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Night Time Testing Question. What do you do?

Discussion in 'Parents of Children with Type 1' started by andiej, Feb 5, 2014.

  1. andiej

    andiej Approved members

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    Hi my son was diagnosed on Xmas Eve. At the moment we test before meals and before snacks, after school, bedtime and 11pm-midnight.

    I am paranoid about night time lows, (though he hasn't had any yet) so i tend to get up if his midnight test is is 6 or less or over 11.

    I just wondered how often you guys check at night and what times, and what instances?

    Thanks in advance.

    Andrea
     
  2. LoveMyHounds

    LoveMyHounds Approved members

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    Before the CGM I tested every two hours at night. Pretty exhausting......
    Nights are scary to me, DD doesn't wake up when low :(
     
  3. Beach bum

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    Well, for the 7 years prior to getting the CGM we tested every night around 3am. It all depended on her late night test as to when and how often we tested. If she was 110 or below, we would test again in 2 hours, if she was 250 or above, same thing. Now that we have the CGM, I still set the alarm, but it's so that I can look at it and decide if action needs to be taken. We also check more frequently if she is sick, if she had an activity later in the evening, or if she had something out of the norm for dinner (for example we had Chinese last night, so that's always tricky and needs more monitoring).

    I always say, "you don't go that long without checking during the day, so why do it at night?" IMHO, diabetes is 24x7. It doesn't go to sleep when you do.

    There are mixed feelings about night time testing. Some feel it is imperative, some feel it's not always necessary. You need to do what makes you feel most comfortable.
     
  4. hawkeyegirl

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    We have had a CGM for almost 6 years, but without it, I would test at midnight, 2, and 4.
     
  5. MomofSweetOne

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    We have a CGM. My daughter doesn't wake to nighttime lows, even though she feels daytime lows. When we first got it, our team required that I check at least once per night by alarm as well, but they have lifted that requirement. The nightlife of diabetes has taken its toll on me.

    If your insurance will cover a CGM, I would highly recommend it. It gives the kids more freedom, less lows (and highs) and lowers parental stress by an unfathomable amount. The sensor wire is tiny & at least Dexcom usually lasts 10 days or more.
     
  6. andiej

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    Unfortunately here in the UK it's next to impossible to get a CGM. I would pay for one myself if the ongoing costs weren't so ridiculous. At the moment Jack's levels do not change much over night, though he is in the honeymoon phase so i'm aware this could change at any time.
     
  7. Sarah Maddie's Mom

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    We managed for 10 years without a CGM and millions before us did too ;-)

    I think what you are doing now is completely appropriate.

    It's a great technology but you can do overnight checks without being up all night. It's perhaps more complicated with a honeymooning kid but knowing when he last ate, last exercised, had a bolus and how much IoB or not and what was for dinner you can look at that bedtime and midnight number and get a pretty good sense of how he's trending. I used to log in a notebook just so that I could see the numbers all in a row and at a glance, get a feeling to the day.
     
  8. sszyszkiewicz

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    I am new too. DS was diagnosed the day before Thanksgiving.

    Your mileage may vary.

    Its a constant math game, but in the end it seems like you have to get a sense of how much insulin is around. What you control is carbs and different insulins and when you inject. What you dont control is how much insulin his pancreas is still producing, how the body reacts to exercise, how fast the basal insulin absorbs and a million other things. So you only can control what you can control and do your best to see how your child reacts.

    On a "normal" school night we shower at 9:00PM (yes a hot shower can drop glucose levels quickly so at 9PM his previous days lantus is gone, and the bolus from dinner is also pretty much gone). he gets his lantus shot at 9:30PM with a blood check. Dinner is usually at least 3 hours ago. By that time there is no bolus insulin around or is on the way to being used. We aim for a blood sugar of about 150 (8.3). if he is lower than that he gets an uncovered snack of some type. If he is higher than that, particularly if over 200 (11) we have a covered snack if he is hungry and we correct down to 150 (8.3) For a kid that weighs 75 pounds 1 uncovered carb adds about 5 (0.18) units to blood sugar. Here is that reference......http://www.diatribe.org/issues/55/thinking-like-a-pancreas

    So we try and get him to 120 (6.7) to 150 (8.3) one way or another.

    then its off to bed.

