NIGHT REACTIONS – CAN YOU FIGURE THIS OUT? | Panic Attacks

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NIGHT REACTIONS – CAN YOU FIGURE THIS OUT?

Question:

[snip] questioning him with regard to Dawn Phenomenon vs. Rebound, it became embarrassingly clear that he didn’t have a clue what I was talking about. This was our visit to a "professional". I do indeed look to the "laymen" in this group for help, because they have been in the trenches and they know what the heck they are talking about. We have learned more from the "laymen" on-line in the last few weeks than from years of doctor visits and reading worn-out diabetes manuals.

[snip] There are good doctors and bad doctors. How about getting a doctor who him/herself has diabetes?

Response:

In [(INT) MISC.HEALTH.DIABETES] on <08 Jan 97 23:50, … Ru We’ve spent untold hours studying the available literature. The closest Ru explanation that makes sense to me is that the fact that her stomach is Ru empty in the middle of the night, combined with the action of insulin, Ru create an "impression" of a drop by the endocrine system, triggering the Ru release of glycogen and adrenaline. This occurs even though she is not Ru really "low". That’s the only explanation we have right now. Ru Any ideas? This is my impression: a marked drop in blood sugar can cause the reaction you mention. It has happened to me both at night and in the daytime. The one idea I have is to explore all ways possible to avoid any quick drop overnight. Insulin adjustment as well as diet adjustment may help. Good luck, nell

Response:

Blood sugar does not differ substantially throughout the body. To suggest that this person should ignore the meter and proceed to adjust insulin based on perception is reckless advice. There are many reasons why one’s perceptions of blood sugar should not be trusted. If one doubts the meter’s accuracy, then test again.

Russ, You & your wife have probably already thought about this, but, just in case, I thought I’d suggest it. I don’t know what meter your wife uses, but she has tested the meter itself right? Just to make sure it’s giving correct readings? Best wishes, Cathy Potter

Response:

– Hide quoted text — Show quoted text -netaxs.com!feed1.news.erols.com!worldnet.att.net!newsadm My wife is still having problems with evening reactions that are wearing her out. She is Type II-R, is currently trying a new regimen of morning and bedtime Lente and morning and lunch Humalog. Here is what is happening: She goes to bed after taking her Lente (currently 20u) around 10PM, with a bg of 160-180. She wakes up, heart racing and pounding around 2 or 3am, tests and has a bg of anywhere from 140 – 190. At first, we figured that she must have gone low just prior to the reaction (maybe a rebound), so we began to wake her earlier and test, but she was not low. Some of you have offered suggestions, but nobody has come up with an explanation of why she wakes up with rapid pulse and pounding heart. These "spells" are quite serious, leaving her worn out and despairing. The doctor has no explanation. She feels strongly that the cause is insulin-related, as it seems so similar to her to a bg low she has experienced in the daytime. But why is her bg not low if that is the case? Any ideas? – Russ White

Here’s an idea I heard once at diabetic camp. I don’t know if this is applicable to type II or not, because I’m type I. I was told that sudden sharp drops in blood sugar – even if the sugar is not too low – can cause low bg reaction-like symptons. So if the bg dropped from high to a bit lower suddenly, that *could* cause the symptoms. Or it might not be diabetes-related at all. Maybe she is having panic attacks or night terrors. Fluctuatins in blood glucose often cause me to have nightmares. — "I think extreme heterosexuality is a perversion." –Margaret Mead

Response:

Excerpts from netnews.misc.health.diabetes: 9-Jan-97 Re: NIGHT REACTIONS Blood sugar does not differ substantially throughout the body. To suggest that this person should ignore the meter and proceed to adjust insulin based on perception is reckless advice. There are many reasons why one’s perceptions of blood sugar should not be trusted. If one doubts the meter’s accuracy, then test again.

Or test the meter — all meters have "calibration" juice to check the meter’s accuracy. toodles, gretchen

Response:

< Do you have any substantial evidence to support your trust in your wife’s "feeling" or is your trust also based on "feelings"?

