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Teenagers and overnight blood sugar management

Discussion in 'Parents of Children with Type 1' started by BrendaK, Nov 18, 2015.

  1. BrendaK

    BrendaK Neonatal Diabetes Registry

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    Thanks for all of the input. I think a lot of the issues here are my own personal fears of transition. Especially because he was diagnosed as an infant. The one part of D management that hasn't changed for me over the last 15 years is the overnight management. I have always done that. He does all of the daytime management very very well. But not many people have done 15 years of overnight blood sugar checks and that's the hardest and scariest thing to let go of.

    He does check in with me before bed -- calibrates the Dexcom and we talk about any action needed.

    I have to think back to when we transitioned to him doing his own daytime management. He was actually better at it than I was. He knows his own body better than I could. I can't help but wonder if he will end up managing overnights better than I can.
     
  2. Theo's dad Joe

    Theo's dad Joe Approved members

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    It IS scary thinking about that in my future. I have a question if you would share Brenda. How did you run night time checks over the years? All of MY instructions were to check at night a couple of times a week, and if you make changes and if there is a lot of activity in the afternoon. I was pretty much told NOT to check every night. Fortunately we got dexcom before my son started using any significant amount of basal insulin and he always ate dinner at least 3 1/2 hours before bed (or I checked) but his doses have tripled in the 4 months since we got dexcom and so I want to know what to expect at night.
     
    Last edited: Nov 19, 2015
  3. Sarah Maddie's Mom

    Sarah Maddie's Mom Approved members

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    I understand exactly what you are saying. I recently had coffee with the mom of a kid dx'd at 13 and I founding myself prefacing almost all my comments with "of course we've been doing it this way since she was small" or something like that. It is different when your kid is dxd young and you have been carrying the nights for years. That said, we found the transition to be pretty organic - it just gradually happened that she took over the nights. We still connect before bed, I do feel I need to at least know if she's 78 or 378 before I shut my eyes, but what to do is on her and I've only checked her overnight a handful of times in the past 6-9 months. And she also does a better job that I do - it's her body and she knows it better than I, even after all these years.

    I think you are really at a perfectly age appropriate place :)
     
  4. BrendaK

    BrendaK Neonatal Diabetes Registry

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    How old is your son? Things were very unpredictable and volatile at night clear until puberty. Partly because that was the age before the Dexcom and partly because he was so sensitive to insulin. Throughout childhood we checked before we went to bed 10-11pm, then on a normal night we would check again around 2am and again in the morning around 6am. Once we got the Dexcom we relied on the alarms (which can sometimes be worse than a single 2am check). If it was a bad night we'd check at 10pm then midnight and go from there. Puberty made it a little easier in a sense because he is definitely not sensitive to insulin anymore. We can make more changes without a high risk of lows.

    The other thing I wanted to mention as to why "it's time" I'm not sure how to say this…… But it is not okay for me to be digging through a 15 year old boys pajama pockets in the dark in the middle of the night to find his pump. It's starting to feel uncomfortable and inappropriate. I've started to avoid giving him corrections at night because I do not want to take off his blankets and dig in his pockets. He does not want that and neither do I. Kind of how we know "it's time for mom to stop…."
     
  5. Theo's dad Joe

    Theo's dad Joe Approved members

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    My son is 9, but he had enough of his own insulin to come down to around 90 in the morning with 1-2 units of Lantus for most of the honeymoon. Even now at 10 months in, he would probably stay in range maybe 110ish by breakfast on 2 units of Lantus but he is at the edge of honeymoon dosage and the margin of error has gone from about 50% to about 5%. He used to be able to eat 15 grams uncovered and be at 90 in 2 hours. Now he would be 200 in 2 hours and moving down very slowly.

    I didn't check at night. The endo said it wasn't necessary. Even on the first night in the ER they gave him 4 units of Lantus even after his blood sugar had come down from 300 to 130 on its own and nobody thought that 4 units of Lantus would possibly make him go low. At the clinic during an orientation a parent asked if night time lows were dangerous and they were told that kids almost always woke up from the adrenaline rush before they got too low at night, however the endo also told me to cut his basal any time he woke up under 100 in the morning. (Later another one told me that I didn't have to change it until he got 2 wake ups under 70 in a week). Again, now with dexcom I can see that he stays around 90-110 most of the time and dips a little right around 5:30 to around 90.

