Nighttime goals

Sorry to be starting so many threads and being so needy Thanks to all for help in my learning.

Question is: what is your nighttime goal for BG? Recently, one of our CDEs mentioned that I should make adjustments because of "lows" that son was having at night. I had changed the basal program so that from 3:30 a.m. to breakfast, sometime as late as 10 a.m. in the morning, he was relatively steady, maybe a very slow drop, to a BG of 93 - 115. He often is in the 90s during sleep with no significant drop. She said that under 100 "should be treated". I thought steady in the 90s was good?? Maybe even really good??

(Note, he does wear a G4, I do at least one night check, usually 2, and I'm up by 6:00 when I check the Dexcom again. Bedroom is adjoining and I can hear alarms if G4 working well.)

We are having a little difficulty with bedtime because we eat dinner around 7 p.m., he wants a snack by 10 p.m. before bed, and so there is a large "hump" or dull spike which will work off by 2:30 or 3 p.m. She saw this as a steady decline in BG over the night whereas I see it is a normal spike due to food and IOB still.

She suggested a very small basal increase at lunch and dinner, which I did adjust, and he had his first nighttime low at 1:30 a.m. in awhile. (And the dex was off - it said 90 and he was 64 and unaware Transmitter dying maybe.) Generally, he is still high at 1:30 so I was surprised for such a significant difference and hold out that some mild to moderate exercise before dinner might have had a delayed effect. On the basal, I'm going back to my old routine. It was at least keeping him safe, but I still wonder that she wants me to treat a 95?

 

Our doctor set the goal of 100 for both day and night. She recommended a slow-carb snack before bed, something dairy, to keep the levels smoother.
But we only checked his night time sugar for the first 3 nights of having a pump, at 3 am, that's it. I have no idea what his sugar is from 8pm till 8am. Is this something to worry about?

 

Yes, how dare you be needy and ask all these questions. Don't you know everything by now??

Seriously though, in my opinion if he is wearing a CGM and you are cheking at night, there is nothing wrong with being in range at night. If I saw a 95 at night I would need to wait about 30 minutes and test her again to see what direction her bg was going. You can tell right away with the CGM so if you see a 95 but he is dropping, then yes, you should treat it. But if he is steady, why not try and keep him in range as opposed to treating it and possibly making him go higher?

Just my two cents. Good luck.

 

In my opinion, if you don't check him for 12 hours during the night you are taking on a risk. You risk missing a high bg that should be lowered. You also risk missing a low bg that could turn into something serious. Each parent needs to decide for themselves how much risk they want to take with their child's health. It is a big responsibility.

 

I agree. The Dr told us to stop checking during the night after three days of wearing a pump, when his 3am sugars were fine. I should probably do some more tests at night.

 

With the Dex, we let her run in the 80s overnight. The Dex almost always catches the lows, and we eat dinner around 6pm, so if I can get basically 10 hours of no food with just basal to manage her, I'm going to keep as tight control as possible - because that's half her day I can keep her in the lowest manageable range that is healthy.

 

Yes. It's rare that nights are the same in growing kids. CGMs are awesome because they can keep track of lows while you sleep & let you get up when needed. I was so tired I slept through the CGM for two hours each night this week & woke to a 56 one night and a 300+ the next.

 

Our low alarm is set for 80 on the Dex. With the Dex, I'm comfortable with steady 80s or 90s at night. Without it, I'd aim higher.

 

+1 with what Hawkeyegirl said.

 

We don't have a CGM. How often should I test him during the night?

 

Please note that this is just my opinion and each parent needs to figure out what is best for their family and themselves.

If I had a newly dx 2 year old, I would be testing multiple times at night. I would test at bedtime, then a few hours later. Depending on what that number was and if I had to do a correction I would probably check one more time in the middle of the night.

Then again, I have been checking Danielle multiple times a night, every night since she was dx at 8 and she is 15 now. Yes I am tired, but to me, it is worth it because I catch many highs and lows that I otherwise would miss. Also, she has to deal with this her entire life, so I don't mind taking the burden from her because it is only temporary for me.

