I wanted to share our nighttime routine and see how it compared with others.
Our son is 7. He was diagnosed last September and is still in honeymoon. I’ve know since the beginning that hypo episodes were a potential danger and something to be aware of. But I recently read something that really scared me. According to JDRF, 1 in 20 people with type 1 will die from low blood sugar episodes. http://www.jdrfbayarea.org/blog/2011/percentage-people-type1-diabetes-die-low-blood-sugar-hypoglycemia/
“JDRF ran a large advertisement in The New York Times and in TheWashington Post. The ad shows a photograph a young girl. Below her are the words: “Piper has type 1 diabetes. One in twenty people like Piper will die from low blood sugar.”
I had not seen it put in terms that stark before. Now I have a whole new level of concern.
Our typical nighttime routine goes like this:
Dinner is usually done by 5:30 – 6:00pm
Between 8:00 – 8:30pm he gets tested, gets his Lantus (2 units) and has his bedtime snack.
My wife does the obligatory “still breathing” check every night but we rarely check his BG in the middle of the night unless he was lower than normal when he went to bed.
Does anyone do middle of the night BG checks every night? Is there a better night time snack? Anything that should be avoided?
We’ve been lucky because he has had relatively few low blood sugar episodes and none that I would call severe. But I don’t want to become complacent. Especially with what I’ve just learned.
My son was diagnosed approx 5 months ago. Still in honeymoon. I check every night 2 or 3 am. I will give him a night time snack before bed. Always looking at the ratio of fat to protein to carbohydrate and fiber. Because it is all about Blood Glucose Stability and not Carbs, right? Mainstream looks primarily at carbs. So good fat along with fiber will give more BG stability. A good bed time snack is something like: apple, peanut butter/nut butter (protein/fat/carb/fiber)
And then add into the calculation, his exercise for the day, stress, hydration, etc.
Hi there. My son is 10. He was diagnosed when he was 3 and has been pumping for almost as long. I have always done at least one nighttime check. He also uses DexCom G4. Since upgrading to the G4, because of its accuracy, there are times when I will just take a peek at that on my nightstand and if all is well, take no action.
I have found out of honeymoon and with pumping only fast acting insulin, combined with a variably active young man, there is just too much unpredictability not to check.
chances are you are going to get a lot of responses to this, everyone needs to do what they feel is right for themselves and their childrens's diabetes, as not everyones diabetes is the same! we rarely test my son overnight. his activity level is mild to moderate he does not participate in organized sports, i say this because intense exercise during the day is probably the biggist cause for night time hypos.. we have always given my son a big snack at bed time, he is 14 and really just wont stop eating but that is another issue.. we include fat and protein in his bed time snack to keep him going either medium fat icecream, low fat chips and cheese stick, english muffin with peanut butter these are his favs these days, the fat and protein help to sustain bs... however it doesnt sound like your son is getting novolog for his bedtime snack so nothing to huge unless you want to cover with a bit of novolog, obviously what ever your endo is recommeding at this point. if your son decided to take up competitive sports i would probably do some testing to make sure he is not dropping.. we test at night if he is up to pee to make sure he is not up because he is high. jacob really hates night times checks and to be honest we havent seen a big need for it.. i still do the night time breathing check after 4 years.. please dont become overinvested in anything you here on tv, trust your instincts if it has been a weird day and you are worried test ... best wishes, amy
Hello Texas Dad, Our daughter is 7 and has had T1 for 3 years. She has been on the Animas Ping for just over a year and does not have a continuous glucose monitor. You will get as many routines as there are T1 families, but just for interest and comparison-here is ours. (At the moment)
dinner 5:30 snack and bedtime check 7:30
check at my bedtime 11 pm
Here is where things vary each night. If our daughter is not in range at 11 pm and we have to give her sugar or a large insulin correction, I set my alarm for 1 pm to make sure she is back in range. At 1 am I make a decision as to whether I will wake at 3 pm for a check as well. Most nights we can get by on the 11 pm check and the 3 am check.
Whenever I have made changes to her insulin pump's basal programs I will test her at midnight, 3am and 6 am for a couple nights to make sure the changes are keeping her in range. (generally every couple of months for significant changes)
I also sneak a check in at 5 am if the previous day was VERY active-like all day at water slides etc. For some reason, Sophia drops during this time in the morning after a day of extreme exercise. The pump has helped us manage those drops as we often lower her basal temporarily to prevent the drop. However...this is me....I still get up to check her to make sure that her sugar is in control.
Sounds like a lot of checking but for us it is necessary. Our daughter sleeps through both severe low and high blood sugars and we have randomly caught extremes in both throughout the night.
I am hoping that we can get a continuous glucose monitor some day soon as I am sure that I would sleep better and we could have a better picture of Sophia's night time sugars and likely eliminate some night time checking.
I am not sure about Boost. Are your son's morning sugars in good range? Our night time snacks are different every night...Sometimes our daughter finishes what she didn't eat for dinner! Sometimes it is toast or crackers and peanut butter. We have used glucerna (similar to boost) on days when our daughter just won't eat. I have found it tough to bolus for the glucerna because of the protein and the delayed high.
