Teenagers and overnight blood sugar management

Carson has had diabetes over 14 years. He's 15 now and it's time to have him start to be responsible for his overnight blood sugar. For those that have gone through this transition: I need some help with how to let go. I've had the responsibility of managing overnights for so long I don't know how to handle giving that over to a 15 year old. But it needs to be done for his health and for mine.

 

I have a 14 year old who has only had diabetes for less than a year but we are in the same situation in which we also want him to take some of the responsibility. I believe the reigns should be handed over slowly as he is ready to handle it and with some support. His biggest obstacle is waking up in the night to do checks and treat lows or correct highs. He is very groggy and would clearly make mistakes.

He and I agree that this should happen and be complete before he goes off to college in a few years and that he be much more independent before he spends the night away at various places. We have tried a few things and so far none has worked well.

His alarm is set for midnight and he never wakes from it independently. I wake him up every night when the alarm goes off and if he needs to do something I urge him to do it until it is done. He is only recently motivated because the clinic has refused to let him have a pump unless he tests four times per day and one of those times is midnight. I am hoping that in time his body will adjust to waking at the same time each night and it will get easy for him.

We will see...

 

Well, I might not be very helpful as my son is a junior in high school and my husband and I still do the overnights when necessary. It's not that my son can't - he handles it when he's away from home - but while he's still home we handle the overnights. Next year when he's a senior we will start making him responsible for attending to his alarms in preparation of him going off to college.

If you want him to start managing overnight, let the Dexcom be your friend. :wink: Does he wake to the alarms? If he doesn't and you have the Share, you can have him follow himself and those alarms are much louder than the receiver itself. I would make sure he's checking right before bed and calibrate. Have his meter/low supplies within reach of his bed so it's easier for him to check.

 

I've slept with his Dexcom (and mine) on my nightstand for years. He doesn't wake easily to alarms but he's never had the chance to either. He's never been in charge overnight ever. He's going on a school trip in January out of state for 3 nights and we are going to have to figure this out. Not just for the trip but for his growing up life in general. DH told me I was going to need therapy for the next 4 years to get myself ready to let him go to college. He's right....

We will be getting the G5 before the end of the year. But I'm not sure I want to be looking at his numbers on my phone the rest of my life...

 

I've tried to reply to this thread three times and end up deleting my post ... In short, I think you have to let your older teen manage in the way they are most comfortable. Obviously they can't be checked out - they need to have juice on the nightstand and check before the go to sleep, make smart, cautious decisions about corrections or reducing basal but I really don't think it's realistic to expect a teen to set an alarm clock for a middle of the night check. JMHO

 

Is this about getting him to do it, or more about you learning to trust him to take care of himself?


Either way, a little at a time is probably the best way to hand it over. Give him some room, including a little leeway for mistakes, and as he earns your trust, you will give it.

My other thought was that he should be allowed to make most of the decisions about the process (unless he wants you to keep doing it completely). Letting him be in charge is going to go over much better than something you are making him do. If he doesn't want to take it over, you may have to create a reward system for him, so he is more invested in it.

How does he do during the day?

 

I'll just say that I taught high school for 12 years and there were very few teens, even fewer under age 15 or 16, who were developmentally ready IMO to be responsible for something like that. Some of the most responsible and mature kids would be ready by that point, but a small minority.

 

I agree with Sarah. When Danielle was 15 and starting High School and actually as she has progressed through High School, my approach was that I managed her overnight because I wanted her to get as much sleep as possible and be as alert as possible so she could perform as well as possible in her classes, sports, etc. I was comfortable with this, and remain so, because I know she is perfectly capable of managing her diabetes herself, and she has demonstrated that when she has done sleepovers, gone out with her friends, etc. I still manage her diabetes overnight and plan to continue to do it until she leaves for college.

 

i still check Ashleigh at night. She's 16. I'm nervous about when she moves out. The girl is a very deep sleeper. Actually all 4 of my girls are, they get that from their dad. Once asleep they're dead to the world. The dexcom alarm can be going off right by her head and she will not wake up. Several times i've found it on the floor under her bed. It actually alarmed and vibrated off her night stand onto the floor. She continues to snore as i check her sugar. I have no idea how she's going to wake to test her sugar when she moves out. She will wake up to drink something if low, but you can tell she's not fully aware of what's going on. We've had some weird conversations that she has no memory of.

 

Mines in college but still living at home. She does all of her own management but if she feels she's off she'll ask me to get her up for a night check. It's not very often.

