how do you decide what times to check during the night?

[3js]

We are checking at 3 and 5 am. We used to check at 1 and 3am, but moved it when we changed the evening nph to bedtime from dinner.

I am going on when the nph peaks. But now I`m feeling like 9pm-3am is too long to go without a check. My husband thinks I`m obsessed with lows.:o

How did you decide what times to pick?

[MelissaC]

We do not use NPH but Lantus and we (or I since DH does not get up unless we areall dying :) check her at bedtime around 8 or 8:30 - DH does check her around 11pm before coming to bed - I get up and check her around 2:00 - 2:30 and then I recheck her around 5:30 when I get up for school.... We usually do not do this but lately her numbers have been out of control - not with lows but severe highs...

Not fun but it needs to be done - hope we all get some well deserved rest soon ;)

[hold48398]

I think it all depends on when your child is the most sensitive to insulin and lows. For us, this tends to be between midnight and 3am. I am always up till midnight (or 11:30pm) anyways, so I check Mia at 9:45pm and before I go to bed, then depending on the number between 2:15 and 3:00am. She then is fine to go till the morning, which is 6:30am for us during the week, or a tad bit later on the weekends. If I happen to wake up between 3am and the morning, I often check her again to be on the safe side. Generally speaking, I am uncomfortable letting her go for much longer than a 3 hour stretch at night....

[kiwikid]

When my daughter was on NPH at dinner I used to check around midnight. If she was going to go low it would be around then. You could do midnight and 4am one night and maybe 11pm and 3am the next? I think varying the times you check, could be more beneficial than the same times every night. :cwds:

[thebestnest5]

We have never used NPH, only Lantus and Novolog.

But, my mom always checked during the peaks and at other times if she "had a feeling", or if the day was full of more activity, etc..

On the pump, we check before bed, and if no active insulin is running and depending on the number:cwds:...we check in 2 hours or so...and then decide if another check is needed. Which is usually another check around 1-3 am.

I have resigned myself to the fact, that I don't expect to ever sleep through the night and I'm OK with that. :)

I don't think checking in the middle of the night is being obsessed with lows. I look at it this way...I couldn't live with the fact that I could have prevented a seizure, stroke, or death in my child by just doing a nighttime check. Dead in Bed Syndrome (I know 2 people in the same town who died from it ..one was a relative, and one was the teenage boy of a family friend) is real and scary enough for me to get out of bed at night. Both of their deaths happened in the last 4 years, too...so there are just too many reasons not to check, IMO. Knowing that I had a full night's sleep if something devastating happened would never, ever be a consolation to me, in fact it would probably haunt me. My DH feels the same way; so we share nighttime BG checks.

Edited to add: That my cousin's death at age 30 was not clear...it could have been kidney failure...or multiple organ failure...all I know is that she talked to her mom the night before she went to bed about going bike riding later and was making future plans and that night she died sometime in the sleep.

[Mama2H]

We have always checked Hailey before she goes to bed around 9 and then before I go to bed around midnight. Then again at 3 AM and once more when I get up at 5:30 AM. It really has been nice to be able to just look at her pump most nights without having to poke her finger. Before cgms it was alway a poke now I only poke for lows, highs, and arrows. If she is steady I just go back to bed :D

[munsonklein]

We check at bedtime, which, since we're homeschooling night owls, is around 11:30 or 12:00, then around 3:00 AM, and then when my husband get up around 6:30 or 7. He and I nearly sleep in shifts. If Sarah's going to go low, she usually will have started to drop by about 3:00. It's a common occurrence for her- she's very prone to delayed post-exercise hypoglycemia, and it can be any time from a few hours to a day and a half after the exercise. 3:00 AM is usually also about 3 hours after her last bolus, so it's also a good time to make sure that the bolus wasn't too big. We'd love to skip a night here and there, but her BG's are just to erratic to risk it. More than 3-4 hours feels like too long between checks to me when she's asleep and probably won't wake up until she's really low. If your child is prone to nighttime lows, you're sort of forced to be obsessed with them. That's not an unhealthy obsession- it's keeping your child safe.

