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Night time numbers question.

Discussion in 'Teens' started by Artgirl, Nov 19, 2015.

  1. Artgirl

    Artgirl Approved members

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    I was told that my daughter should be at 6 before bed and if she is not then I need to give her more carbs and snack to make sure that she doesn't have an overnight low, this terrifies me to death. Last night she was at 5.9 and even though she ate the extra snacks I was very scared all night. Can they feel a low happening? will they wake up? How can I make sure that this won't happen, I am new at this and overnight scares me and I don't want to stay up all night worrying about this either.
     
  2. Christopher

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    In my opinion, the best way to calm your fears about her overnight numbers is to check her several times during the night. Check her once at bedtime and if she is not at the number you want her to be at either, give her carbs to bring her up or insulin to bring her down. Then check her a few hours later. Depending on her number then, you may need to treat in a similar fashion. And you may need to check her again a few hours after that.

    Each child is different, so you will have to see if your child will wake up from a low. I know my daughter usually does not wake up when she is low. Sometimes she does, but I am not going to take that chance.

    I would also recommend creating a signature so people can see what kind of insulin she is using, if she in on a pump or MDI, if she is using a CGM, etc.

    Good luck
     
  3. rgcainmd

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    To add to what Christopher wrote in the response above, I highly recommend getting a Dexcom Continuous Glucose Monitor as soon as possible! I am not as new to this whole Type 1 diabetes thing as you are, so I have come to depend on my daughter's Dexcom's alarms alerting me to highs and lows. Not all people awaken to lows; unfortunately it is less common for kids, including adolescents, to wake from lows. Many adults awaken from low BGs because they sweat a great deal and end up waking up in a pool of sweat.

    It's important enough to repeat: Get a Dexcom ASAP; it makes overnights a whole lot less nerve-wracking!
     
  4. sszyszkiewicz

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    First I wanted to say that I am sorry for the diagnosis. Every time someone new arrives it reminds me (and likely the majority of us who frequent these boards) of our own stories and children and those first few months, which were a whirlwind.

    The fear you have is something that you are going to have to learn to deal with. Lows happen all the time. They can be managed but there are no 100% rules you can follow with diabetes and children that will work each and every time under all circumstances. There is danger there, but there is also danger driving a car and we do it all of the time. you manage the danger by wearing seatbelts, stopping at stop signs, and doing the speed limit.

    Every family deals with the risk differently.

    For me and my family there was a check before bed, and a decision about an uncovered snack was made. I dont know how old your daughter is or how much she weighs, but this article provides a sense of how much 1 carb will raise blood sugar

    http://diatribe.org/issues/55/thinking-like-a-pancreas

    Then we set an alarm for a few hours into the night to see how the levels were (we checked my son in his sleep). if he was below a certain level we would give him some juice and check again in 20 minutes. If he was above a level we slept until morning. So for example if bedtime was 10PM (my son was 11 at diagnosis), i would check again at 2AM.

    You do not want to hear this, but the reality is numbers can drop fast and even if you checked every 30 minutes your daughter might still go low. Going low is not uncommon. It will happen more often than you think at all times of the day, and night. The trick is, I believe, that they don't stay low for a long period of time. That is how I calmed myself. So if I checked before bed, halfway through the night, and then again at wake-up. If they were below what i considered safe there was a snack to bring him up, and then a test again 20-30 minutes later to make sure. This way, even if he was low, it was only a few hours in between. I felt like i was managing the risk.

    There is more than one way through this. Every parent on this board will have a different and equally valid strategy.

    The best advice is to look into Continuous Glucose monitoring (CGM)technology by a company called Dexcom. it will give you a real good approximation of "the number" every 5 minutes. It can send alarms. You can watch the number over your cell phone. another alternative is the Freestyle Libre, not available in america, but available in other countries. The Freestyle Libre doesn't alarm you but makes the checking of the number easier.

    Good luck. You can do this.
     
  5. Artgirl

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    Thanks for the replies, the hospital never mentioned anything about checking overnight at all, they said as long as she is over 6 its fine if she is under 6 then more snack at bedtime are necessary, wow, I will have to call in to clarify this, heavens I can't imagine getting up in the night as well to check....better be safe then sorry.
     
  6. rgcainmd

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    I can't imagine anyone being discharged from the hospital after being newly diagnosed with T1D without instructions to check overnight. This omission was negligent and dangerous!

    When you have a chance, please fill in the "signature" portion of your Forum account. This will make it much easier for people to respond to you and will help insure that you get germane advice.

    Did the hospital give you the "Pink Panther" T1D newbie book or something similar? If not, that's where I'd start. I'd follow-up with Gary Scheiner's Think Like a Pancreas. Just my opinion...
     
