my body before game time and simply hoping for the best.

As diabetics, we have to resist the temptation of immediate security and trust ourselves to find solutions more beneficial to our bodies in the long run. I challenge each one of us to continue to explore the blood glucose levels in which we feel comfortable exercising. Obviously it is imperative that you exercise extreme caution, as there will undoubtedly be challenges along the way in the form of going too low. But in my experience, it was when I truly challenged the lower end of my higher “exercise BG range” that I overcame a lot of my fears about “going low” and ultimately flourished. I found a new range where I experienced a ton of energy, a clear mind, and a higher conditioning level. While you definitely want to exercise at a blood glucose level above your normal, resting level, the key is to find a level that’s not too high.

Through Lyfebulb, consulting with your doctors, and your own safe experimentation, you have the ability to work out and keep up with (or surpass) the insulin producing, non-diabetic athletes in the world. All it takes is patience, persistence, and dedication to the cause.

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