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7K views 63 replies 7 participants last post by  Sam037 
#1 ·
Advice

I am diabetic 2. I currently take 1000 Metformin breakfast and dinner, 4m glimepiride at breakfast, and recently have added 50mg of Januvia with breakfast. I have had one heck of a time making it through the night. Since Januvia was added I am waking up sweating.
I was told to eat a snack if my reading are below 180. It seems I have to go to bed with readings between 179-200+ not to wake up sweating. Last night my reading were 150 at 11pm. I ate one handful of Pepita seeds, one handful of nuts, and a cheese stick. I had read an article that I should eat all protein. At 4am I woke up sweating. I got up and check bs after I composed myself and the reading was 124 which is not low blood sugar. I have tried other snacks with whole wheat bread, cheese stick, and 2 table spoons of peanut butter. I still get the same sweating around 1:30-4:30am. Can someone help me with this problem. I am staying up until 11:30pm until I go to bed. At 11pm is when I eat the snack. I don't know how much to eat or if I have to try different things. When I take my blood sugar it is never low. Most around 130ish. Sure would like some help. Sam037
 
#2 ·
Hi,
My name is Sam037. I have had diabetes for many years. I am still on meds and not insulin. I am so happy to join in hopes that I can find help which is not being solved by my doctor. I posted it, but don't remember what forum. Anyway, I am happy to find people that have the same problems that I do. This disease is sure not for sissies. :smile2:
 
#6 ·
Now.... to welcome you to the forum.

We're glad you joined us. Can you tell us a bit more about your overall blood sugar management? What is your diet like - specifically, what is your daily carbohydrate load. And what was your last A1C. This kind of information will help other members understand your situation better.

It appears that you aren't doing well at all with the Januvia. What were your blood glucose (BG) levels before taking it?

As you read through this forum you will find that most of us have greatly reduced our consumption of carbohydrates, which helps a great deal toward lowering and stabilizing our BG. We test a lot to see what the foods we eat do to our BG and if they raise it beyond the safe limit (140) then we either moderate portions or eliminate the food entirely.

You might want to look at the information on Blood Sugar 101 There are two sections that may be of interest to you: "How To Lower Your Blood Sugar" (a testing method), and "Diabetes Drugs" (pros and cons for all the medications prescribed for diabetics).
 
#7 ·
My diet

Thanks VeeJay,
My last A1C was 8.6. This was 4 months ago. My doctor I don't see until December. I see his PA. The put me on 100mg of Januvia, but I woke up with real problems on that dosage. I was having bouts of neuropathy in my sleep. I also have some heart problems (afib) and am on my 4th pacemaker after a complete ablation way back when. I found out this past year I have PSTD going back to the Vietnam era. My wife had always told me she thought I had it, but I just thought it was me being very nervous etc. I just can't talk about it, but broke down in my doctors office after something was mentioned by his assistance. I have been going to him for 18 years. He just told me I had seen things most people don't see. Which is true. My diet in the morning. I have a small bowl of egg beaters with flax in them, half of slice of turkey bacon, a slice of avocado, and a few blue berries. At lunch more protein, than carbs. My wife fixes it, but I don't eat very much. I weight 142lbs. Then we eat at around 6-6:30pm. I have a larger meal. I was on wafarin for 18 years and a few months ago the PA changed me to Xarelta. I sure enjoy my greens now. So I eat usually a salad, another carb, and then my protein such as fish and on Saturday night I have red meat. Then I have been having a piece sugar free pudding pie and a piece of pumpkin pie using Stevia. I was told to take a snack if my blood sugar is under 180. I read to take nuts, seeds, and cheese stick which is a protein snack. I asked the PA how much and he gives no answer. He says I am different than most diabetics because I am so thin. So I find myself trying to have my blood sugar high before going to bed which is 11:30pm. When my blood sugar is high like 175 I sleep until 6am and then eat my breakfast. My readings have been pretty good, it just this having the sweating occur like it did around 4am this morning. I have had it happen a quite often, but when I get up to go take it, it is not low. At 4:30am it was 124 and an hour later it was 142. I have had readings as high as 212, gone to bed, and sleep from lights out until 6am when I eat my breakfast. The PA keeps telling me I am going to be ok. I think he believes some of what I am experiencing is anxiety, but I don't think so. I have had bad dreams wake me up many times, but I never sweat until now. What I can't understand is why I have this sweating (no other hypo symptoms) and then when I check my blood sugar within a half hour it is not that low. For instance, one time I woke up two hours after going to bed. My blood sugar had dropped 40 points from 167 to 138. If that is a sudden drop would it make me sweat? I read somewhere if you don't check it right away your liver begins releasing glucose into the blood stream. I don't have any complications other than ED which I use Cialis for. Anyway, VeeJay this is my present story. My doctor is so busy I only see him twice a year. My cardiologist wants my A1C at 7. I walk for thirty minutes at 3.0mph every morning. I did walk a bit yesterday around 2pm, but only for twenty minutes at 2.7mph. Thanks for any comments. I am going to eat more tonight so my blood sugar is higher when I go to sleep. I didn't mean to write a book, but I guess I have. Do you know I have not seen a dietitian except once. This was two years ago and she wants me to eat 60 carbs/meal. My cardiologist couldn't believe it. OH VeeJay do you think I need to eat more before going to bed than what I am doing. I just don't know how much to eat if my bedtime reading at 11pm is in the 160's or below. Any higher than that I seem to be ok. Have a good evening.
 