 

Luke (13yo) treats anything under 100. He does not have a CGM. He checks once a night between 2-3am. If he is very low (below 70) he checks again in 15 minutes and then again in a couple hours. We backed off on the lantus and he doesn't really go that low at night anymore unless there is something atypical about his day (extra exercise). He is still a new diagnosis so I'm sure it is about to change I liked it when he woke up in the 80's or 90's. He is waking up higher now but to many lows isn't good either.

 

I think it depends upon your own nighttime habits. I would try to cut the time you don't know the numbers in half. I would test at his bedtime and then before you go to bed (let's say 11:00pm) and when you wake up. If you are up for the day at 6:30, then I would aim for one middle of the night check around 3:00 - 3:30. To me, and this is just my opinion, it's not a long term solution to only get sleep in a couple of hour spurts. It happens to the best of us sometimes and some nights your intuition will tell you that you need to check more (illness, crazy day, big holiday meal/other eating situation that you think may make bgs haywire overnight, not liking what's happening between his bedtime and yours, etc), but I don't think it's a liveable solution as a routine.

 

At 100 I only treat if she's drifting down and it's still early morning. Since we started the Dexcom I shoot for a bed time number around 110-120 and I'm good with waking numbers of 70-110. I set the low alarm between 65-80 depending on how accurate and comfortable I am with that particular sensor.

For those who don't have a CGM, it is life changing, especially at night. If your insurance will cover it you'll never regret getting one.

 

I agree, and I wonder if our CDEs request that I treat under 100 is because she deals with a lot of people without CGMs? Son actually is 110 - 120 most mornings and drifts slowly to the 90s by wake up. During this drift, I am up and watching his numbers and starting the day in the 90s seems to go better with breakfast spikes.

They have us targeting 140 for bedtime, which I don't think I'll mess with right now because he is more sensitive to insulin at night and seems to have good numbers most nights with that target.

 

That would be great advice if diabetes played by any rules. But it doesn't. So even if you see three days of a consistant pattern, that does not mean it will continue like that on the 4th, 5th, 6th, etc day.

I think it is easy for some Endo's to give this kind of advice, because it is not their child. It totally changes when it is your child who's health could be damaged (or worse). It changes your decision making process.

 

This is our approach as well. Before the Dexcom, DD's daytime target of 100 was raised to 120 at night, however, we only treated if 90 or below (subject to the usual caveats about high activity, slow carbs, etc.)

 

Thanks to all of you for confirming what I thought which is that for a 12 year old (I think maybe different for younger?), we are okay at a cruising altitude in the 90s, especially if all systems are working (Dexcom and mom is checking or awake). My dr. actually said last time we saw him that he wasn't all that concerned by BG in the 70s if not dropping. Perhaps new technology will make lower numbers more safe and not unusual? Again, younger children discussed here may have other protocols.

 

His BG is fine before and after bed. If he was low during the night, then he would wake up low, correct? The low BG wouldn't correct itself because there's basal pumping all night, so he would wake up low in the morning?
And if he was high at night, then he would wake up with a wet diaper, but he doesn't.
That's a good sign, right?

 

Not necessarily. In a functioning pancreatic world, the pancreas is releasing both insulin & glucagon (and more) to regulate BG. Our kids' bodies are impaired in more than just insulin function. If they released glucagon when going low, we would have far less concerns. But SOMETIMES they do release glucagon. So, without knowing what is happening during the night, a high BG in the morning would look like more insulin is needed when it might be masking a glucagon release that occurred due to a prolonged low. Think Like A Pancreas describes it in more detail.

An adult friend told me when he began CGMing, he was going to bed and waking at the same number so he thought his nights were good. When he got the CGM, he learned he was spending HOURS in the 40s each night and coming up by wake-up, whether from a glucagon release or just different basal needs at different times.

If you have coverage for a CGM, I would recommend requesting one today. Call Dexcom and they'll figure it out and get a prescription from your doctor. They're that life-changing. Within 24 hours, you'll wish you'd left the hospital with one.