  7. DiabetesMama

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    Hi Artgirl. Glad you are asking lots of questions. I know this is scary and overwhelming, but you CAN do this. I am shocked that they did not tell you to check her numbers in the middle of the night! Our endo office had us check for quite awhile until we felt comfortable about what to do for our son's needs. Some kids have numbers that are all over the place and some have very stable numbers through the night. You will just have to monitor her for a bit to see what her numbers do at night. We all have different styles of how and when to check our kiddos in the middle of the night and I would suggest if you can to definitely get a Dexcom system. That is the only way I am getting any sleep. Now I must admit the first three days I cannot trust the numbers fully until it gets settled and stable, but after that warm up period, I trust it almost 100%. Is your daughter on a pump or MDI's? (multiple daily injections) How does she feel about maybe getting a pump? Is she opposed to wearing a pump or a CGM? I know this is all so very new to you both, but these are good questions to ask her and make sure she is comfortable with the idea first. I HATED the idea of my son getting a pump at first, I was so scared of needles and the inset was like an I.V. and I was opposed to him having something on him all the time. He was braver than I ever was! He was the one that wanted to watch the free DVD about pumps that they sent us home with from the doctor's office. He was so intrigued, I was terrified. Maybe it was just the idea of a machine taking care of him rather than me, I am unsure of what I was going through. But I will tell you the truth, the thought now of him not having a pump is more scary to me than anything else. We LOVE the pump and CGM. They both are so very important in his health and wellbeing. I love the CGM because I know that it's doing something I never could, monitoring his numbers 24/7. The pump can give him the correct amount of insulin around the clock that I never could. What a beautiful gift for our kids to make this disease less difficult on them. It has made such an impact on his outlook on life. I wouldn't push the issue with her right now, but maybe just ask her about how she feels about the pump or cgm. If she doesn't like the idea of being hooked up to something, ask about the CGM. There are no cords with that, and one sensor can last anywhere from 1-3 weeks average and can give you much needed peace of mind. Take it one day at a time and I promise, you both will get through this. Hugs for both of you. Keep us informed.
     
  8. Christopher

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    I can't imagine NOT checking at night. Think about it this way: Would you go 8-10 hours during the day without checking her bg? If you don't check her at night, how do you know if she is going low or high? Are you assuming that she stays steady all night? Just some things to think about. As for clarifying with the hospital, I am not sure what that is going to get you. If they never mentioned about checking at night before, chances are they are not going to instruct you to do it now.
     
  9. Artgirl

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    Okay so I got a hold of our Endo doctor who reassured me I did not have to check her night time sugars unless she has 3 days of under 4 in a row....as long as she is at above 6 and has her snack at bedtime she is fine....they would have told me before release???? This is a very reputable hospital and doctor and none of the staff from nurses to doctors mentioned that to me. So I am not sure why everyone else has to....again if her numbers are lower than 4 then I would call them asap for instructions!! Is this normal??
     
  10. sszyszkiewicz

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    Here is an article you may find interesting
    http://www.diabetesforecast.org/2014/Jan/6-tips-for-checking-a-child.html

    the blood sugar units mentioned are American, but you can convert to your units using this tool
    http://perinatology.com/calculators/GlucoseSIunits.htm
     
  11. rgcainmd

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    (The bolding is mine.)

    "Everyone else" doesn't have to, whether an endocrinologist told us to or not. I choose to because, bottom line, "Dead in Bed" syndrome exists. A very small percentage of children, even if everything is perfect blood sugar-wise at bedtime, go precipitously low overnight for no predictable reason, do not wake up to the low (as most children don't), and die. I am not telling you this to worry you needlessly, but I would have been beyond angry and in disbelief if no one had informed me of this when my daughter was diagnosed with T1D. Here are links to two articles about "Dead in Bed" syndrome:

    http://www.diabetes.co.uk/diabetes-complications/dead-in-bed-syndrome.html

    http://www.childrenwithdiabetes.com/d_0n_g00.htm

    I strongly suggest you read the article sszyszkiewicz posted the link to:

    http://www.diabetesforecast.org/2014...g-a-child.html

    in order to understand what people (who clearly know more than your endo) recommend RE overnight checks and the reasoning behind doing them.

    I won't even try to understand why your daughter's endocrinologist is giving you such bad (and frankly dangerous) advice. Does s/he actually believe that if you tuck a child with T1D into bed at a "safe" BG level, they are going to stay at that level throughout the night? Because that's just not the way it works. Don't believe me, get a CGM to see exactly what your daughter's BG does overnight...

    When it comes to life, and to T1D in particular It's better to be safe than sorry.
     
