Low Blood Sugar at Night: Nocturnal Hypoglycemia

Low blood sugar at night is a common danger for people with diabetes. It is important for both you and your sleep partner to know the warning signs and have a plan for treatment.

awake at night nocturnal hypoglycemia

Untreated hypoglycemia can lead to a seizure and be life-threatening.

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You know it is important to have tight control of you blood sugar with diabetes. Tight control is how you prevent diabetes complications. One of the dangers of tight control is letting your blood sugar get too low, called hypoglycemia. [1]

The most dangerous time for hypoglycemia is when you are sleeping, a condition called nocturnal hypoglycemia. Up to 50 percent of diabetics may have episodes of nocturnal hypoglycemia. [1] In fact, almost 50 percent of hypoglycemic episodes occur at night and more than half of dangerous episodes occur at night. [2]

Risk of Nocturnal Hypoglycemia

Nocturnal hypoglycemia is most dangerous for people who take insulin, but it can also happen to people with type 2 diabetes who take oral diabetes medications. [1] You could be at risk if you: [1-3]

  • Skip dinner or have too little to eat before bedtime
  • Exercise before bedtime
  • Drink alcohol at night
  • Have a past history of nocturnal hypoglycemia
  • Are sick
  • Take NPH insulin, which has its peak affect in about 6 to 8 hours
  • Have recently changed your insulin medication
Nocturnal Hypoglycemia

Early morning wake-up calls often are simply one of many low blood sugar symptoms.

Symptoms of Nocturnal Hypoglycemia

It is important for both you and your sleeping partner to know the warning signs. Sleeping through the warning signs is especially dangerous because your blood sugar may go lower before you can correct it. [1-3] If you sleep alone, you may be at higher risk. [1]

Warning signs occur when your blood sugar drops below 70 mg/dl. When this happens, your body releases hormones like glucagon and epinephrine to increase your blood sugar. This causes warning signs like a racing heart, sweats, and tremors. These warnings are your body’s way of telling you to get more sugar into your system quickly. [1] Hopefully they will wake you from sleep, but some people sleep through. [1-3]

If hypoglycemia wakes you up, these are the symptoms: [1-3]

  • Being cold and clammy or hot and sweaty
  • Feeling shaky and trembling
  • Waking from a nightmare
  • Increased or slowed breathing
  • A pounding or racing heart
  • Waking up with a headache

Your sleeping partner should wake you if he or she notices any of the warning signs or if you are more restless, noisy, or breathing irregularly in your sleep. [2]


Untreated hypoglycemia can lead to a seizure and be life-threatening. [1] Both you and your sleep partner should be prepared to treat this condition. If you wake up with signs of hypoglycemia, or if your sleep partner wakes you and you are aware enough to manage low blood sugar, check your blood sugar with your glucose monitor. [1-3]

If your blood sugar is low, eat some hard candy, drink 4 to 5 ounces of fruit juice, or take 3 to 4 glucose tablets. Retest your blood sugar. If you are still low, have a snack with a carbohydrate and a protein, like whole wheat with peanut butter. Call your doctor to report your hypoglycemic episode in the morning. [1-3]

You should also ask your doctor if you should get an emergency glucagon kit. If you are at risk for hypoglycemia, your sleeping partner could use this kit to treat a hypoglycemic episode if your partner can’t wake you. The kit is a syringe with glucagon that your partner can learn to use for an emergency  glucagon injection. If you don’t have a glucagon kit and your partner is unable to wake you from a suspected episode of hypoglycemia, your partner should call 911. [2]

How to Prevent Nocturnal Hypoglycemia

Start by talking to your doctor about a bedtime blood sugar target. Ask about your risk for hypoglycemia and if you should get a glucagon kit. Don’t miss dinner, exercise before bedtime, or drink alcohol at night. Have a sugar and protein snack before bedtime, like a wheat cracker with cheese. [1-3]

If you have had symptoms of nocturnal hypoglycemia, work with your doctor on a prevention plan. This may include switching to a longer acting insulin that does not peak during sleep, or changing your insulin dose. You might be asked to set an alarm and check your blood sugar in the early morning for a while.  For people at high risk for nocturnal hypoglycemia, a continuous glucose monitor (CGM) may be the best solution. A CGM can check your blood sugar every 5 minutes and can set off an alarm if your sugar gets too high or too low. [1-3]



  1. Type2Diabetes.com, Nocturnal Hypoglycemia
  2. Johns Hopkins Medicine, Nocturnal Hypoglycemia
  3. North Shore University Health System, Nocturnal Hypoglycemia

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Chris Iliades, MD

Chris Iliades has an MD degree and 15 years of experience as a freelance writer. Based in Boothbay Harbor, Maine, his byline has appeared regularly on many health and medicine … Read More

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  • You need carbs when you’re active.
    I do weight training.
    If i don’t eat carbs, my muscles will disappear.
    I’ve already tried a low-carb diet.