#8 ·
I'm going to give you general advice that works for most diabetics.

There are three basic nutrients - carbohydrates (which raises blood sugar), protein (which may raise it some if one eats in excess) and fats (which do not raise blood sugar). So, for a diabetic, it makes sense to greatly limit carbohydrates, keep protein moderate, and fill up with fats.

It appears you are eating very little, and practically no fat. Its no wonder you're having difficulty controlling your blood glucose (BG) levels. When you don't eat very much and you're hungry, your liver most certainly will help you out with some glucose. The problem is that the pancreas doesn't provide a counterbalance of insulin to keep BG stable.
My blood sugar had dropped 40 points from 167 to 138. If that is a sudden drop would it make me sweat?
If you are experiencing Reactive Hypoglycemia, this is one of the symptoms. And it doesn't have to result in an actual low/hypo BG, it's the fall/crash that causes the terrible feelings (I know, I had this for years).

The treatment for both Reactive Hypoglycemia and diabetes is to not let BG go high in the first place. And this requires a systematic effort to keep the amount of carbohydrates with each meal low - making up the difference in calories with fats.

Blood Sugar 101 is a good site for understanding diabetes. The section "How To Lower Your Blood Sugar" is an excellent testing protocol for determining what the foods you eat are doing to your BG, and what to do about it if BG goes too high.

Take a look at the low-carb/high-fat (LCHF) way of eating here https://www.dietdoctor.com/low-carb Many of us on this forum find this way of eating to be extremely helpful in managing our diabetes.
 
#9 ·
A word of caution:

glimepiride and Januvia are powerful drugs with some serious side effects. When they lower your blood sugar by causing the pancreas to secrete insulin, the timing and amount is unpredictable - which is probably why you've been on this BG rollercoaster.

If you do lower your carbohydrates, keep a careful watch on your BG so that you don't go too low. You may need to adjust your dosage. (Personally, if it were me, I'd drop the Januvia before lowering carbs - just too risky.)
 
#10 ·
Hi Sam!

I wake up hot and sweaty between 2-4am too. :D

A quick drop in blood sugar can trigger feelings of hypoglycemia. You may want to stop targeting such a high pre-bedtime blood sugar goal and work towards getting your body used to safer numbers during the day. Over time your body will get used to not being high all the time, and taming wild swings helps you feel better all the time.

While it can be a sign of hypoglycemia, I wouldn't assume that it must be your blood sugar. There are other things that can cause similar symptoms, it's worth sharing this with your doctor and following up on a few other possible causes.

A few other things that the doc may look into just based on what mine has checked out already: nightmares, sleep apnea, cortisol, serotonin and sex hormones. I'm sure there are more, especially since you have heart trouble.