One thought, why not do a check when you get up to do the "are you breathing" check? You are up already.. Hope this helps. I have never heard the statistic of 1 in 20...I think every family needs to do what works for them. All kids are different and so are the T1 families they belong to! There are some great ideas on this forum. I hope you will feel supported-in what ever routine works for your family. Stephanie
My son is almost 4 and he was diagnosed at 21 months. Even at that early age, we didn't do too many middle of the night checks, as long as he went to sleep at a reasonable number. He has a CGM but I haven't been able to use it because he takes it off too much (remember, he is 3) but when he does keep it on it is great for checking trends and knowing if an additional check is necessary. One other thing to consider would be an insulin pump as this will allow you to change basal rates before bedtime. I
I have two kids with T1D. It's a fine line between being duly diligent and becoming obsessive and sleep deprived over night time checking. For us, if the before bedtime numbers seem a little funky or if there has been a lot of activity like during the day such as extra exercise, then we feel a night time check is in order. Certainly when an illness is present it's a good idea to check in the night to make sure they don't wake up too high and start the day off badly. A CGM is also a great tool to consider to give you peace of mind and help detect both low and high blood sugar trends. An alarm will sound when the blood sugars go out of whack and that's great. One more thing to add is that we just attended a conference wherein a pediatric endocrinologist told us the rule of thumb is that if your child has had a hypoglycemic event during the day, then you should check them in the night because they are unlikely to feel it during the night time.
My daughter has had at least one overnight check every night since 4 days after she came home from the hospital at dx. That’s 4 years ago next week. We were told not to check because there was no need, so we followed the endo’s advice. While researching online I discovered there were a lot of parents checking at night. Their reasons sounded valid, do I started checking. Less than a week after I started, I found her having a hypo in the 30s. Good bedtime number no active insulin & no activity. At first I checked out of fear of lows. She’s been hypo unaware since dx & has woken from 2 lows in 4 yrs. Now I check because 8 hours is a long time to go with a high BG. I wouldn’t let her go that long during the day without checking, so why shod I overnight? Hormones are a bear to deal with!
As for the ad you mentioned, I have to say I was & am very upset about that whole campaign. If you research enough, you’ll find the odds are much more in your child’s favor than that ad would have you believe. Yes, there is a risk. But there’s also a risk every time your child gets in a car, or crosses the street. Knowledge is power, even in the face of fear.
I agree with tiaE, that ad is more alarming than helpful. My 12.5 yr old daughter has been T1 for 2 yrs 3 months. I check her blood sugar evry night around 2 am. As time goes on you will better understand patterns of BS based on foods eaten and activity level. And of course there are the gazillion other things that affect BS. I check her BS on week nights and my husband takes the weekend shift. I’m a stay at home mom and can do this but the weekend break is a blessing. She had a CGM for almost a year. I did not have to get up as much but sometimes the alarm would go off and it was wrong when I check with a finger prick. She has the older Dexcom 7. The newer ones may be more reliable and something you may want to consider. My daughter was more bothered by the constant outward reminder that she felt the CGM gave. She also did not like that it limited what she could wear. I really think you can’t go wrong doing a nightly check. We only have them with us for so long. One day they will be grown and on their own. For me it is worth it. I realize many people have full time jobs and that getting up every night reaks havoc in daily function, so I pray you find what works for your family. Someone told me once it never gets better. I disagree!! The more you educated yourself about it and the more you learn how things affect your son, the easier all the routine things become. Best of luck to you
My daughter is 8 (diagnosed at 3 1/2). Snack of choice in our house is chocolate milk before bed. I have heard from older diabetics that ice cream or yogurt is a good choice as well. We have always checked overnight between 2 and 3. Yes, a lot of sleepless nights but in our case worth it. Bedtime is always between 7 and 8 so she gets tested around 11pm. She is not very active nor in organized sports but still tends to go low at night. If we adjust basal on her pump, she tends to spike and be over 300. So for us a night time check is/was always necessary. We have since started using the Dexcom G4 CGM and if by chance she is within normal range during the night we do not test. But if she seems to be going low or high we test and treat or test and correct. We know many families that do not test at night. Testing is a personal preference and if your child does not need it then there is no reason to do it. For us it is a personal choice and makes us feel better if we do.
First off, you’re a good dad for doing everything you are doing (even the worrying - although the kids never wish you to do that!). All the parents are - it is such a hard thing for parents to go through. I have had diabetes 29 years. I got it when I was five. My parents were also fantastic! I would suggest that your son have some protein before going to sleep - that keeps the sugars stable longer (a piece of cheese - 25 g or so - is good). My parents also did something very smart when I was young. They kept a baby monitor in my room until I was a teenager. If I was having a low, I would almost always make some noise and they would hear it. I also always have and had juice and/or honey by my bed at all times. I also have an extra blood sugar meter right by my bed so that it is easier to test (no searching around for the meter).
Hey Texas Dad, My son has been T1d since Sept 2011, so we have almost 2 years experience. We have had one seizure-type episode, just this past January, so I have a great fear of hypo situations, they are relatively quick and easy to correct, but scary as heck. We have dinner between 6-7, then do a check before giving a snack (& correction if necessary.) Snacks we try to do something with protein, such as yogurt/gogurt or Blue Bell ice cream. Often I will check him before I go to bed, around 10-11pm, then I always get up once at night, I try to do it 1/2 way between the hours I get to sleep, like if I go to bed at 11, and will be up at 7, then I will test at 2:30 - 3:00 am. Usually all is good, but we've had a lot of juice too. It takes 5 minutes, and I know it disrupts your sleep, but that 5 minutes can certainly save your child from a severe hypo event. Good luck to you!
I have 2 kids with Type 1. My daughter is 15 (was dx at 5) and my son is 12 (dx at 11). I rarely do over night checks unless they were low within 2-3 hours of bedtime, there has been a change in dose or if they have had a particularly active day. As far as snacks go, my kids always have a snack that combines protein and carbs. That helps to stave off lows over the course of the night. You need to do what works for you.
