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Night time BG checks?

Discussion in 'Parents of Children with Type 1' started by momof2kids, Mar 3, 2011.

  1. Amy C.

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    My son doesn't wake up with the night-time testing and never has in over 13 years of testing. Your daughter might at first, but then would probably start sleeping through it.

    Dead in the bed is what motiviates me. Plus the fact that lots of corrections are made one way or the other in the middle of the night.
     
  2. Lisa P.

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    Three years into this, I am perfectly willing to believe that YDMV enough that some folks can safely avoid night checks under normal circumstances, but I think it's the exception to the rule.

    We regularly would miss lows or highs without night checks. We do multiple checks every night. The CGMS helps because we don't have to always do a meter test and because alarms and trend lines help us know when we are likely to have a good space where we don't need to check.

    We check toes at night. She never wakes up. She rarely wakes fully to eat when it's necessary.

    Here's what I think of. In the day, we check her regularly. It's not just meter bg checks, we look at her. If she's looking tired, peaked, gaunt, pale, blue circles under her eyes, if she's shaky, sleepy, cranky -- these are all signs that she might be going high or low. When she's asleep, we can't use any of those cues. We can't look at her and know if she's high or low. So a bg test (combined with cgms for us) is, to me, even more essential at night. Selah can sleep for 12 hours. Being above 500 or under 40 for half of that would be very unhealthy and probably very dangerous. In our situation, I can't see not checking at least once every night.

    Best to you in finding what works for your family. :cwds:
     
  3. hawkeyegirl

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    We have the CGM and only check if it alarms.

    If he doesn't have an operating sensor on (very rare), we always check. Multiple times a night. If you don't check at night, you will miss highs and lows, guaranteed. It's just a matter of how comfortable you are with that.
     
  4. bnmom

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    The endo told us to test at 3am for the first 2 weeks, then after that said I only needed to check him at 3am if his lantus dose had changed.

    I was so relieved to be sleeping again - then I heard about "dead in bed". 3am checks are now a regular thing and will continue to be for as long as ds lives at home.

    He usually sleeps right through it - even more so since we started using the One Touch Delica lancets (tiny needle makes it almost pain free)
     
  5. mom24grlz

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    I check Ashleigh 1-2x's at night. Most of the time her numbers are fine but we have had occasions where she was low and didn't even know it. She can recognize a low when she's awake, but will not wake up for a low during the night. I have to wake her up and get her to drink some juice. Our endocrinologist office also says I don't need to check her in the middle of the night, but I will for my own peace of mind.
     
  6. Sarah Maddie's Mom

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    Pretty brilliant statement, Lisa. :cool:
     
  7. momof2kids

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    Now I'm wondering this - if there is a concern, especially for something as severe as convulsions or death, how the heck to do you decide WHEN to check? What if you are checking at 3am every night but something happens at 2am? Obviously, you have to choose something and anything is better than nothing, but geesh - it sounds tough.

    We have already decided that we really want CGM and now it sounds even more important. We don't typically have highs above 250 during the day and even lows are rare unless she has missed a meal or is playing really hard. Who knows about at night, though. She's fairly consistent when she wakes up but I sure don't know what happens while she's sleeping.

    She doesn't have a pump yet and is honeymooning really well for now, so she takes very little insulin (1/2 unit Lantus, ~ 2 units Novalog these days). I think because of those things, we've been fairly comfortable with skipping the nighttime checks. I think we'll need to change that as we get ready to pump and her honeymoon ends.
     
  8. Becky Stevens mom

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    This is a very good question. Many people try to pick a "middle of the night" time. Say if your CWD goes to bed at 9:00 and gets up at 7:00AM you may want to check at 2:00AM. Or others check before they go to bed at 11 or 12 and if all looks ok they may not check again or may choose to check at 4AM. Alot of the timing has to do with what foods were eaten, activity (could there be a delayed hypo from lots of late afternoon activity?), peak action of some insulins (lantus will sometimes peak after 4-6 hours) so if its peaking after those many hours that would be a good time to check. Please dont be too worried about fatal reactions to lows at night. I wont tell you that they never happen but are extremely rare. I think its important to test so that if there is a high or low reading you can do something to fix it so your child can sleep comfortably for the rest of the night (Sarah Maddies Mom made that excellent point)
     
  9. Sarah Maddie's Mom

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    You learn your kid.:cwds:

    You gain an intuitive sense of your child, and you look at the numbers and you look back at the day and really... you hope that you're making the wisest decision.

    Try not to get too panicked. It's very terrifying to think of anything happening to our kids at night, but we have to live as well. And we have to sleep.:eek:

    DIB (and I'm loath to even type that) is very rare and not fully understood. We have to balance the risk with the quality of life and simple things like being able to drive our kids safely the next day.