Yes, Dan, I do have substantial evidence to support my trust in my wife’s feelings. They are usually right! You indicate that you have spent "untold hours studying literature…" and now you are looking for an explanation from an on-line news group consisting of laymen who may be more than willing to share their unsupported "feelings" with you and some professionals who I would hope would do nothing more than recommend that your wife consult a practitioner (face to face).

Dan…..really. Have you ever been to an HMO doctor? My wife has been to a dozen. If you can get them to listen to anything you have to say, or make eye contact for 10 seconds, it is a miracle. In fact, we visited a doctor just last week with this problem. The doctor looked at the chart, mumbled a little, and then gave an instruction for a change in the insulin dose that made no sense at all. When I argued with him, questioning him with regard to Dawn Phenomenon vs. Rebound, it became embarrassingly clear that he didn’t have a clue what I was talking about. This was our visit to a "professional". I do indeed look to the "laymen" in this group for help, because they have been in the trenches and they know what the heck they are talking about. We have learned more from the "laymen" on-line in the last few weeks than from years of doctor visits and reading worn-out diabetes manuals. Your wife’s health would be best served by a visit or even a telephone call to her doctor rather than an on-line request for strangers’ opinions!

Dan – you try calling our doctor. If you can get through to him (impossible), see if you can understand what he’s saying (a nice guy, but he has trouble speaking English). I’ll stick with my friends (you can call them "strangers") on-line. -Russ White

Response:

| Any ideas? – Russ White Your wife could be having lows. Your meter only tests for blood sugar in the arms, not in the brain. If your brain senses low blood sugar, it will alarm the body. It sounds like your wife is taking too much ultralente. 20 units twice a day is too much. How about reducing that to 10 units twice a day. And complementing this with an increase in R before meals?

Response:

Russell White writes: My wife is still having problems with evening reactions that are wearing her out. She is Type II-R, is currently trying a new regimen of morning and bedtime Lente and morning and lunch Humalog. Here is what is happening: She goes to bed after taking her Lente (currently 20u) around 10PM, with a bg of 160-180. She wakes up, heart racing and pounding around 2 or 3am, tests and has a bg of anywhere from 140 – 190.

Russell, I am curious if your wife feels other things besides her pounding heart – does she feel tense, or scared, or sweaty? Does she feel like she is standing on the edge of a tall building? Or is it primarily just a pounding heart? If she also feels some of these other things, I have a few thoughts which I will explain if relevant. Mark

Response:

Do you have a actual count of her normal pulse and night time racing? – Hide quoted text — Show quoted text – Russell, I am curious if your wife feels other things besides her pounding heart – does she feel tense, or scared, or sweaty? Does she feel like she is standing on the edge of a tall building? Or is it primarily just a pounding heart? If she also feels some of these other things, I have a few thoughts which I will explain if relevant. Mark Mark, No – I know where you’re heading. It is not anxiety – she is steady as a rock emotionally. She feels strongly that it is insulin related, and I trust her feelings. It is strictly her heart beating fast and hard that wakes her up. Sometime she also feels sweaty. We’ve spent untold hours studying the available literature. The closest explanation that makes sense to me is that the fact that her stomach is empty in the middle of the night, combined with the action of insulin, create an "impression" of a drop by the endocrine system, triggering the release of glycogen and adrenaline. This occurs even though she is not really "low". That’s the only explanation we have right now. Any ideas?

Response:

Hi Russell; This is just a thought I had. If there is no evidence that your wife is having a low in the night then perhaps she is suffering from anxiety attacks. A few years ago I went through a period of time that was very stressful. The stress manifested itself via anxiety attacks in the night. I would wake up sweating and my heart pounding rapidly. I thought I was having a heart attack and was going to die. This made the attacks even worse. The Doctor prescribed a mild tranquilizer which I took for about 3 months. I rarely have an attack now and I feel much better knowing that if I do I am not having a heart attack. I am not diabetic, my son is, so I know diabetes had nothing to do with my attacks. Good luck! Brenda – Hide quoted text — Show quoted text – Sorry if this is a re-post. On first try it didn’t seem to go through, so I am re-typing: My wife is a Type II-r; she is trying a new regimen of morning and bedtime lente (currently 20u each), and morning and lunch Humalog (as needed); we have been having a consistent problem with her waking up at 2 or 3am with a racing and pounding heart. This is very serious – it wears her out and leaves her feeling weak. What’s strange is that we have tested at varous times in the night and she is not low (she’s usually from 135 – 160 at bedtime and in the middle of the night – then wakes in the morning with 180 – 200). So there is no evidence of a rebound. So what’s causing the racing heart? Some of you have made suggestions, but no one has explained the heart reaction, even her MD. My wife feels strongly that it is an insulin-related reaction in some way (it reminds her of the sensation of a low during the daytime). Has anyone got any ideas? - Russ White

