Causes & risk factors
Risk factors based on diabetes type1–4
Factors that may increase risk of nocturnal hypoglycaemia5,6
- Diabetic neuropathy
- Physical exercise, especially during the evening
- Excess insulin during the day
- Previous episodes of nocturnal hypoglycaemia
- High dose of basal insulin
- Failure to check blood glucose at bedtime
- Excess rapid-acting insulin to correct high glucose, particularly at bedtime, or to cover bedtime snacks
- Premix or short-acting insulin before dinner
- NPH insulin (isophane) in the evening
Key needs to mitigate risks
- Yale JF et al. Hypoglycaemia. In: Diabetes Canada Full Guidelines. 2018. Available at: https://guidelines.diabetes.ca/cpg/chapter14.
- International Hypoglycaemia Study Group. Minimizing hypoglycemia in diabetes. Diabetes Care 2015;38:1583.
- Inzucchi SE et al. Management of hyperglycemia in Type 2 diabetes, 2015: A patient-centered approach. Diabetes Care 2015;38:
- Weinstock RS et al. Risk factors associated with severe hypoglycemia in older adults with Type 1 diabetes. Diabetes Care 2016 Apr;39:603.
- Vu L et al. Predicting Nocturnal Hypoglycemia from Continuous Glucose Monitoring Data with Extended Prediction Horizon. AMIA Annu Symp Proc. 2019;874-882
- Brunton SA. Nocturnal hypoglycemia: Answering the challenge with long-acting insulin analogs. MedGenMed 2007;9:38.