Either way, sorry that you are going through that. Dealing with this myself, I know how hard it is to have your sleep messed up so consistently like that.
 
#11 ·
My diet

My wife just said I am eating 2 carbs at breakfast, 20 at lunch, and around 40 with evening meal. She is guessing around 60 carbs a day.
She says I am getting around 50 fats per day. VeeJay, where do you get your fats from? Is there a way to print what you read and take it to the PA. I had not every heard of Reactive Hypoglycemia. The pharmacists don't even know about it for I asked three different ones about this problem. I know PA hasn't or he would have told me why I have these reaction when the my blood sugar is not in hypoglycemic range. My cardiologist told me the endocrinologist he know are having good luck with Januvia so I didn't question taking it. I most certainly appreciate your advice. The PA didn't want to put me on insulin. I know nothing about it. What is really strange is I have a niece who is an assistant professor ( dietitian/nutritionist at Boston College. She has never helped me other than she did tell me to stay as I am and not to go onto Januvia. I email her a question and she never replies so I quit. She has two children and of course her working. I understand why she doesn't have the time. I am going to make an appointment to get off the Januvia. Of course I will be right back where I was. But I can see I eat little carbs through the day. Well time to take my bs. It was 73 last night. I am going to read the basic 101. I have had his for at least 25 years. My A1C were 7.2 - 7.5 until the reading 3 months ago. I also read that an A1C is not the best method of keeping track for it just gives an average. It doesn't tell one how many lows, highs, or moderate readings one has had. Good evening. Sam
 
#12 ·
VeeJay,
This is what I eat. I don't drink alcohol, don't eat wheat even whole wheat, the only fruit I eat are 3-4 blueberries in the morning. My wife makes the pumpkin pie and sugar free pudding pie with no crust. I also noticed this was for loosing weight. My cardiologist wants me to gain weight. I suppose this is where the fat comes in, but I am not to eat saturated fat. He did tell me the red meat which is usually a filet on Saturday night. I eat nothing but sardines or Salmon with my lunch. Most of my fat comes from Extra Virgin California Olive Oil. That is all she cooks with. I will say I have began eating more protein than normal. My diet was not working and I believe it is because diabetes I have read is progressive.
 
#14 ·
I feel for you as you struggle to gain the upper hand with your diabetes. We have other members here who went onto insulin for similar difficulties, and after they did they wished they'd done it sooner.

Have you considered insulin, rather than more medication? This is what I would do if I couldn't keep my BG low and stable with diet and possibly metformin (a safe medication). It would also be easier to gain some weight.
 
#13 ·
Daytona,
Does this happen to you every night? My blood sugars have been better, it's just waking up all sweaty. I am just used to such a thing. I think VeeJay may be right about the Januvia, but it is now been on the market for ten years. You think I need to just put up with the sweating? I have been told to take a snack if lower than 180. Last night I ate all protein for a snack. I had read an article protein turning to glucose much later in the night. My blood sugar was 150 last night, I took a .5 handful of pumpkins seeds, the same for nuts, and then a cheese stick. It didn't hold it until when I wake up. I don't know if I didn't eat enough or the wrong thing. I talked to a nurse that told me one had to find the exact snack. Her father took nothing but peanut butter. I have no problems during the day at all. It is all just at night. Great to know someone else has this problem.
 
#16 · (Edited)
I did read that those on insulin go into hypoglycemia for at least two hours every day
That is very much not true, especially for type 2 diabetics who often have a working response to actual low blood sugar (<60).

Daytona,
Does this happen to you every night?
For the most part yes, I'm too stinking hot in the middle of the night, no matter what the room temperature is. :devil:

You think I need to just put up with the sweating?
The sweating is a sign of something, I don't think anyone is telling you to put up with it.

I have been told to take a snack if lower than 180.
Correct me if I'm wrong, but it sounds as if your doctor is encouraging you to stay above 180 at all times?