  • I’ve been waking at 3 and never considered that it could be a blood sugar issue which I experience during the day. I’ll try the middle of the night protein snack and hope for the best.

  • The blood sugar thing is very likely the problem for a lot of people; but if addressing that does not seem to help, there are other possible causes, especially for people who already have an excellent diet.

    According to Julia Ross [http://www.dietcure.com/fat_is_not_the_enemy.html]:

    “It turns out that, among other things, omega-3 is an MAO inhibitor, meaning it paralyses the MAO enzymes that destroy mood-boosting brain neurotransmitters like dopamine. Believe it or not, these fats can even be over-stimulating to some people. If you find yourself waking up bright and alert at 4 a.m. after too much omega-3 supplements, you’ll have to cut back.”

    In the comments section on a different health-oriented web site I pointed this out to another commenter who had tried and tried all the usual remedies for this same problem, but to no avail. He replied a few weeks later to say that after years of suffering, just cutting back on his omega-3 supplements did indeed completely solve his problem with waking up in the middle of the night.

  • I have a DRY mouth – and wake me up – at 3 or 4 am – I thought it was a sign of high sugar ??
    can any one explain ? I do NOT check sugar …

    Started taking Metformin ( 1000 mg ) ER – and helped a lot – reduced frequency

  • I wake up with tons of energy. .and ready to concur the world. But then I crash so bad I just wanted to go back to sleep. I’m eating right and getting enough sleep. But now so exhausted. .blood sugar?

  • I went low sugar (25 grams or less per day) for 8 weeks which almost put me into the hospital 3 times. My GI went haywire, my liver enlarged, my gallbladder had issues, my pancreas had issues, my stomach bled and I couldn’t sleep. I went back to a high carb diet and slowly my world is almost back to normal but my 9:50 mile time running went to 13 minutes due to muscle wasting. I do get up at 2-3 am everynight though often with a panic attack out of nowhere, I think I run out of glycogen, maybe repairing muscle since I work out everyday. I don’t know. I’m also fatigued in the afternoons. I want to quit sugar but I get so sick when I do.

  • I do all of this and I am so frustrated. I am non-diabetic hypoglycemic…its hereditary, not prediabetc. Ive had this since I was a teenager and I am now 40. I eat a high protein diet, small portions every few hours, low carb (and only complex carbs) cut out all sugars and I still wake up in the middle of the night, eat and have trouble going back to sleep. I have lived on 3 or 4 hours sleep this past year and I cant do this anymore. Sleeping pills dont help, I am forever exhausted and at this point would rather be diabetic because I would have some highs at least instead of constant lows since there is no medication for low sugar. I cant even exercise because that lowers blood sugar. Im tired of eating constantly and this is what I am sentenced to for the rest of my life but how can I sleep more than 4 hours a night?

  • I have the same problem and have battled this for about 20 years. When I wake up I normally need to use the bathroom. If you find any solution that helps you let me know. Thank you.

  • I have hypoglycemia. Wake up every night at 3:00 with moderate hunger pains. The only food that I can eat that gets me through the night is a slice of toast. Then I am able to sleep longer.

  • I find if I eat about 6pm foods such as cheese and lettuce, milky porridge, cauliflower cheese and turkey, banana, camomile tea, white rice and chicken, all of these can help settle me down to sleep. Try to eat foods with melatonin or tryptophan. Dairy products are good at this time. Avoid anything high in iron or vitamin c as well as caffeine. Caffeine takes 10 hours to leave your system and vitamin c/iron and other fruits make you alert.

