AskNadia: Type 1 With A 9.9 A1C and Frequent Low Blood Sugars at Night   


Dear Nadia,

 I have type 1 diabetes and take Actrapid thrice and Lantus at bedtime.  At night, I have low blood sugars, but it drops during the day, and my blood sugars are normal. What is even more confusing is that my Hba1c is 9.9.  What is your opinion on what I can do?


Dear Amna:

It must be incredibly frustrating to experience low blood sugar and have a high A1C.

Your question is complicated. The high and low blood sugar can be a result of many variables.

The good news is there are solutions, and with your healthcare professional team, you can find the balance in reaching your desired A1C and blood sugar range. Call your health team or schedule a visit so they can isolate the variables and sort this out for you.

Actrapid Insulin

Actrapid is short-acting insulin. It is distributed in Australia, the U.K and manufactured by Novo Nordisk, the insulin company from Denmark.

In the U.S. Humulin and Novolin insulin are the two-short acting insulins. The rapid-acting insulin; Afrezza, Apidra, Humalog, and NovoLog are the fast acting insulins. The onset of the U.S. rapid-acting insulins is 15-to 30 minutes which is close to Actrapid insulin which starts taking effect within 30 minutes.

Low Blood Sugar at Night

If you are experiencing low blood sugar at night, this could be due to several reasons:

Somogyi Effect

This a process where your night time medication can lower your blood sugar when you are sleeping. Even if you do not feel the hypoglycemia symptoms, your liver releases glucose to fight the hypoglycemia (low blood sugar) by releasing sugar to bring up your glucose level.


Your nighttime medication may need adjusting. If you are taking two different types of insulin short and long-acting, it could be that the onset of the two insulins combined need adjusting. Call your healthcare professional and be specific about what time you are taking each medication, when you are eating, how many units of the short-acting insulin and the long-acting Lantus basal insulin you are dosing.


If you are exercising or exerting yourself more than usual, this can reduce your insulin requirements. My former husband, a Type 1, experienced low blood sugar for two days after he started a new regiment. Once he made the connection between the exercise and his dosing, he was able to achieve the right balance.


Are you eating less or skipping meals and still taking the same insulin dose? Dosing the same amount of insulin and skipping meals can also be a possible reason you are experiencing a nighttime low blood sugar.


Consuming alcohol while taking insulin or type 2 medication can cause a hypoglycemic episode. It takes the liver two hours to metabolize one alcoholic drink. Too much insulin, in this case, may create hypoglycemia.

False Hypoglycemia

You did not mention if you tested your blood sugar when you felt you were experiencing the hypoglycemia symptoms.

My mother had an A1C of 10 and she thought she had hypoglycemia but it turned out when her blood sugars were closer to the normal range, she felt as is she was having low blood sugar. Why?  because she was so use to having her blood sugars hovering around 240 mg/dl. For her, the normal blood sugar range gave her the false perception that she was having a hypoglycemic episode.

You need to test your blood sugar to insure you are in fact having a low hypoglycemia episode. In the U.S, anything below 70 mg/dl is considered a low blood sugar that may requires treating.

Treatment for Low Blood Sugar

People with diabetes that take insulin generally will have their blood glucose meter on their nightstand or in their drawer with a snack or glucose tabs handy should they need it in the middle of the night. Discuss this with your healthcare professional and ask them how many carbs you need to consume to bring up your blood sugar. Glucose tabs in the U.S. have four carbohydrates per tablet. They are chewable and dissolve in your mouth quickly with an array of flavors.

Also, discuss having a snack with your healthcare professional before you turn in for the evening.

Your High A1C

A 9.9 percent A1C is an average blood glucose reading in the neighborhood of 212 to 240 mg/dl. I want to applaud you for wanting to reach your target range.

The treatment for high blood sugar is the opposite of treating a low blood sugar.  Eating less and if you can, go out for a walk, is what your healthcare professional may recommend. Eliminating a snack may also help bring down blood sugars.


Celebrations, holiday parties, working long hours and managing your daily life can be stressful. Just stop and think of all the things you must manage daily and or weekly: getting to work on time, buying groceries, making meals, paying bills, raising children, taking care of animals, family time, the list goes on.  I do not know about you, but I feel stressed just reading all that needs to be done. Add diabetes self-management to all your daily tasks and the stress tower may start looming behind you.

You can also experience good stress, being excited about an event or completing something that was a goal can also raise your blood sugar.

What happens when the adrenaline and cortisol hormone is released? It raises your blood sugar and blood pressure.


Some medication will raise your blood sugar.

In 2009, the Veterans Affairs in the U.S. conducted a study of 345,417 patients with and without diabetes, to see if taking cholesterol-lowering medication, increased their fasting plasma glucose. After a two-year period, they concluded that there was an increase in high blood sugars for both groups.

Prescribed steroids as an anti-inflammatory for arthritis and asthma can raise your blood sugar. Blood pressure medication like diuretics used for hypertension, depression medications, antipsychotics and anti-rejection drugs for people that have organ transplants. For women, if they use birth control, this can also cause fluctuating blood sugars.

Work with your healthcare professional to refine your insulin dose. Once they help you isolate the reason for the high blood sugar from the low, taking into account medication, diet, exercise, and stress, the prescribing dosage can help minimize the hypoglycemia and hyperglycemia.

I hope this was helpful. Let me know which changes you have made.

Wishing you the best in health!


You might also be interested in reading these two article:

How to Lower Your Blood Sugar When it is Over 200

What Type 2’s Can Do When Their Blood Sugar Soars

You can now pre-order my new book “Sugar Happy- Your Diabetes Health Guide in Achieving Your Best Blood Sugars and Letting Go of Your Diabetes Complication Fears” launched on April 6th and pre-orders ranked #7 on the Kindle top 100 new releases.

This book is for both Type 1 and Type 2 people living with diabetes. It is meant to be a guide, allowing you to look up any topic by interest.

For a limited time before the June 3rd release, I am offering the Kindle version for 99 cents.


Nadia’s feedback on your question is in no way intended to initiate or replace your healthcare professional’s therapy or advice. Please check in with your medical team to discuss your diabetes management concerns.


AskNadia and receive her unique perspective on your question.


My Story


About Nadia:

AskNadia (ranked #1 by Google), named “Best Diabetes Blog for 2017 by Healthline and one of the top 50 diabetes influencer’s blog that is a must follow, and with 23 nominations, Nadia Al-Samarrie’s efforts have made her stand out as a pioneer and leading patient advocate in the diabetes community.


Nadia was not only born into a family with diabetes but also married into one. She was propelled at a young age into “caretaker mode,” and with her knowledge of the scarcity of resources, support, and understanding for people with diabetes, co-founded Diabetes Interview, now Diabetes Health magazine.


Nadia has been featured on ABC, NBC, CBS, and other major cable networks. Her publications, medical supply business, and website have been cited, recognized and published in the San Francisco Chronicle, The Wall Street Journal, Ann Landers advice column, former Chrysler chairman Lee Iacocca, Entrepreneur magazine, Houston News,, Brand Week, Drug Topics, and many other media outlets.


































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