Here are the very conservative recommendations from the American Diabetes Association (ADA):

* Before a meal, blood sugar between 70-130.
* Under 180 2 hours after a meal
* A1C under 7%

Here are the slightly less conservative recommendations from the American Association of Endocrinologists (AACE):

* Fasting blood sugar should be under 110
* Under 140 2 hours after a meal
* A1C under 6.5%

Either way, your doctor is giving you advice that is against the standards.

None of us here can tell you what to do. But we are all encouraging you to decide for yourself (with the help of a doctor, maybe not this one):

* What level of blood sugars do you want to aim for to prevent diabetic complications?
* How do you want to achieve your blood sugar goals, such as further adjusting your diet, or reevaluating your current medications?
* Are you willing to accept all the known risks of Januvia, over other medications that have been proven over decades to be safe when taking correctly (such as insulin)?

I'm not trying to be mean or tell you what to do. :smile2: My apologies if it comes across that way. I only want to summarize what most of the members are saying and highlight the choices in front of you.
 
#15 ·
I didn't say no to insulin, it was the PA that stated I would have a difficult time with it. I did read that those on insulin go into hypoglycemia for at least two hours every day, but don't know it. Have you ever read anything like this? Well
I will be going to bed in three hours. The two nights before last I had no problems, but my blood sugar at bedtime was in the 170's at 11pm. I know I sure get tired of worry about it. I have never had any advice as to diet. My wife read and fixes my meals. I sure look forward to daylight. My wife gives me a rubdown most overnight. My brother said his wife has never given him a rundown. Of course she had headaches and rub her head, but hers are throughout the day. With me a good night VeeJay. I have had problems since I began the Januvia, but my reading have been better. Honestly when I first began taking it things were much worst during the nights. I was told my body would adjust. The first week on the 50mg I had no problems at all.
 
#17 ·
No Daytona the PA is telling me at night to take a snack if my reading is below
180 at bedtime. My readings have been pretty good, but if I go to bed with reading in the 160 and below then I have problems. Last night was not a good night. My reading at 10:30pm was 150+. So I began eating nuts, Pumpkin seeds, then a string cheese. I kept urinating, but I would take my blood sugar again after urinating and it was 152. This was an hour after the first time of snacking. This time I ate some cottage cheese and four small whole week crackers. I had to urinate again within an hour. I watched tv until 1am. I was afraid of having the reading suddenly drop. VeeJay says I am having Reactive Hypoglycemia. I did fall asleep and at 4am I could feel a bit of sweat under my arms. I am very tuned to my body. I have been this way most of my life. I was told by my cardiologist that Januvia has been good for diabetics. It has been on the market for ten years. We read that at night I should eat more low glycemic foods and high fiber foods. I am not able to see my doctor, but twice a year. I have been seeing him for 18 years, He has been among the top interns in the Phoenix Magazine three times. The PA is very bright and he knows what is going on. So if the reading is 170-180 I don't have to eat anything. I don't know why I kept urinating last night. If I don't reply quickly don't think I don't want your feedback. I don't get on the computer normally until after lunch. I got around 4 hours of sleep last night. As far as the insulin went he told me he was hesitate because of my anxiety. I mentioned in to VeeJay that I have PTSD from Vietnam war era. I have read that people on insulin have a lot of problems with hypoglycemia too. I don't know anything about taking it or when to take it or the kinds there are. I do know there are short and long acting. I had a neighbor that injected to much and he went into insulin shock. I remember the paramedics being there. How do they know how much one should take? Even my doctor wanted me put on the Januvia. They started me out with 100mg and I was going into read hypoglycemia at night. The PA is right, it scares me and now the Januvia is scaring me. The days are fine, but the nights I get tense. Thanks for your suggestions.. Oh my reading at 6am was 172. It jumps around a lot. It was 73 Wednesday evening.
 
#18 ·
No Daytona the PA is telling me at night to take a snack if my reading is below
180 at bedtime.
Ah, okay I was confused and thought you had to eat a snack any time of day to stay above 180. :smile2:

I watched tv until 1am. I was afraid of having the reading suddenly drop. VeeJay says I am having Reactive Hypoglycemia.
Based on your early morning blood sugar readings, it doesn't sound like reactive hypoglycemia. That is the term for when your blood sugar goes very low, like less than 70, then your body reacts by bringing your blood sugar up quickly. So I wouldn't worry about that right now. If you are able, please do not let that add to your worries. It is not dangerous and you do not need to stay up later than you prefer to avoid it.