    Last edited: Nov 19, 2015
  12. Snowflake

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    We were also told at diagnosis that we didn't need to check overnight and that our daughter would wake with a low. I think this is pretty typical advice from endos. It was only through a Facebook group that I was inducted into over night checks - from which I quickly learned that my kid absolutely does not wake to lows!

    In addition to the worst case scenario laid about by other posts, overnight checks are very useful for good long term management. It really helps to know what's going on for that 10-ish hours of sleeping to make lantus/basal adjustments and to understand the impact of certain foods. All that said, there are parents on here who don't check every night, maybe because their overnights have proven predictable, and I think that's perfectly ok as long as you've been given enough information to really make an informed decision.
     
  13. Sarah Maddie's Mom

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    In short, pretty much everyone here was told they didn't need to check at night. Most people who bother to seek out CWD and become members are not your average D parent. The difference is that these parents have elected to educate themselves, to read, to share tips, to learn about their child's dx and most have come to realize the value of checking at night, especially for kids in honeymoon, in puberty, who participate in sports or who are hypo-unaware. No one "has to" check - but most of us understand why it matters and many elect to.
     
  14. Artgirl

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    Thank you for the replies, before my daughter was diagnosed with diabetes she has woken up several times usually around 5 to 7 am with lows where she was shaky and hungry, and asked for food, as well we had 2 episodes of her waking up and fainting with a bleeding nose( not sure if that was related to a real low sugar), so I am aware of the risks. I am definitely keeping an eye on her during the night. Now that we know of the diabetes and her numbers before bed and food intake I feel as if we are better prepared for overnights...and of course watching her. Thanks again.
     
  15. Christopher

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    So just to clarify, they are saying that as long as she is 6 at bedtime you don't need to check because she will stay at 6 the entire night because......?? What? Did you ask them how they know that? How could THEY possibly know that? How could YOU possibly know that unless you check her in the middle of the night? Just because she goes to bed at 6 and wakes up at or around 6 does NOT mean she stayed at 6 the entire night.

    I know all children are different, but I have been doing this 8+ years and have checked my daughter every single night, multiple times at night and I almost always have to make some kind of adjustment. It is just the nature of the disease. There are many nights that she goes to bed at a "safe" number and then in the middle of the night drops dangerously low. If I had not checked there could have been a serious problem. I am not saying this to scare you, but to educate you.

    I don't care how "reputable" the hospital is, there is no way they can account for all the variables that effect her bg during any particular day. Exercise, illness, food, puberty, that it is Friday, etc all can effect her bg.
    Then again, it is not their child who's life is on the line, is it?

    Each family needs to figure out what is right for them individually and I am sure you will do that. Just don't be lulled into a false sense of security because someone at a hospital told you so.

    Yes I am very passionate about this topic, so take my advice with a grain of salt.

    Good luck
     
    Last edited: Nov 20, 2015
  16. Artgirl

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    Hi there, yes basically as long as she is at 6 you add more carbs and a protein and she should be fine for the overnight. I am all new to this and just relaying what I have been told which is obviously not the norm here. I hope I can trust the professionals that are caring for my daughter. What can I say, I never knew anything about diabetes before last week and this is very scary and overwhelming so all I can so is ask, ask, and ask and read and share and research!! Thanks again.
     
  17. Christopher

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    I am not sure what else I can say to help you understand. So a 6 mmol/L where you live is a 106 mg/dl here in the states. So how many carbs do they want you to add? Do you or they know how much 1 carb will raise her bg and how long it will stay raised? Do you think she will react the same way every night to those carbs? Or maybe they just want you to have her bg be very high at night to hopefully make sure she doesn't go too low and you can get your sleep and not check her. Do they think that is a good long term management strategy?

    If you feel it is best to trust the "professionals" that are caring for your daughter and not listen to the people on this forum that live with this disease every single day (and night) for 5, 10, 15, 20 years, then that is completely your prerogative. I wish you all the best.
     
    Last edited: Nov 20, 2015
  18. sszyszkiewicz

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    It sounds like you have other things going on besides diabetes.
     
  19. Artgirl

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    What do you mean other things going on?Like other medical conditions? They did a full exam at the hospital!
     
  20. sugarmonkey

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    We're another family who were never told to test at night, but we do. I have seen many times where Phillip has gone to bed at 8 and dropped to 2. I still can't get Phillip's father to realise that just because he goes to bed at 8 and wakes up at 8, it's highly unlikely he's stayed that number all night long. Last night for example, he was 10 at bed. We didn't correct and 2 hours later he was HI on the meter (27.8). I don't know where that came from, but if we hadn't corrected it he would've woken up really sick.

    The main thing to remember when it comes to diabetes is the doctors are going by the textbooks, but diabetes hasn't read the book. It's not very often that what the textbooks (and doctors) say is the reality.
     

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