Cathy

[Carrie]

I usually check two hours after her last snack, which she usually eats around 10 p.m. Depending on what that BG number and how much active insulin she has will determine if I re-check her in two more hours.

[Momof4gr8kids]

My daughter pumps, so we do a midnight check and then a 6am check. If anything has to be done we check inbetween, but it just depends on the circumstances, like is she tending to go low an hour after correction? Is her correction not covering her, ect... If she wakes up low then the next day I try to hit it at least every 2 hours to see at which point she went low if I can't relate that low to something that is unique to the day before, like dance class, or a mistake with carb counting ect...

Does your DS go low often at night? Or are you just worried about the peak? If it is the peak, I'd suggest a good bedtime snack to help avoid it, and maybe the 6 hours wont weigh on your mind so much, or moving the first check up a little since NPH can vary by about 25% on the peak and timing.

Good luck, Jamie

[wilf]

When my daughter was on NPH at dinner I used to check around midnight. If she was going to go low it would be around then. You could do midnight and 4am one night and maybe 11pm and 3am the next? I think varying the times you check, could be more beneficial than the same times every night. :cwds:

Wow.. what was your endo thinking, giving your daughter NPH at dinner? Its peak effect starts 4 hours after injection, and would tend to lead to the midnight lows you were observing. The dinner meal should only be covered by bolus insulins, so as to avoid night-time lows.

By the way, since we're all up, now is a good time to check.. :)

[kiwikid]

Hi Wilf
I think that a lot of kids (and adults) are started on the the 2 injections a day (pre breakfast and pre dinner) of mixed long acting/short acting insulins when they are diagnosed. They certainly were when Rachel was dx'd 5 yrs ago, before Lantus was widely available, and I think most kids in our area (and probably in most of NZ) still are.

[wilf]

Hi Wilf
I think that a lot of kids (and adults) are started on the the 2 injections a day (pre breakfast and pre dinner) of mixed long acting/short acting insulins when they are diagnosed. They certainly were when Rachel was dx'd 5 yrs ago, before Lantus was widely available, and I think most kids in our area (and probably in most of NZ) still are.

The 2-injection per day method of diabetes treatment (also still in use here in Canada) may work for some, but overall in my opinion is an outdated way of managing diabetes.

In particular I am concerned any time I hear of people getting a long-acting insulin like NPH with their supper time injection. In those cases the NPH is having its peak effect around midnight, which will lead to night-time lows. It will also have almost stopped working by the early morning hours, leading to unwanted BG rises due to the "dawn effect".

Successful and safe management of BG levels are in my view best assured if you are on a pump (and know how to use it), or if you are receiving multiple daily injections of insulin. Typically the intensive insulin regimen should include long and short acting insulin with breakfast, short acting insulin with lunch and supper, and long-acting insulin at bed time. If one is on Lantus, then it's usually 1 Lantus injection per day, with bolus injections of short acting insulins at meal times.

[Heather(CA)]

Seth is on Lantus, I test him at night if I didn't like his 3 hours after dinner number or if he had hda lots of exercise that day...He does not get tested regularly at night, only if there's an issue. If I were you, and if it's poss. I would switch to Lantus asap:cwds:

[saxmaniac]

I agree with Heather.

When the Lantus is right, his overnight numbers are pretty stable. Regular late night checks are not the rule. Always right before we go to bed around 12am, but we usually sleep (if the baby lets us!)

If we have some late-night high and do a correction, then most certainly we'll do a late-night check.

Then, a few random 3-4-5am checks every few weeks to make sure we're not getting too complacent.

[3js]

Hmm. My son has been on nph/nr twice a day since dx. He gets 22nph am, 1nph pm. The nr is a sliding scale, plus we give 1unit for 30g carbs for extra food, or pizza.

Wilf, wasn`t your child high with just the fastacting at night? I sent you a pm. I hope you don`t mind re:insulin and bg#`s.:)


Thank you everyone for the replies. I really appreciate it.:)