  • Hi,I am currently training for my first half marathon and I have changed my diet massively,I’m eating a lot of protein foods minimal sugar loads of fruit and veg and the only dairy I have is eggs,I find myself waking up at 3am every morning with dry mouth and need to rush to toilet straight away,would u suggest adding a small amount of sugar to my diet like a chocolate bar a day could this help me ? Thanks

  • I wake up at about 5 a.m. I make a whey protein shake with whole milk every night before I go to bed when I wake up, I drink my shake and I can go back to sleep. I used stevia and a small amount of coconut sugar to sweeten the shake. This helps me to go back to sleep. On the days that I run I increase the amount of protein in the shake. I’m going to try reducing my processed sugar intake during the day as well. Great article. Thanks!

  • I have been suffering with sleep maintenance insomnia for about 17 years. Five doctors and fur nutritionists could not find my problem until recently a new acupuncture nutritionist studied my symptibs questionare and figured out I have low blood sugar. He recommended a high animal protein diet atleast 3x a day with protein snacks and good. Arbs in between. I have been sleeping much better and have cut back on the sleep meds substantially but still can’t get eight full hours without that brain wake up alarms at 4, 5 or 6 AM. Too early. Can you suggest anything else to help me get those valuable eight hours of sleep to really feel good. I’m stick of the headaches and morning long hang over of Intermedzzo RX. Thank You.

  • I have been on a no sugar low carb diet for years..I lost a heap of weight but it finally caught up with me. I collapsed and ended up in emergency. The cause was hypoglycemia and low potassium. The hypoglycemia causes my potassium to run dry and alot of people do not know this could be happening to them to. Previous to collapse I had warning signs, yes indeed would wake up at 3am in a state of panic, rapid heart beat cold weak faint disorientated chest pains etc.
    Low carb high protein is not good and shld not be advised especially for people with hypoglycemia . Protein does NOT raise blood sugar levels.
    I eat a spoonful of natural oats with a little honey before bed. All my food is now Low GI. I always keep some orange juice banana , jelly beans near my bed incase of big drop. After excersice is my worst moments . High protein diet actually made me worse…
    I’ve put on a little weight by not being so strict with carbs but I wld rather live as its a serious condition of not PROPOLY attended to.

  • I’ve been waking up at 4 AM (fall daylight savings) and at 5 AM (Spring) for years. I am happy that I have found this article and I am experiencing this “low blood sugar” as we speak. I ate 2 tablespoons full of peanut butter because I didn’t have anything else, high in protein. Drank half a glass of water because I am dehydrated when I wake up after 3-5 hours of sleep. I am starting to feel a little sleepy now. I believe if I close my eyes and relax, I’ll be able to fall back to sleep. Thanks so much for the article. It has been helpful. I’ll schedule an appointment with my doctor to perform a women’s health check and see if I have anything wrong or unhealthy with me this year? I am 37 yrs old and have always been healthy. I’ll prepare a protein diet to test within this week to see if I am able to sleep longer? Thanks again. I’ll comment back about my results.

  • hi friends … please note that women are usually most prone to low blood sugar than men , when they have a lot of carbs. the sugar spikes and then falls really low.

    if you really truly wish to have good good uninterrupted sleep.. instead of eating rice etc at night… before sleeping you must have a few spoonfuls or a small bowl of curd… / yoghurt

    you will sleep like a baby and love us indians for giving you such a wonderful tip

    remember yoghurt mixed with your salad or yoghurt mixed with your rice or bread etc at night.. will ensure your sugars are at a comfortable place throughout the night … and you should wake up later in the morning

    of course yoghurt being something that could give you a cold , make sure you dont overdo.. and if you mix yoghurt in hot food it sort of warms up .. tastes different .. but will not end up giving you a cold … rather than just having cool yoghurt out of the fridge.

    also people with diabetes , please do not mix your yoghurt with carbs at night…
    yoghurt can be mixed with steamed veggies add the spices you like etc.
    the yoghurt will ensure no dips happen so you shouldnt wake up and in most cases not even have a nightmare .. since yoghurt has iodine and it will ensure the thyroid is regulated through the night …

    always give yoghurt a break ,,, as in have it for say a week at night … and then stop for a few days .. this is to ensure you dont have blocked nose, cold etc.

    hope this helps… and remember do not eat anything in excess .. thinking that yoghurt helps lots of people overdo yoghurt… just eat moderately … because yoghurt has live cultures and you dont want to overload your system even with good bacteria because then that becomes bad for your health and intestines and may cause haemorrhoids to appear or worsen, irritable bowel syndrome et.

    remember that moderation is the key but yoghurt is a virtue that if used moderately is fantastic

    please make sure

  • I am confused now. I wake @3am wide awake & heart pounding. Sometimes I eat a couple of bits of chicken before bed but I still wake up & I’m starving & shaking. Some of the responses here say to ear protein & fat before bed others say to eat a carb to raise blood sugar. I though carbs spike blood sugar then drop sharply. I am having extreme exhaustion (CFS) I haven’t been hungry during the day & sometimes nausea. I am going to eat more during the day high protein & I also eat a lot of veggie. Can someone pls tell me which it shld be? Carbs or protein before bed.