    Anyway, 4 months of Dex has showed no night time lows as we have raised his Lantus. He pretty much hits 100 by midnight and slips down 10-15 points by the time he wakes up so we have gotten the advantage of running around 100 for 7+ hours every night so far. I wondered if most people are fine with kids running under 100 at night. When I called the on-call endo about night checks, she told me that they advise giving 15 grams of carbs at night any time a kids goes under 130!

    So do people tend to try to run higher/safer after the honeymoon is over?
     
    Last edited: Nov 19, 2015
  6. Sprocket

    Sprocket Approved members

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    Totally agree with this. I am teaching my daughter (13) gradually over her teen years and I am completely confident she will be independent and ready to look after herself by the time she goes to university. I feel it is my job to learn everything I possibly can how to best manage diabetes, and teach her. This includes doing night time checks and adjustments. She'll have to deal with it herself for many years ahead. It is my pleasure to help her in any way I can for as long as I can.
     
  7. caspi

    caspi Approved members

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    As the Mom of a 17 year old boy, I totally get it. My son lays his pump next to him while he's sleeping so it's easy for me to get to but on those rare occasions that it's stuffed back in his pocket, I wake him up or have my husband search around for it. :wink:
     
  8. Mish

    Mish Approved members

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    Hi Brenda!
    We're not quite there - in that Ian doesn't really show any care that I still do the night checks, which isn't often. Whereas he's taken over the days easily. But I have had the same feelings as you lately during the night corrections, like I'm starting to think it's time, like if he woke up and found me poking around his pajamas he'd be horrified. He's also 15. (how did this happen, that we have boys who are 15? weren't they just 5 ? ) I don't have any answers for you, but just commiseration.
     
  9. BarbDwyer

    BarbDwyer Approved members

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    My son (14yo) doesn't want me doing anything to him in his sleep. I wake him up to test and he does his own correction. He does not wake up on his own, and he doesn't always remember waking up - but I do wake him. He does it on his own when he stays over with a friend. I have him text me at night.

    He wants me to quit nagging about levemir before bed. He has not been responsible so he is it in 'trouble' but he has to deal with my involvement in that. He woke up very high this morning. I suspect he forgot it but we really don't know. Three strikes - back to mom being involved ;)
     
  10. sugarmonkey

    sugarmonkey Approved members

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    I wish doctors would stop saying this! It's one of the most inaccurate things in diabetes. My son has never woken up to a low, and we've tested him and caught plenty overnight. From what I've seen others say on here, very few kids wake up to lows.

    As for them taking over the nights, my son can do it when he has to, but doesn't if I'm around to wake him up. Brenda, I think your situation is a bit different, in that you're dealing with Carson's and your diabetes. If he's willing to take over, go with it.
     
  11. MomofSweetOne

    MomofSweetOne Approved members

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    100% agree. My daughter has awakened due to a low once in over 5 years. The lowest I've found her at (during sensor start-up) was a 32.

    I heard an endo asked this question last summer, and my respect for her is high because she faced a group of parents who wanted assured that nothing bad would happen in the night, that their kids would wake up. She said that isn't always true, and she'd had personal experience with someone not waking.

    To the OP, your son will likely start waking easier as he comes through puberty. My daughter used to sleep through absolutely anything, but now she often stirs as I give her juice, etc. In some ways, I'd like to reverse the clock, and we now battle fatigue in both of us after bad nights. We've had two rough nights in a row, and she just headed upstairs for bed from exhaustion. I told her to just sleep through the night if she can; otherwise she can do schoolwork when she awakens.

    As others have said, they do wake better to the cgm when they're away, but it still isn't easy and I'm not comfortable without a back-up person I can call if she isn't waking. When she was at an academy this summer, she was exhausted and it took 16 calls to get her to wake one night. I got less sleep than when she was home, and I wasn't thrilled with all the comments from a friend about how much I must be enjoying the freedom of the empty nest. Um, no, I'm so sleep-deprived that I'm longing for the ability to just be able to jam a juice box in her mouth or punch in a correction myself and return to sleep!!
     

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