“Sleep is the golden chain that ties health and our bodies together.”
~ Thomas Dekker, 16th Century English dramatist & writer
“Proper sleep has helped me get to where I am today as an athlete, and it is something that I continue to rely on every day.”
~ Tom Brady, NFL Quarterback
Copying my model to ensure solid nighttime blood sugars may make the biggest impact on your A1C, and maybe even on your overall quality of life.
Think about sleep from a ‘percentage of the day’ standpoint. About a third, or 33%, of your life is spent under the covers. Sleep is so important that in some parts of the world, like Australia, they’ve acknowledged it by erecting a massive three-sided statue in Sydney, signifying the optimal way to spend a day: eight hours to work, eight hours to play, and of course, eight hours to sleep. And, from a blood sugar perspective, if you’re able to control 33% of your day entirely in-range, there’s a good chance A1Cs will improve!
Quality sleep also helps T1Ds control blood sugars during the day. It’s estimated that a ‘tired’ T1D requires as much as 30% more insulin during the day to maintain the same blood sugar levels as a well-rested T1D. In other words, a lack of sleep means a T1D needs to introduce more variables into their daily routine.
In my experience, more variables usually mean blood sugars will be less steady, which will cause me to lose more sleep. It’s a hamster wheel a lot of T1Ds step onto. In fact, on average, T1Ds in the United States lose over 500 hours of sleep per year due to poor blood sugar control! It’s a cycle that has plagued generations of T1Ds and hasn’t slowed.
This was the case for me as well until I started studying the effects of my routines via a CGM. After a few months of carefully noting my bedtime preparations, and studying the blood sugar graphs the following day, I was able to design a foolproof evening routine I swear by. You won’t catch me any day of the year, at any location on earth, where I’m not strictly adhering to this routine. It’s that important.
Nighttime sleep is a time that’s completely free of the temptation of eating carbs or giving insulin. In other words, it’s an eight-hour chunk of time where zero variables should be at play. It’s a time where you can, and should, win every day, free from worry.
The secret to a good night of sleep starts with the choices you make before going to bed, including when to eat, what to eat, and how to prepare the bedroom. So, without further ado, here’s how I design my evenings for a good night’s rest.
I eat a low-carb, low-fat, and low-protein dinner before 8:00 p.m.
Sounds a little bit like the Diet chapter, right? That’s for a good reason. It’s the same concept. In case you forgot how this works, I’ve summarized the logic here for you to reference again.
Eat dinner before 8:00 p.m.: I generally like to eat dinner prior to 8:00 p.m. Here’s why. I go to bed around 11:00 p.m. every night. That means, whatever insulin I give (very little at dinner) and carbs I eat (very few at dinner) will have balanced out by the time I lay my head down at 11:00 p.m. Most fast-acting insulins last around three hours in the body, peaking sometime during the first few hours. This means if I’m done with dinner around 8:00 p.m., and have already given my insulin, then I’m usually able to go to bed three hours later without any variables actively running through my body.
Avoid high amounts of carbs: Decreasing the amount of carbs decreases the amount of insulin needed to cover the carbs, thus increasing my odds of my blood sugars staying stable before bed.
Avoid high amounts of fats: This one’s tricky. Fatty foods don’t always come hand-in-hand with carbs (though, they certainly do with pizza). But fatty food is hard to deal with as a Type 1 diabetic. This is because fats tend to make T1Ds more insulin resistant two to three hours after consumption. The result is that most T1Ds tend to go high a few hours after eating fatty foods, like pizza.
Avoid high protein dinners: Some protein is okay. I like to have a small steak for dinner occasionally, or a few pieces of chicken with a salad. But, large amounts of meat can wreak havoc for you due to something called gluconeogenesis.
Gluconeogenesis is a process in which your body converts protein to glycogen. Your body can do this with small amounts of protein and not affect blood sugars. But, with large amounts of protein, I always notice a steady increase to my blood sugars after I go to bed.
I double-check my basal insulin rates
As an MDI insulin user, I give my basal insulin at night around 11:00 p.m., right before I go to bed. One thing I consider, though, when giving my basal insulin is whether or not I did anything unusual from an exercise standpoint. If my exercise for the day consisted of my normal activities, then it’s business as usual for my basal insulin. But, if I worked out for a remarkably long time, or did something extraordinarily strenuous, I might consider lowering my basal rate by a 5-10%.
I prepare my bedroom
If you follow the recommendations for dinner and basal rates carefully, you’ll undoubtedly sleep better in the future. Occasionally, though, you still might wake up from random lows or highs. Yup, even I wake up from time to time. But I’ve been able to reduce the negative impact on my sleep by preparing my bedroom appropriately. To do so, I keep three things within arms’ length of my bed:
1. My CGM receiver
My phone serves as my CGM receiver. So, every night before I go to bed, I make sure to keep my phone next to me plugged into a charger. Remember, it won’t do me any good if the battery dies in the middle of the night.
2. My fast-acting (Fiasp®) insulin pen (for the rare occasion)
For those occasional mid-night highs, I have set my CGM to alert me quickly. To correct the high, I’ll check my blood sugar level, quickly do the correction factor math, and administer my insulin. At first, this might take a bit more time because, for some, it’ll be the first time doing the math. Once you do it a few times, the correction factor calculations will come to you more naturally.
3. A 12oz bottle of orange juice (for the rare occasion)
Placing food near my bed turned out the biggest time saver me, and a great way to treat midnight lows. I used to get up in the middle of the night and walk to the fridge, where I’d eat random leftovers. This took upwards of ten minutes to complete. Not fun at 3:00 a.m. So, to accomplish the task at hand; raise my blood sugar quickly and predictably in a way that didn’t fully wake me up; I decided small bottles of OJ were the best solution. (It’s also one of the most economical ways to solve midnight lows as well.)
A few years ago, I found listings on Amazon® for 24-packs of 12oz bottles of OJ that are delivered to my door in two days with Amazon Prime®. This has been an absolute game-changer. A few times per year, all I have to do to ensure quick corrections of midnight lows is scroll over to the Amazon® app on my phone, order a 24-pack of OJ, and voilà… two days later, I have the final item I need to ensure a solid night of sleep.
~ Sweet dreams. 🙂
 Continuous Glucose Monitor
 Except basal insulin running in the background.
 This can vary by person.