I got around 4 hours of sleep last night. As far as the insulin went he told me he was hesitate because of my anxiety. I mentioned in to VeeJay that I have PTSD from Vietnam war era. ... The PA is right, it scares me and now the Januvia is scaring me.
Thank you for sharing and I apologize for jumping to conclusions. I didn't catch that you have PTSD and anxiety. We didn't intended to give you more things to worry about at night, and I think your doctors are taking into account a lot more than we knew about from only a few exchanges. So please, keep working with them and stick with what you are doing.

By the way, your pre-bedtime snack ideas are great! Nuts, seeds and cheese are great choices to help stabilize your blood sugar overnight.
 
#19 ·
Thanks Daytona,
I will say a few weeks ago my blood sugar dropped from something like 160 to 134 in one hour. I had the sweating, but I was not in hypoglycemia. It really scared me to go back to sleep. The PA wasn't that concerned. I begin getting tense around 8pm. I was in a store with my wife this afternoon and then I had some sweating underneath my arms. I was afraid I had a drop in my glucose. We got home and it was 157. This was an 1.5 hours after lunch. Thanks for your help. There is nothing better than to have someone to talk to
when something isn't going as you expect. This has been why wife has been the greatest person in my life. We have been married 45 years. So you don't think I need to freak out if I begin sweating at night. What I diabetic goes into hypoglycemia doesn't the liver begin dumping glucose into your system?
 
#20 ·
Correction: I don't know what I was thinking about your liver pouring glucose into your system when a Diabetic 2 goes into hypoglycemia. It doesn't because one must take instant carb. Sometimes I don't feel it, but I just can't figure out why I begin sweating at night and my blood sugar is not that low. It just does not make sense. When I check it, it is not low. I didn't walk on the treadmill this afternoon and my supper test was 132. Not a good reading before having supper. Thanks again for responding.
 
#21 ·
Hi Sam -

Welcome. Stick with this crew, they know what they're talking about.

So I'll add my two cents, mainly just sharing my experience with this lovely disease.

- I resisted insulin for a long time, but luckily came to my senses (thanks to all here) and starting using it and it changed my life. I had to beg my doctor to prescribe it - her concern and every other health professional I spoke to - constantly harped on about the hypo concern. And I have gone low a few times - 50's but it merely resulted in feeling a bit shaky and very tired. And was easily corrected.

- I won't take any other drugs except Metformin, mainly because of what I learned from Blood Sugar 101 Diabetes Drugs - Quick Summary

I recommend you read that - VeeJay gave you the link - I think it will really help you.

- I'm so happy you have such great support in your wife. And thank you for your service! Are you able to maybe talk to mental health care professional to help you with your PTSD?

- I really believe we have been duped by the sugar industry over the years and that fat is good for you. https://www.dietdoctor.com/

- I too get night sweats, but that's because I'm full blown menopausal which I know is not the case for you! but just wanted to commiserate about how horrible it is to wake up in the middle of the night soaked.. :)

- Regardless of what you take away from this forum, I wish you all the best of luck in getting this under control. Also, I would peck around at other posts so you can get a sense of what people here are doing to control their BG.

