Purgatory
The day after a bad T1D night is one of the most horrendous places to be.
I don’t use that word lightly. Purgatory. Not quite hell — you’re functioning, technically — but nowhere near anything that resembles okay. A kind of suspended, deteriorated state where everything is worse than it should be and nothing quite works the way it’s supposed to.
The anxiety is tenfold. Not the background hum that most T1Ds manage routinely — the acute, disproportionate, everything-feels-threatening version that a sleepless night produces.
The blood sugars are unstable. Cortisol from sleep deprivation raises insulin resistance. The careful management that usually produces predictable results stops working the way you expect. You correct. It doesn’t land right. You adjust. Something else shifts. The numbers refuse to cooperate on the day when you have the least capacity to deal with them not cooperating.
And emotionally? In the moment, it genuinely feels like it won’t end. Like this is just what life is now. That particular feature of sleep deprivation — the way it distorts time and makes temporary states feel permanent — is one of its cruellest effects.
What a Bad T1D Night Actually Looks Like
For those who haven’t experienced it, or whose partners are trying to understand it, here’s what the night itself can involve.
CGM alarms pulling you out of sleep at 2am, 3am, 4am. Sometimes for real events — a genuine low or high that needs treating. Sometimes for the margins — readings that are technically within range but brushing the alert thresholds. The alarm doesn’t care which it is. It goes off either way.
The after-effects of treating a nocturnal hypo — the adrenaline surge, the difficulty getting back to sleep once glucose has been consumed and the body is still running on stress hormones.
The hypervigilance that prevents deep sleep even when nothing is technically wrong. The half-awake state that passes for rest but provides almost none of the restoration actual sleep does.
And the cumulative effect: a night like this once is manageable. Several in a row, as many T1Ds experience, produces the purgatory state I described above.
The One Thing That Reliably Helps
I’ve tried various approaches to recovering from a bad T1D night. What I keep coming back to — the thing that reliably shifts something — is getting outside into nature.
A walk. Preferably somewhere with trees, open sky, natural light. Breathing it in. Sometimes sketching it.
I know how that sounds. Simple. Maybe too simple for something that feels as acute as post-insomnia T1D purgatory. But the physiological effect of natural light and movement on cortisol is real and measurable. And there’s something beyond the physiology — something about being in the presence of things that are larger than my blood sugar, larger than my difficult night, larger than my anxiety — that resets the perspective in a way that nothing else quite does.
Nature doesn’t know I had a bad night. It doesn’t ask how my levels are. It just is — and being in it, even briefly, returns me to something more baseline than I was when I stepped outside.
What Else Helps
Beyond the walk, a few other things that actually make a difference on the day after:
Reducing the management targets for that day. On a post-insomnia day, chasing tight control is a losing battle. Widen the acceptable range. Aim for manageable, not perfect. Give yourself and your blood sugar some room.
Not catastrophising the unstable readings. The instability on a sleepless day is physiological — cortisol-driven, insulin resistance-related. It is not evidence of fundamental management failure. It will resolve when sleep is restored.
Telling someone how you actually are. Not “fine.” The real version. Even a text to one person who understands is enough to break the isolation that makes the purgatory state worse.
And going easy. On yourself, on your expectations, on the day’s demands. A T1D running on no sleep is doing something genuinely difficult. That deserves acknowledgement, not additional pressure.
It Does End
In the moment, it doesn’t feel like it will. That’s the sleep deprivation talking.
It ends. The night comes, sleep happens — usually deeper than usual after a bad night — and the morning after is categorically different from the one you just got through.
That knowledge — held in reserve for the worst moments of the post-insomnia day — is worth something. Not much when the anxiety is tenfold and the numbers won’t cooperate. But something.
Related reads:
Beyond Type 1: How T1D Affects Sleep
Until next time,
Pete
T1D Mindset Coach