 

I think kids will surprise you - when they HAVE to wake the alarms, they'll figure out a way to do it. There are parents who are just as deep of sleepers and they figure something out (Share alarms, put it in a glass with pennies, etc).

If I'm in the house, my daughter wouldn't wake to an alarm if her life depended on it. But if I'm out or she's at a sleepover, she hears them.

 

I would like to challenge your arbitrary statement that "it's time to have him start to be responsible for his overnight blood sugar".

Why exactly is it time?

Is it because you don't want to do it anymore? If so then it would be good to look at exactly why not, rather than dumping this responsibility on your son at an age where most kids can't handle it..

 

I agree with Sarah 100%.

Speaking for myself, I don't plan on "training" my daughter to take care of overnights until one year before she heads off for college. I know it's exhausting, but I have always done all of the overnight monitoring, even before I was a single parent. Even if my daughter did awaken to Dexcom alarms, or alarms of any kind for that matter, I personally feel that it's my responsibility as her parent to allow her to get as much uninterrupted sleep overnight as she needs. Even after she goes away to college, I will continue to be her extra eyes and ears overnight via Dexcom Share/Follow.

Do I do all of her T1D management? No, not by a longshot. She is "on her own" with me as backup via Share while I am at work, which is about 50 - 70 hours per week. She knows how to count carbs, how/when to use temp. basals, how to adjust corrections, etc. She does all of her pump changes, unless she is feeling particularly burned out and wants me to take over for awhile. But I don't mind doing as much as she needs for as long as she needs because she is the one who will have to deal with T1D for the rest of her life, not me. I want to shoulder as much of this unfair burden as possible. I'm a mom; it's my job.

 

Have you considered giving him a few nights a week and keeping a few for yourself? Are you using the share? If so you could keep your alarms wider on your nights (say 55 and 300) for back up. Your health matters too and if you need a break you need a break...

I guess I am trying to say that I don't think it is crazy to give some nighttime responsibility to the 15 year old. When I was 15, I was a junior in high school and I shared nighttime responsibility with my parents because they traveled for work and when they had overlapping business trips, nights were my responsibility. I did completely fine and it was great preparation for college to get that experience in small doses (1-2 weeks at a time) while in a familiar environment. Managing things during normal day to day life is completely different than a few nights here or there on a school trip or sleepover. I was NOT the most responsible kid (lots of drinking etc.) and I was at one of the most rigorous high school's in the country and playing varsity sports at the time. So I really do think most kids (ideally with dexcom share for back up) can handle 1-2 nights a week to give their parents a break. Everyone has different approaches but I think there are as many advantages to giving a 15 year old some nighttime experience on a consistent basis as disadvantages.

 

It's time for several reasons. He needs to be able to be a normal kid and go overnight places without me. He's never been on any overnights. He needs time to practice this before he goes to college, gradually. And he WANTS to do this and feel independent. I would do it the rest of my life if I could but it's not healthy. I do not rely on anyone to check me at night (I am also type 1). I want him to feel capable.

I'm curious: your signature says your daughter is 19. How have you handled overnights? At what age do you finally let go completely? And how?

 

Because I am a type 1 myself, yes I need a break from managing 2 Dexcoms every night and he is wanting more responsibility. My diabetes is particularly difficult to manage right now and dealing with 2 Dexcoms at night every night is affecting my health as well. We are getting the G5 soon.

We gave him the Dex last night for the first time. I got up to go to the bathroom at midnight and checked on it. He put it in a bowl with coins and a cowbell. It woke him up at 2 with a high alarm. He corrected, went back to sleep and was very proud this morning.

 

We measured overnight as long as she was at home (to age 18). She measured on sleepovers.

Once she moved away from home she did her own measurements at night. This isn't something you need a lot of practice at, it is just something you do when the time comes.

 

I don't know how volatile his overnight BGs tend to be from day-to-day, but is is possible to spend a few days to focus on fine-tuning his overnight basal as accurately as possible and then giving him the reins? Before he goes to bed could you sit down with him, discuss his day, and jointly determine if he needs to adjust his basal or set additional overnight alarms?

 

I agree - any of us T1's diagnosed as adults have never had someone else doing this for us, and it wasn't exactly a monumentally difficult task to take on (annoying, sure, but difficult, no) - you do it because you have to.

I think there may be some uncertainty for a young adult transitioning away from parents being their primary caregiver(s), but bottom line is that he knows what to do and is capable of doing it. Is he going to make mistakes? Sure, without question, but that's just part of D management.

 

^^^This.^^^