Response:

Here is a posssible theory. I have read about and experienced hypo symptoms at normal or even higher BG after a sudden drop from even higher BG. If you ate late, say an hour before bed time and the BG measurement, then took the shot, then the time lag before the insulin shot kicked in would allow the BG to climb. The effects of digestion may not have kicked in at the time of your measurement. So….you eat, then measure and take the shot, then the BG goes high, then the BG on the way to normal makes your brain believe that it is in trouble, causing the hypo symptoms. This is purely a guess, dignified by the title theory.

: My wife is still having problems with evening reactions that are wearing : her out. She is Type II-R, is currently trying a new regimen of morning : and bedtime Lente and morning and lunch Humalog. Here is what is : happening: She goes to bed after taking her Lente (currently 20u) around : 10PM, with a bg of 160-180. She wakes up, heart racing and pounding : around 2 or 3am, tests and has a bg of anywhere from 140 – 190. : At first, we figured that she must have gone low just prior to the : reaction (maybe a rebound), so we began to wake her earlier and test, but : she was not low. : Some of you have offered suggestions, but nobody has come up with an : explanation of why she wakes up with rapid pulse and pounding heart. : These "spells" are quite serious, leaving her worn out and despairing. : The doctor has no explanation. : She feels strongly that the cause is insulin-related, as it seems so : similar to her to a bg low she has experienced in the daytime. But why : is her bg not low if that is the case? : Any ideas? – Russ White —

Response:

Mark, No – I know where you’re heading. It is not anxiety – she is steady as a rock emotionally. She feels strongly that it is insulin related, and I trust her feelings. It is strictly her heart beating fast and hard that wakes her up. Sometime she also feels sweaty. We’ve spent untold hours studying the available literature. The closest explanation that makes sense to me is that the fact that her stomach is empty in the middle of the night, combined with the action of insulin, create an "impression" of a drop by the endocrine system, triggering the release of glycogen and adrenaline. This occurs even though she is not really "low". That’s the only explanation we have right now. Any ideas?

Response:

create an "impression" of a drop by the endocrine system, triggering the release of glycogen and adrenaline. This occurs even though she is not really "low". That’s the only explanation we have right now.

Russell, Actually I was not thinking of anxiety, which is a rather vague concept to me, but more of the "fight or flight" response which is specifically triggered by the adrenaline that you mention. Sweating is also a sign of the adrenaline response. The reason that I am thinking along this track is that I sometimes feel a tenseness, pounding heart, slight sweating, and being "scared" when I take more insulin that I need. And, like your wife, when I measure my BG during those times, I am NOT hypo – my BG once was 220. The only soluction I have found is to reduce my insulin dose. In other words, I am convinced, like your wife, that these feelings ARE insulin related, but are also NOT hypoglycermia related. Or, to put it another way, insulin is CAUSING these feelings, but the connecting mechanism is something other than a low blood glucose. I even mentioned this to my MD last week as to why I had to decrease my insulin dose back to its previous level (I had tried, like I do frequently, to increase it that morning). So now the question is: what is insulin doing to the body to lead to, what appears to be, a "fight or flight", adrenaline mediated, response? I am just starting to read studies in this regard, but so far have found that there are insulin receptors in the brain (i.e. the nervous system – where adrenaline has some of its effects), and that studies are being done on the effect of insulin on various mental functions. As I find out more, I will report back to you. Mark