    It's a process, not a rule. You will come to a place where you feel that you've reached the best possible plan for your family.:cwds:
     
  10. momof2kids

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    That makes sense. Perhaps much of the reason she is often so tired is that she didn't sleep well due to BG fluctuations.

    For the first few weeks after dx, she was understandably traumatized every time we had to check her BG. It was a truly horrible thing to check her at night. It would take both of us to hold her down and she just screamed and screamed, so obviously we were very relieved when we could stop doing them!

    Now that she's comfortable with doing her own BG checks during the day, I guess it probably wouldn't be too bad. I had forgotten how much she has changed wrt/BG testing.
     
  11. Sarah Maddie's Mom

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    We do a lot of alternate site testing. Maddie likes her forearms... maybe that's something that you could try?
     
  12. Tuff

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    Yes I should've added that my son never wakes up for the night checks. Even when he needs a juice he opens his mouth and drinks while he sleeps. Similar to a baby and a bottle. If it is a severe low I will rouse him a bit just so I know he's okay.
     
  13. momof2kids

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    Well, it sure would be wonderful if she could sleep through them. I'm going to talk to my hubby about all this and maybe we'll start doing some night time checks at least to see where we are. It might also be a good thing to get her used to so that when she starts pumping it will be one less change for her to adjust to.
     
  14. Christopher

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    Thanks for that Darryl. It just confirms why I check every single night.

    To the OP, I am a big believer in checking at night. I have checked her every night, multiple times a night ever since dx and I will continue to do so until she is out of the house. The main reason is to be able to catch highs/lows and treat them. And I catch things often. As for when to check that is a pretty individual thing. It also will be driven by what actions you take when you check. I would start by checking at bedtime, then (depending on the bedtime number of course) 2 or 3 hours after that. If you give insulin to bring down a high, you are going to want to check another 2 or 3 hours after that.

    In the beginning Danielle would wake up every time I tried to check her and it would be a 15 minutes screaming crying tantrum. It was a real nightmare. Eventually she slept thru the finger sticks and she even sleeps through getting a shot (for the most part).

    Good luck whatever you decide to do.
     
    Last edited: Mar 3, 2011
  15. JacksonsMom

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    Jackson was diagnosed at the age of 3. We were told the same thing, check for the first two weeks and that's it. We are still checking. In the beginning I dreaded it. He would wake up and it would be a huge ordeal but it didn't take long at all before he would sleep through them. He started sleeeping through shots and like others have said, doesn't wake up to drink the juice, he just does it in his sleep. I think in a perfect world we could not do the checks if we could have basals always be spot on, not have lows from exercise, highs from fast spikes or hormones, bad sites, fevers, etc etc then maybe we could skip the middle of he night checks but for me it's not worth the risk. I can't tell you how many lows we have seen.

    Be careful, with spring comming up and outdoor play increasing you should keep an I out for delayed lows from excercise that can occur during the night! Spring can often be an adjustment time for young kids as their activity increases!!
     
  16. buggle

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    We use CGM, but I still wake up multiple times to check it during the night. When he doesn't have a working CGM, we set the alarm every 2-3 hours to check. My son's BGs are too unpredictable, so we aren't willing to take the risk of not checking.
     
  17. momof2kids

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    Do you wake up and check even with CGM because you don't trust the CGM to be good enough?
     
  18. wilf

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    Every child is different and every family's situation is different, and the degree of BG variability will be different at different ages for the same child.

    During DD's honeymoon, we started by checking nightly but she was always in range so we slacked off to every week or two just to make sure she was on track. As her honeymoon faded, we started seeing highs and lows in those weekly overnight checks and started to step up the frequency.

    I would say that now over 4 years in we check most nights, unless we have good reason to believe that there is no risk of a low and yet she's also not so high we need to correct. We pretty much always check if she has any IOB for a correction.

    Our case is not as extreme as Darryl's - but I'd say that on about 50% of the nights we check DD is on the low side and needs carbs, on 25% she is high and needs a correction, and on 25% she is in between.

    Obviously the tighter the range you are trying to keep BG levels within, the greater the odds of a child being outside that range and needing a correction or carbs.
     
  19. shekov

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    I still test most nights. In the past week we have caught 2 highs (over 250) and one stubborn low (72, 82, 82, 101)

    My dh is the night owl so will do a test around 11pm-midnight range.

    If that # is in range with no IOB AND I feel I have her overnight basals correct, she doesn't get tested again until I get my older dd up for school at 5:45 am.

    D dd gets up at 7:30 so this gives me time to correct a higher or lower # before breakfast.
     
  20. Lisa P.

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    This is one aspect you may want to consider later, after the honeymoon.
    We avoided multiple night checks for awhile by running her on the high side, which was reasonable for a toddler since she could drop fast and we couldn't check every hour every night. :eek:
    But after a year or so, I realized that night is half her day. So if I let her run high for half her life, that's going to impact her long term health. We had to tighten it up, hence more checking.:(
     

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