Checking son through the night

My son who is now 14 was diagnosed type1 at 12. He was on injections for a full year (Humolog and Lantus) and then as of April 2012 he/we switched to the pump. Hence no more Lantus.My big fear was he was going to go high or low sometime throughout the night and literally for over a year now I wake at 12Am, 2AM and 5AM to check his BG. Luckily he does not awaken. It is beginning to take a bit of a physical toll on myself, but what does one do? I have to say although his overall numbers are very good, (an A1C of 7 and under and we are diligent carb counters) he has had at least 6-10 occasions over the last year with a dangerous low (39, 45, 60, etc!). His endo asked how I do this and still go to work, I told him there does not appear to be an alternative. He had no reply.
I am fine with continuing these late night vigils if there is no other alternative. Or is there?

I'm not a parent, so I probably can't understand the anxiety and responsibility parents feel. And exhausting that must be to get up through the night so many times! Since he is now on a pump, you have the option of setting his overnight basal time zones lower. Does he have lows during the night? Have you noted at what time periods these happen so you can create separate time zones and lower the basal two hours before those times? If not, then my suggestion is to lower it a bit anyway for your piece of mind and then ween yourself off of those nightly checks. You need to take care of yourself so you can take care of Anthony.

As for the lows you mention, they sound quite infrequent and a low is not dangerous if you can manage it yourself which it sounds like you did? Lows, unfortunately, are a part of the game and after awhile you just treat them and take them in stride. It's only when I see a pattern (which 6-10 times a year definitely is not!) that I consider altering doses to control the lows.

Another option is a CGM which might give you piece of mind, though it is my own personal bias that another object would just drive him nuts. Lots of people swear by them; that way maybe you could just check him once before going to bed and make sure he wasn't trending downwards.

Bottom line is if his basal is set right and he goes to bed at a reasonable number (and you can determine that to be what makes you comfortable) he should not go low during the night. If he is, then he needs his basal tweaked. My guess is he's just fine.

One last thought: You might want to read some of Jacobsmom's posts. Jacob is also 14 and she is doing a great job on turning some of the control of his D over to him.

It totally takes a toll. I feel it every morning, and yet, what is the option? My colleague told me that it's important to have a four hour uninterrupted chunk of sleep. So we try to do that. With a 2 a.m. check.

My first thought was that you guys could definitely benefit from a continuous glucose monitor (CGM). When I was a kid, I would always wake up when my blood sugar was going low, but I know not everyone wakes up on their own. If your insurance will cover it, a CGM could give you a lot of peace of mind and much more sleep!

Or you could try testing just once or twice at night, instead of 3 times. Also, getting your son's night-time basal rate right, and then make sure he tests before bed. If his blood sugar is in range, and has a correct basal setting, he should be OK for the night. You also will need to take into consideration whether he had a lot of activity that day, and if he did, you might have some residual lows in the night, and maybe do extra checks during the night if that's the case. But, I do think there are other alternatives to 3 tests a night that you could explore.

I've only done checking in the middle of the night when I got my pump and when I used to stay up partying in the middle of the night. Until I was in my early 30s, I only slept 5-6 hours/ night a lot of the time as, even when I was partying, I would generally get up pretty early.

I have a CGM now, that seems to work pretty well at helping me balance my numbers and accumulate data to make effective changes in rates and ration. I think that some parents also find them reassuring, although many of them continue to get up and test, just to be sure. Here's a shot of the sort of data I get. The dexcom has advantages over the Medtronic in that the range of the receiver is longer, so you can keep it in one room while junior sleeps away. Here's a pic of my last 24 hours:

Thanks so much for your reply. And you are correct, he asked not to have the CGM on because, "Dad, it's just so much stuff on me.", Plus he is a bit on the thin side and CGM needs a bit of fat or it is uncomfortable. I will check out Jacobsmom's post. Thanks so much.

Will try and space it out to 4 hour blocks. Thanks so much.

Thanks so much for your reply. Tried the CGM but between that pump site and the CGM he felt a bit overwhelmed. For the most part his overnight basal accurate, it for those times when he has "unexplained" lows that freak me out. Thanks again. Paul

Thanks so much for your reply. Tried the CGM, but he is a bit on the thin side and we were getting crazy readings plus it was a bit overwhelming right after the pump. Maybe in a few years. For now, like you mention, I probably will be one of those parents that checks through out the night. Thanks for the advice and congrats on those numbers -- 79 average for 24 hours.

Before I started pumping ('08) and CGMing ('10), I was shooting R and NPH, because I was "fine" and didn't need to change what I was doing, because I thought, perhaps erroneously, that I knew what I was doing. I was really flying by the seat of my pants, probably much riskier, etc. I had tons of night sweats (lows), AM highs, up and down and up and down. I didn't give much thought to "emergencies" because, while I don't know how low it went, I always got up. I am quite fortunate as I'm sure that the risk taking was every bit as risky as my doctors would have said if they knew what was going on. At the time, I didn't really have the ability to articulate what I was doing.

You are way ahead of that. I think that getting up 3x/ night is not good for your long-term health. I would also maybe rethink "dangerous" in terms of low as 60 is not nearly as dangerous as 39. Those numbers always need to be taken in context of the situation and, as in the line I posted 60-60-60-60 can work out fine, particularly if you are sleeping and not running around, driving, exercising, etc. If it's 70-60-50, that's a problem. I occasionally did tests 15 minutes apart, to see what was going on before I taught classes, etc. b/c I didn't want to let the people paying me to teach them down by getting suprised. That might be a strategy to sort of impersonate a CGM, which cranks out a reading every 5 minutes or so. In terms of your night, sleeping through 12 and doing 2x tests 15 minutes apart at 3:00 AM might tell you more than two tests spaced farther apart.

Great advice that I will heed. Thanks again. Paul