Why does hypoglycemic sweat stink so bad?
August 24, 2009 6:43 AM   Subscribe

I am a type 1 [insulin-dependent] diabetic, and sometimes at night, when I haven't eaten enough to cover the insulin I took that evening, I 'bottom out': my blood sugar goes down very low and I wake up bathed in sweat and must go searching for orange juice. My question is about this: The nighttime sweat from low blood sugar just... stinks. It is powerfully rank sweat, as though I had not washed in many days. My partner agreed, he has noticed that it is different from any other sweat I sweat. "You NEVER smell like that any other time. It's a low blood sugar thing." Yet only at night! I also become clothes-soakingly sweaty if low blood sugar happens during the day, BUT it seems 'normal', the same as when I exercise. Can anyone tell me why this might be? Why is the night-time hypoglycemic sweat so incredibly smelly?

I feel sure someone will ask, so: Though I have had the disease for 30 years, I am a well-controlled diabetic; my doctors proclaim themselves pleased with my tests, which I get done faithfully on schedule. Indeed, if I am bottoming out from time to time as I say, I am not in perfect control; I do make mistakes.
posted by st looney up the cream bun and jam to Health & Fitness (9 answers total) 2 users marked this as a favorite
Best answer: Drawing from personal experience of your problem, I'm inclined to think it might be because there's just so much of it. When I wake up after a midnight hypo I feel like I've been in a bath. If you've been lying in a hot bed for 5 hours sweating, I'm sure there's more chance for bacteria to fester a bit.

As an aside - and I know this is kind of an obvious thing to ask - but have you ever tested your blood sugar when waking up from this. My nurse told me that there's a sort of a 'bounce' when the liver releases a whole load of sugar after you've been hypoglycemic for a while. I've been told to watch out for high blood sugar after a night-time hypo.
posted by I_pity_the_fool at 7:11 AM on August 24, 2009

Oops that was a fail. Didn't mean to press "post." Feel free to delete that.
Diabetic Ketoacidosis is what I meant to link to, and what you've got is the opposite. It's not uncommon for over-insulined folks to stink-ass.

When you're insulin deficient, you smell sweet, somewhere between honeysuckle and acetone. When you've got too much, it's the opposite.
posted by TomMelee at 7:17 AM on August 24, 2009 [1 favorite]

I would also hypothesize ketoacidosis, though it may be more complicated than that. Certainly, when you are that hypoglycemic, your liver is working on burning fats, producing ketones. Such heavy amounts of sweat, however, require some chemical changes in your body, and I find my adrenoline is vastly increased when I am so hypoglycemic (also, things like blood pressure and heart rate go up, et c.) I know that service animals for persons with diabetes are trained to sniff out "lows" and assist - so I'd venture there is something particular that happens to your body when you are low, and it may be more than just ketones.

(I've been T1DM for 25 years myself and have had this happen).
posted by mccn at 7:54 AM on August 24, 2009

Some people think that dogs can smell hypoglycemia. Since people's lowest dips are often at night (you aren't awake to notice or do anything about it) it's logical that the smell would be greater. When your system gets going for heavy exercise or terror the smell is stronger also.

Hypoglycemia triggers (assuming someone don't have autonomic neurophathy yet) a counter-regulatory reaction with adrenaline, noradrenaline, and glucagon. There is also an autonomic nervous system response. Adrenaline and noradrenaline also control sweating (and lots of other things), so there's your sweat and stink.
posted by a robot made out of meat at 8:12 AM on August 24, 2009

What robot said, but is it especially redolent of ammonia? Ammonia in your sweat is caused by burning protein instead of carbohydrates (which would make sense).
posted by aquafortis at 8:59 AM on August 24, 2009

What robot said, but is it especially redolent of ammonia? Ammonia in your sweat is caused by burning protein instead of carbohydrates (which would make sense).

As I'm sure the FP knows, it's usually described as a smell of acetone or honeysuckle.
posted by I_pity_the_fool at 9:25 AM on August 24, 2009

btw... have you looked into altering when you take your long term Insulin?

Sounds like you're having to treat with food for an insulin regimen that may not be working exactly right (not that there is an "exactly right" to the ART of long term regimens!)?

Dunno what you're taking, but if it's an Ultra-lente (as I'd assume from what you've said)... you might try backing up the dosage time to before bed... so the 8hour onset (approx) starts when you go to sleep... the sleep slows down the onset... (and if it doesn't slow it down enough... inject it into your butt... that'll slow it even more - injection sites can alter absorption - leg/ intra-muscular shortens onset and overall effective life for eg).

Then, by the time night comes around... it'll be on the wane - I use Lantus, and even though it's rated at 30hour... I experience that it's on its way down after dinnertime... and if I eat late, I must adjust my sliding scale a bit to account for lower level/ available insulin level... this might help w/ overnight...

I know this wasn't your question, but as a Type I ... it's immediately where my mind went - thinking "why is this guy accepting this problem (as I perceived it)?"

Anyway... have never experienced different smells, but have experienced very different "types" of lows... depending upon how they present (time period, what I've eaten, how much exercise, time of day, altitude, etc.)... seems you've got some good thoughts already on the stink-thing already though.

posted by Jiff_and_theChoosyMuthers at 9:31 AM on August 24, 2009

Best answer: Do you shower in the morning? I'm wondering if it's just the day's worth of bacteria and dirt that makes it smell?
posted by luckypozzo at 11:38 AM on August 24, 2009

Best answer: You have two main kinds of sweat glands, apocrine and eccrine.

The main burden of thermoregulation is borne by the the eccrine glands, but they are less active at night and tend to be inactive during sleep.

Apocrine sweat glands, on the other hand,

are coiled tubular glands that produce a viscous, cloudy, and potentially odorous secretion. They begin secreting at puberty; the sweat produced may be acted upon by bacteria, causing a noticeable odor.

I think your body turns on the apocrine glands at a higher level when you need to sweat while asleep because the eccrine glands are turned down or off.
posted by jamjam at 6:43 PM on February 5, 2010

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