Waking up shaky, sweaty, confused, or exhausted in the middle of the night can be frightening, especially if you live with type 2 diabetes. Night-time hypos, also known as nocturnal Hypoglycaemia, occur when blood glucose levels drop too low during sleep.¹
Although nocturnal hypos are more common in people using insulin or sulfonylureas, they can affect many people with type 2 diabetes. Understanding the causes, symptoms, and prevention strategies can help improve both safety and sleep quality.
Hypoglycaemia occurs when blood glucose levels fall below 4 mmol/L (70 mg/dL).² A nocturnal hypo is simply Hypoglycaemia that occurs while sleeping, typically between midnight and 6am.
Because people are asleep during these episodes, symptoms may go unnoticed until morning, increasing the risk of severe Hypoglycaemia.³
Some people wake during a hypo, while others remain asleep and only recognise symptoms the following day.
Several factors may contribute to low blood glucose overnight.
1. Diabetes Medications
Insulin and sulfonylurea medications can continue lowering blood glucose levels during sleep.⁵
Common medications associated with nocturnal Hypoglycaemia include:
2. Skipping Meals or Eating Too Little
Going to bed without enough carbohydrates may reduce the body’s glucose reserves overnight, increasing the likelihood of Hypoglycaemia.⁶
3. Alcohol Consumption
Alcohol suppresses the liver’s ability to release stored glucose into the bloodstream, which can significantly increase overnight hypo risk.⁷
This effect may last several hours after drinking, making night-time hypos particularly common after evening alcohol consumption.
4. Increased Physical Activity
Exercise improves insulin sensitivity for hours after activity. Evening exercise can therefore lower blood glucose levels during sleep.⁸
5. Delayed or Missed Bedtime Snacks
People who require a bedtime snack to balance medication action may experience overnight hypos if snacks are skipped or delayed.
Frequent nocturnal Hypoglycaemia can negatively affect both physical and psychological wellbeing.⁹
Potential consequences include:
Fear of nocturnal hypos may also lead some people to intentionally maintain elevated glucose levels overnight, which can worsen long-term glycaemic control.¹⁰
Monitor Blood Glucose Before Bed
Checking blood glucose levels before sleeping can help identify risk patterns, particularly after:
Continuous glucose monitoring (CGM) systems can provide additional overnight protection through real-time alerts.¹¹
Eat a Balanced Evening Meal
A balanced dinner containing complex carbohydrates, protein and healthy fats may help stabilise glucose levels overnight.
Suitable bedtime snacks may include:
Be Cautious With Alcohol
To reduce risk:
Review Medication Timing With Your Healthcare Team
If night-time hypos occur frequently, healthcare providers may recommend:
Medication changes should always be supervised by a healthcare professional.
If you suspect Hypoglycaemia:
Seek emergency assistance if symptoms become severe or you cannot safely treat yourself.
Diabetes-Specific Nutritional Formulas (DSNF), like Glucerna*, are formulated specifically for people with diabetes or impaired glucose tolerance, with a low GI slow-release carbohydrate blend aiding slower glucose absorption. Glucerna is clinically shown to help manage blood glucose levels from Day 113-15, within target range (up to 90% of the time) within 4 weeks16 and reducing HbA1c to improve long-term blood glucose management in six months.17†
You should speak with your doctor or diabetes educator if:
Individualised diabetes care plans can substantially reduce nocturnal Hypoglycaemia risk.
Night-time hypos can be distressing for people living with diabetes, but they are manageable with appropriate monitoring, medication management, nutrition, and support. Understanding personal triggers and working closely with healthcare professionals can help reduce overnight lows and improve both safety and quality of life.
Eating right when you have diabetes doesn’t have to be complex – it is about knowing what is best for you and your diabetes management plan. Knowing which foods are low-GI can be a helpful way of keeping track of your diet. Read on for a breakdown of what ‘low-GI carbohydrate’ means and how this might be helpful.
While there is no cure for diabetes, many treatments are available to help control blood glucose levels. A healthy lifestyle plays a big role in managing blood glucose levels and reducing the risk of complications.3 This article will explain briefly how type 2 diabetes is managed.
When you have diabetes, you may wonder what ‘eating right’ means for you.
Here we’re busting some of the myths around food and diabetes. Keep reading to learn more.
Food for Special Medical Purposes. Use under medical supervision.
References:
1. Tired of nighttime hypos?, Diabetes Australia, Accessed at: https://www.diabetesaustralia.com.au/blog/tired-of-night-time-hypos/, Accessed May 2026. 2. American Diabetes Association, Diabetes Care. 2026;49(Suppl 1), Accessed at: https://diabetesjournals.org/care/issue/49/Supplement_1, Accessed May 2026. 3. Frier B M, Diabetes Metab Res Rev. 2008;24(2):87–92. 4. Somogyi M, Am J Med. 1959;26:169–191, Accessed at: https://pubmed.ncbi.nlm.nih.gov/13617275/, Accessed May 2026. 5. Seaquist ER, et al. Diabetes Care. 2013;36(5):1384–1395, Accessed: https://pubmed.ncbi.nlm.nih.gov/23589542/, Accessed May 2026. 6. Kalra S, Mukherjee J J, Indian J Endocrinol Metab. 2013;17(5):819–834, Accessed at: https://pubmed.ncbi.nlm.nih.gov/24083163/, Accessed May 2026. 7. Turner BC, et al. Diabetes Care. 2001;24(11):1888–1893. 8. Colberg SR, et al. Diabetes Care. 2010;33(12):e147–e167, Accessed at: https://pubmed.ncbi.nlm.nih.gov/21115758/, Accessed May 2026. 9. Martyn-Nemeth P, et al. J Diabetes Complications. 2016;30(1):167–177. 10. Davis S N, et al. Diabetes. 2005;54(12):3592–3601. 11. Battelino T, et al. Diabetes Care. 2019;42(8):1593–1603, Accessed at: https://pubmed.ncbi.nlm.nih.gov/31177185/, Accessed May 2026. 12. Diabetes UK. Treating a hypo. Diabetes UK Clinical Guidance; 2024, Accessed at: https://www.diabetes.org.uk/sites/default/files/2025-03/EoL_TREND_2024_v11-1.pdf, Accessed May 2026. 13. Dávila LA, et al. Nutrients. 2019;11(7):1477, Accessed at: https://pubmed.ncbi.nlm.nih.gov/31261732/, Accessed May 2026. 14. Devitt A, et al. Journal of Diabetes Research and Clinical Metabolism. 2012;1(1):20. 15. Mottalib A, et al. Nutrients. 2016;8(7):443, Accessed at: https://pubmed.ncbi.nlm.nih.gov/27455318/, Accessed May 2026. 16. Peng J, et al. Br J Nutr. 2019;121(5):560–66, Accessed at: https://www.cambridge.org/core/journals/british-journal-of-nutrition/article/breakfast-replacement-with-a-liquid-formula-improves-glycaemic-variability-in-patients-with-type-2-diabetes-a-randomised-clinical-trial/3814F388CEBC6D7FD00FDD74707DB32, Accessed May 2026. 17. Chee W S S, et al. BMJ Open Diabetes Res Care. 2017;5(1):e000384, Accessed at: https://drc.bmj.com/content/bmjdrc/5/1/e000384.full.pdf, Accessed May 2026.
*Glucerna is formulated for people with prediabetes, diabetes and gestational diabetes, as part of a diabetes management plan (including diet and exercise).
†Glucerna has been shown to lower HbA1c by 1.1% in 6 months when used as part of a structured lifestyle intervention and motivational interviewing.17
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