Response:

| My wife is still having problems with evening reactions that are wearing | her out. She is Type II-R, is currently trying a new regimen of morning | and bedtime Lente and morning and lunch Humalog. Here is what is | happening: She goes to bed after taking her Lente (currently 20u) around | 10PM, with a bg of 160-180. She wakes up, heart racing and pounding | around 2 or 3am, tests and has a bg of anywhere from 140 – 190. | At first, we figured that she must have gone low just prior to the | reaction (maybe a rebound), so we began to wake her earlier and test, but | she was not low. | Some of you have offered suggestions, but nobody has come up with an | explanation of why she wakes up with rapid pulse and pounding heart. | These "spells" are quite serious, leaving her worn out and despairing. | The doctor has no explanation. | She feels strongly that the cause is insulin-related, as it seems so | similar to her to a bg low she has experienced in the daytime. But why | is her bg not low if that is the case? | Any ideas? – Russ White Your wife could be having lows. Your meter only tests for blood sugar in the arms, not in the brain. If your brain senses low blood sugar, it will alarm the body. It sounds like your wife is taking too much ultralente. 20 units twice a day is too much. How about reducing that to 10 units twice a day. And complementing this with an increase in R before meals?

Response:

Russell: Since your wife’s bg tests during these "attacks" are not in the range of hypoglycemia, it appears that she must seek an explanation elsewhere. They could even be anxiety attacks. At any rate, this is clearly something she should be discussing with her doctor. He/she is the only one that can prescribe any drugs or medical or psychiatric consultations that may be necessary. dkc – Hide quoted text — Show quoted text – My wife is still having problems with evening reactions that are wearing her out. She is Type II-R, is currently trying a new regimen of morning and bedtime Lente and morning and lunch Humalog. Here is what is happening: She goes to bed after taking her Lente (currently 20u) around 10PM, with a bg of 160-180. She wakes up, heart racing and pounding around 2 or 3am, tests and has a bg of anywhere from 140 – 190. At first, we figured that she must have gone low just prior to the reaction (maybe a rebound), so we began to wake her earlier and test, but she was not low. Some of you have offered suggestions, but nobody has come up with an explanation of why she wakes up with rapid pulse and pounding heart. These "spells" are quite serious, leaving her worn out and despairing. The doctor has no explanation. She feels strongly that the cause is insulin-related, as it seems so similar to her to a bg low she has experienced in the daytime. But why is her bg not low if that is the case? Any ideas? – Russ White

David Cohler, South Pasadena, CA Media Access Consultancy http://members.tripod.com/~dcohler/

Response:

My wife is still having problems with evening reactions that are wearing her out. She is Type II-R, is currently trying a new regimen of morning and bedtime Lente and morning and lunch Humalog. Here is what is happening: She goes to bed after taking her Lente (currently 20u) around 10PM, with a bg of 160-180. She wakes up, heart racing and pounding around 2 or 3am, tests and has a bg of anywhere from 140 – 190. At first, we figured that she must have gone low just prior to the reaction (maybe a rebound), so we began to wake her earlier and test, but she was not low. Some of you have offered suggestions, but nobody has come up with an explanation of why she wakes up with rapid pulse and pounding heart. These "spells" are quite serious, leaving her worn out and despairing. The doctor has no explanation. She feels strongly that the cause is insulin-related, as it seems so similar to her to a bg low she has experienced in the daytime. But why is her bg not low if that is the case? Any ideas? – Russ White

Response:

Sorry if this is a re-post. On first try it didn’t seem to go through, so I am re-typing: My wife is a Type II-r; she is trying a new regimen of morning and bedtime lente (currently 20u each), and morning and lunch Humalog (as needed); we have been having a consistent problem with her waking up at 2 or 3am with a racing and pounding heart. This is very serious – it wears her out and leaves her feeling weak. What’s strange is that we have tested at varous times in the night and she is not low (she’s usually from 135 – 160 at bedtime and in the middle of the night – then wakes in the morning with 180 – 200). So there is no evidence of a rebound. So what’s causing the racing heart? Some of you have made suggestions, but no one has explained the heart reaction, even her MD. My wife feels strongly that it is an insulin-related reaction in some way (it reminds her of the sensation of a low during the daytime). Has anyone got any ideas? - Russ White