  • So happy I found this site.I am a diabetic.Have been waking up after only 1.5 hrs of sleep and usually cannot get back to sleep for 3-4 hours makes for a long night.I never connected it with type 2 diabetes. I am never hungry during the day just force myself to eat a little something. But at 3 am I could sit down and eat a full meal.Thank you so much for this article.

  • I had all these issues, waking up around 3am, blood sugar crashing in the afternoons, no appetite in the mornings. Life was really a struggle because I never had proper rest nor energy. I ended up seeing a functional medicine doctor, he helped me with a diet and recommended supplementing with organic chromium yeast. I have to admit I was skeptical, but it really worked. I am stable, less irritable, I have enough energy to make it through the day without grabbing sweets or desserts all the time.

  • This article makes sense to me. I have had glucose level crashes for years. Usually before lunch time. Now I wake up every morning at 3 to 3:30 am every morning. I get solid sleep between 10:00 pm and that time. Although I am not hungry, I believe this glucose drop is similar to my pre lunch drop. After eating lunch I feel great. Maybe a small 3 am protein snack is key.

  • I am astonished that you do not bother to mention if this advice applies to type I, type II or non-diabetics or to all three. Eating a low-carb-high-fat diet is good for everyone, but failing to advise the insulin-dependent diabetic to reduce the amount of insulin if she/he regularly experiences night-time hypoglycaemia is irresponsible.

  • Why aren’t the questions on this website addressed? I find this more often than not on lots of sites and I do not understand it!

  • very insightfull..i ocassionally suffeer from hypoglyceamia n lately i have been waking up exactly 3am in the mornings..not untill rerading your article makes share sense.thank you once mor.please try see to it that those pertinent questions put out there be answered as this could be of immense help.
    i am from nigeria and in this part of this part of the world you find some illness quite strange and would barely attribute one waking up so early with expected conditions as this.from the questios raised on this platform i relate with almost all the questions asked.as i also experience high palpitations as well ,dizziness n sometimes waking up feeling so dry n thirsty….
    i would be glad to see you respond to us.
    best wishes

  • I’ve never had low glucose problems until my gastric bypass surgery. I lost the weight, happy with the results but, my glucose hasn’t been right. When I start feeling like my sugar is getting low I’ll eat a glucose tablet, which it does help. During the night I’ll wake up with extremely low glucose. Either I’ll eat something real quick with sugar or eat another glucose tablet. Unfortunately, this problem wasn’t explained to me before surgery and had to figure this out on my own.

  • I am awake at 2 a.m. my heart was pounding and I have a cold sweat and I am peeing many times.Also I feel nauseous , my diaphragm feels constricted.Is this low blood sugar? Dinner was 4 chicken wings and a salad w olive oil dressing

    • Hi Jennifer, thanks for you comment. We cannot provide individualized medical advice, so it’s best that you contact your doctor. Thanks again!

  • Just gone on to your site i am shocked to see that it goes back to 2013 things have changed since then Get rid of them and start from 2019.Come on surely you must realise that.I shown it to my GP he could not believe it sort your self’s out

  • Oh my word! Eureka!!! That is why the last 2 weeks I can’t fall back to sleep and my mind is racing. I am a type 2 diabetic since 2007. I have never had this problem beore. I have been adjusting my insulin lately and that is why this seems to be happening! I WILL BE EATING peanut butter or cheese before bed tonight! Thanks for the info! P.s. I will check my B\S too.😇

  • Currently experimenting keeping my blood sugar (and cortisol) stable with foods containing Resistant Starch. So far the results have been very very encouraging. Instead of waking up 3-4 hours after falling asleep, I started waking up 6-7 hours after. Still not perfect, but a huge improvement!
    By the way, keto diet did NOT work at all. The more I tried to comply with it, the worse I felt, and the worse I slept. On the contrary, a whole-grain jumbo oat porridge keeps my blood sugar stable much longer than a keto-inducing food. Hope this helps someone here.

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