    3 hours after his lantus shot I check him. Regardless of everything at that point the only insulin at play should be his lantus and whatever his pancreas decides to kick in. if the number is over 110 (5.55) I go to bed for the rest of the night. if it is less than 110 but greater than 90 I check in two hours. if it is less than 90 I check in 1 hour. I treat if he goes into the 60's (about 3.6).

    he is in his "honeymoon" so his body seems to be driving him towards 70 (3.8) each night then he starts to rise after 4AM (ask me how I know that.....)

    with the above he typically wakes up at 7AM about 85 or 90 (4.8 to 5).

    Once sports starts after this weather clears I am sure things will be different, but for the last few weeks this has been working. We are looking into getting a CGM, because these individual points in time don't really provide enough information but it's all we have at the moment. there is only so much you can do with a fingerstick.

    this is what I have been doing. Just remember I am as new to this as you. There are lots of other people with more experience than me!
     
  9. Christopher

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    Good question.

    I have always felt it is important to check during the night. Not only are you catching low/high bg's and keeping your child safe/healthy, but it is also giving you valuable information as to how their body is dealing with things, be it a certain type of food, exercise, illness, etc. The other advantage is having her wake up close to in-range as possible. I have found that if she wakes up with a high bg it is difficult to bring her down. So I check every night, several times a night and have done so ever since she was dx.

    I usually check Danielle at bedtime, then around Midnight, then around 3am. Obviously, if I give insulin in the middle of the night for a correction I may check more often to make sure she doesn't go too low.

    The lack of sleep is tough and some nights are better/worse than others. But I don't mind because it gives me a certain comfort level and I also know I will only be doing it for a few more years.
     
    Last edited: Feb 5, 2014
  10. DavidN

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    We test roughly at 11:00am before bed and 2:00am. Never less sometimes more depending on what's going on. We did this pre-CGM and still do it with CGM, but sleep better with the CGM.
     
  11. mamattorney

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    We are almost a year past diagnosis. We tested overnight at the very beginning (couple of weeks), then not at all for a couple months and then I started testing once around 2:00a.m. when summer started because of all the varied activity. I almost never had to do anything during that first summer (correct or treat), but I continued the 2:00am test knowing that it gave her some peace and security and also because if I skipped it I felt an overwhelming sense of guilt (my personal issue). Then all the sudden (maybe October), her numbers jumped really high and I started testing at midnight and 3:00 because I wanted to catch the highs before they got too bad and do my best to have her wake up at a normal number. This wackiness (it soon became day and night) caused her to finally decide to try a cgm and she started that in November.

    Now she tests before bed and I do not set any alarms. I do check the dexcom before I go to bed (midnight-ish), but I only get up if it alarms.
     
  12. glko

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    My 9yo is also in the honeymoon phase, dxd in August 2013. My husband has had type 1 for 29 years. Apparently we are outliers here but we rarely test during the night and at this point in his disease I don't think it is helpful for us under most situations. He still makes lots of insulin - same as op he trends down toward but not below 70 and then rises early in the AM to settle in between 80-110 consistently before breakfast.
    I realize that the honeymoon will wear off and at that time we may need to test more at night, which is part of the reason we are happy to not do it now. This is a marathon and the fewer sleepless nights we have the better for all of us. I have to say we all sleep great and after the first month I have no worries about letting him ride during the night and no worries that he would not wake up if he got into the 50s.
    Situations where we do test between 11 - midnight before we go to bed include: heavy exercise in the evening, a late high carb high fat snack with lots of active insulin on board, or if he is sick.
     
  13. Christopher

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    I would think that this would be a time I would want to test at night, because you never know when his pancreas is going to release insulin and drive him low.

    Are you are basing this on actual evidence that in the past he has woken up when he is very low? Because for many people with Type 1 they do not feel their lows when they are asleep. Just to be clear, I am not judging and whatever works for your family is great. I just don't want anyone to read this and think that kids feel their lows when they are asleep.
     
