Why Your Mystery Blood Sugars Might Be a Sleep Problem
If you've ever woken up to a blood sugar that makes no sense, went to bed at a perfect number, did everything right, and still saw a confusing morning high, this episode is for you. Neil Greathouse, who has lived with type 1 diabetes since...
The episode, word for word
Quick question.
When's the last time you slept through the night?
Not woke up briefly and fell back asleep. Actually, fully, undisturbed, slept the whole night. Didn't check your CGM. Didn't roll over to look at your phone at 2am. Didn't lie there doing blood sugar math in your head at 3am when you couldn't tell whether you were fine or not so you just laid there and stared at the ceiling for a while.
Just... slept like somebody slipped you an Ambien.
Take a second. When was that?
OK. Yeah. That's kind of the whole point. I can't remember for me, either.
My name is Neil Greathouse, and this is Your Best T1D Year.
All right. Welcome back. If you're new, hello, welcome, please stay. We're in Week 1 of the Sleep Challenge. If you missed Friday's episode, here's the whole game in one sentence: we're tracking our sleep for eight weeks and figuring out what it's actually doing to our blood sugar. That's it. You're caught up.
Today I want to talk about something that doesn't get acknowledged enough.
Type 1 makes sleeping harder. Not in a general "I have a lot on my mind" kind of way. In a very specific, very documented, this-disease-does-this-to-your-sleep kind of way. And I don't think most of us have ever had that called out for us.
OK. So. Let me ask you something. What woke you up last night?
Was it the CGM? I know that sound...almost like a jump scare in a horror movie. The low alert, the high alert, the urgent low alert, the alert that fires because of a false low and now the sensor is reading something that makes no sense and you have to poke your finger at 3am to confirm that you are, in fact, fine. Just fine. Great. Yes I love technology (singing).
Was it a low? An actual low, where you had to get up, find something to eat, wait it out, recheck, wait again, hope you didn't overtreat, try to fall back asleep while the glucose tablets or gummies are kicking in and your heart is still thumping from the alarm?
Was it anxiety? Not about anything specific. Just the background hum of "I should check" even when your CGM shows a flat 110. The one where you're lying there and the number is completely fine and some part of your brain is still like... but what if it's not.
Was it nothing? You just woke up anyway?
That last one. Let me tell you about that last one.
Because one of the things we're going to cover in this challenge is that people with type 1 diabetes have documented differences in how they sleep compared to people without T1D. We spend more time in lighter stages of sleep. We have elevated hormone levels running overnight that keep us closer to the surface. We don't fully check out the way other people do.
I know. Suuuuuuuuper great news, Neil. Thanks!
Here's the thing though. Most people with T1D don't know this. Nobody told us. Our endocrinologist talks about A1C and time in range. Our diabetes educator talks about carb ratios and pump settings. And our sleep is just... out there. Unmanaged. Affecting everything. And nobody's been connecting those two rooms.
I think we can connect them.
I've been awake at 3am more times than I can count. I know the specific quality of 3am wakefulness when you're T1D. There's the one where you're totally fine and you know you're fine and you're still awake. There's the one where you're dropping and you're reaching for the juice boxes on the nightstand. There's the one where you're just lying there doing inventory. Thinking about your last bolus. Wondering.
It's a particular kind of tired. Not just sleepy tired. It's like "locked in for a sneak attack" tired. The tired of a person who has been paying attention to something important all day and cannot fully stop paying attention to it at night.
And I think that deserves to be named. Because we can't fix something we haven't named.
OK. Continuing from Friday. If you're tracking your sleep hours, keep doing that. Today I want to add one thing: write down what woke you up last night. Just one line. Alarm? Low? Anxiety? Just woke up for no reason? Couldn't fall asleep in the first place?
You don't have to do anything about it today. You're just collecting data. Being a scientist about your own experience.
And if you slept fine last night, great. Write that down too. Those nights matter.
Hey, I want to be really clear about something. If you were awake at 2am last night, staring at your CGM or your ceiling or both, you were not alone. There are 1,200 people in this challenge. A pretty solid percentage of them were also awake at 3am. You are in very tired, very good company.
You're not doing a bad job. This disease is relentless and sleep is where it gets you quietly. I'm proud of you for showing up.
Type 1 diabetes is relentless, but managing it doesn't have to be. New episodes drop every Monday, Wednesday, and Friday. You're not doing a bad job, you're doing a difficult job.
This is the script as read on the mic, lightly tidied for reading. Education, not medical advice. Talk to your care team before you change anything about your insulin.