Good luck!
Kris
 
#22 ·
HI AUNTIE KRIS,
Insulin scares me. I don't really know how they chose what to give you, when one should take it, etc. I had a neighbor that tried to adjust his for a larger meal, over adjusted, and paramedics were called. The PA said he thought I would have a difficult time taking it with my anxiety as I have. My wife and I have been married 45 years. Back when I was in the service there was no name such a PTSD. When I came out I went back to college and couldn't even raise my hand to ask a question. During the Iraq war was the first time I ever heard it mentioned. It was around that time my wife told me she felt I had it. It's been 50 years since the war. Within the past year I was at the doctors office, and his assistant said something, and I just broke down. I began talking about things that only my wife knew about. My doctor said, "Good Lord, you have PTSD. At least it gave me an answer to why I have always had the problems I have had. I am 73 now and am much better than I was in passed years. I did a lot of drinking back then. I don't want anyone trying to get me to talk about it. My brother now knows. It was over the phone and for the first time I was ever on the phone talking he didn't say a thing. Normally he is to busy to talk. I had a difficult time telling him. Lot's of crying etc. He told me if I ever wanted to talk to call him. To tell you the truth
I just don't want to bring those memories back. Getting back to the insulin, how do they know what kind and when to take it. I guess it just scares me when I should be afraid to these drugs. Thanks for writing AuntiKris. Sam
 
#23 ·
Just wanted to address this comment of yours. I'm not saying you should, or should not, be on insulin. Just giving you some information about it.

Insulin scares me. I don't really know how they chose what to give you, when one should take it, etc.
You would not have to figure this out on your own.

The doctor would chose how to start you out on insulin based on what your blood sugar levels are - your fasting, and what your post-meal levels are. And he (and possibly a diabetes educator) would start you out with a conservative level of insulin (below what you might actually need) so that you would not go low unexpectedly. Based on your experience with that level of insulin, they would have you gradually increase the insulin until your blood sugar is within an acceptable range.
 
#24 ·
Sam,

Completely understand about the PTSD and not talking about it. Just throwing stuff out there to see if it can help in any way. I'm sorry it's been a struggle for you.

As for insulin, I'm a newbie so if I misspeak, I know others can correct me as I only have a very basic understanding of how it really works.

There are two types of insulin, basal and bolus.

The bolus insulin is the type that you take with a meal to cover the rise in BG and is fast acting. This requires a lot of calculation and tinkering, etc. and sounds stressful to me too! Seems like that's what your neighbor took.

The basal insulin is not fast acting. It's job is to match the liver’s secretion of glucose into the bloodstream (and to prevent the liver from over-secreting glucose). This is what I am taking. I started with a VERY low dose - like 2 units - and tested, tested, tested as I increased my dosage. As I said, it's really changed my life. I take it at night before I go to bed - a quick shot - and that's it.

Now, obviously you and your doctor know you better! So there's no pushing here, just sharing my experience, because it's been such a good thing for me. :)
 
#25 ·
AuntieKris,
Have you ever had a hypo on insulin during your sleep? See, I don't feel them anymore. I have been in the 60's and didn't know it until I took my reading the next morning. This is why he cut me from 100mg of Januvia to 50mg. I did sleep well last night after taking my snack at bedtime. The reading was 160, so I ate nuts, seeds, etc. I didn't sweat last night. I had asked someone does exercising in the morning effect bs during ones sleep at night?
 
#26 ·
Yes, I've woken up in the 60's a fair bit, but I always come up quickly once I start moving around and eat. And occasionally been in the 50's but have woken up and had a little snack and am fine. I think because I was in the 200's and 300's for so long and know of all the damage I was doing, that going a little too low seems tolerable to me.

Basically, the possibility of going too low is outweighed by the peace of mind insulin has given me in allowing me to control by BG much better than prior to insulin. I'm definitely mindful and manage the lows, but I've found it's not so hard to work it out. And unlike you, I'm very aware of when I go lower, so there's that.

As for exercise, personally it does wonders for my BG overall and helps me sleep better at night.
 
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#28 ·
For many people that I have talked to, the immediate blood sugar lowering effect of exercise lasts a few hours. Over time, consistent exercise helps you maintain good blood sugar all the time. I wouldn't assume that exercise is the cause of any unexpected blood sugar readings 10 hours later.
 
#29 ·
Hey Sam,

As for the night sweating, we (on the forum) can't diagnose or treat you. We threw out a few suggestions but really it is best to share your concerns with your doctor and they will be able to help you.

From what I see, you are doing a great job with your eating plan, exercise and sticking with the medications that they have put you on. So if you are having problems that they don't know about, or something has changed, let them know about it. :)
 
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