  14. susanlindstrom16

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    Our typical night is: check around bedtime, then before I go to bed between 11-12, and then I set my alarm for 3am. I really don't feel like I am up all night or anything, since it usually only takes about 5 minutes. Sometimes its hard to drag myself out of bed, and those are the times that I remind myself how much worse it is with an infant that doesn't want to go back to sleep at 4am!
     
  15. Jeff

    Jeff Founder, CWD

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    On the topic of nocturnal hypoglycemia, it's best to let the data speak. Many studies show that there is more nocturnal hypoglycemia than many people thought, and that people with type 1 cannot be counted on to wake up when low.

    I share the studies below not to alarm anyone, but to be sure that we are making decisions on whether to check at night or use a CGM based on the best evidence available.

    Here are some studies worth reading:

    Prolonged Nocturnal Hypoglycemia Is Common During 12 Months Of Continuous Glucose Monitoring In Children And Adults With Type 1 Diabetes
    http://care.diabetesjournals.org/content/early/2010/02/25/dc09-2081.abstract

    Nocturnal hypoglycaemias in type 1 diabetic patients: what can we learn with continuous glucose monitoring?
    http://www.ncbi.nlm.nih.gov/pubmed?cmd=Retrieve&dopt=Abstract&list_uids=17652003

    Nocturnal hypoglycaemia in Type 1 diabetic patients, assessed with continuous glucose monitoring: frequency, duration and associations
    http://onlinelibrary.wiley.com/doi/10.1111/j.1464-5491.2007.02107.x/abstract

    Defective Awakening Response to Nocturnal Hypoglycemia in Patients with Type 1 Diabetes Mellitus
    http://www.plosmedicine.org/article/info:doi/10.1371/journal.pmed.0040069
    PDF Full Text

    Awakening from Sleep and Hypoglycemia in Type 1 Diabetes Mellitus
    http://www.plosmedicine.org/article/info:doi/10.1371/journal.pmed.0040099
     
  16. sszyszkiewicz

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    Boooooo ! Clearly a regulator that is clueless.
     
  17. wilf

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    Is your son honeymooning?
     
  18. jmg707

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    You will probably get varied responses because everyone is different. We are about 1 1/2 years into this and I still test multiple times at night. Now, mostly, that will depend on what has gone on during the day. If there has been lots of activity, illness, an odd schedule, pump setting changes, etc....then I test more often. Typically we test close to bedtime (8pm) at her bedtime (9:30pm or so) and then again at my bedtime (11pm-12am). Based on the last number we are up and testing again at either 2am or 3am. I would say that I rarely skip the 3am check. It has become such a habit that I am awake anyway so, why not :)
     
  19. sincity2003

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    We are just over a year in, and as always YMMV, but the first couple weeks, we checked right before bed at 9pm, again at midnight and then DH checked him at 3am before he left for work and I was back up at 6am for work, so I checked him. After those first few weeks, we dropped the midnight check, but DH still checked at 3am. When he went on the OmniPod, we didn't have the Dexcom yet, so we were checking every 2 hours around the clock.
    With the Dexcom, we now check before bed, DH is still up for work at 2:30 am, so he checks just to make sure, and then unless it alarms, I don't get up and do another check until breakfast at 7am. On the nights DH is off, we just change the settings a little more aggressively on the CGM and we don't get up unless it goes off.

    Also, DS feels his daytime lows, but has never felt an overnight low. We have realized that if he has a nightmare, that's a sign that he's low, and he knows to get up and come and get one of us so we can test, but that's only happened twice in the year.
     
  20. TheTestingMom

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    I check DS at bedtime which is 9:30pm, midnight, between 2am - 3am then again between 6am - 7am. Of course I may check more depending on his numbers. I've caught both low lows and highs, more often than not he doesn't wake up OR remember us treating the low. Same goes with highs, he seems to get ketones fairly easy so I need to be on top of everything. I don't get back to sleep very quick, so I'm tired and grumpy a lot :blue: I don't hesitate to take a nap during the day when I can get one :sleeping:
     

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