'Night Glucose Testing'

[Med Help]

A Yale University diabetes educator's comments in the current issue of Countdown magazine about night blood glucose testing in children with juvenile (type 1) diabetes have sparked considerable debate. The article and Yale's response can be found at:

http://www.jdrf.org/nighttesting

We would welcome hearing from forum visitors who would like to share their own experiences with night testing. Please post your comments here in this forum.

Thank you.

[galzee]

I just want to put my two cents in on this one as it is one of the issues that I like to stress to those newly diagnosed families.  Whether or not you choose to do 3am bg checks, you should ALWAYS be prepared and have a non-expired glucagon kit where it is handy in the event you need to use it in the middle of the night.  It is also super important that you know how to use it.  My 16 year old daughter was diagnosed at the age of 21 months and the only severe hypoglycemic event she has had was a couple of months after her diagnosis, in the middle of the night. We were never advised by her diabetes healthcare team that we should be checking her in the middle of the night, so we weren't.  Needless to say, after going through that and seeing her that way (seizing)...we do now.  Granted, it's not every night, but it depends on where she is at when she goes to bed and what activity she's had during the day.  There are so many factors (some of them unknown) that determine blood glucose readings.  For example, she just spent 10 days at the National Youth Leadership Forum on Medicine and because of her increased activity (using her brain and walking around campus), she tested every night and made reductions to her insulin needs for the first three days as she was in the 80's at 3am and even with treating with a juicebox, she was waking up in the 50's and 60's.  It took three days of adjustments before her body adjusted to her new routine.  The example is just to prove that even after 15 years of having diabetes, it's still important to know where your blood sugar is at and you can't possibly know it without testing.
     One issue that wasn't brought up was that with so many kids on the pump, testing more frequently is very important since hyperglycemia is the main concern when on the pump.  We've already had the pump fail during the night and may not have known it until the morning if we weren't doing the 3am check.  It wasn't the pump itself, but the infusion set failing.
     As far as the emotional aspect of frequent testing, we have never been uptight about the 3am checks, it has just been something that needed to be done.  We haven't made a huge deal out of it and so far, my daughter doesn't see it as such either.  Our attitude is that we all have issues in life that we must deal with, no matter how unpleasant they might seem at the time.  To us, losing some sleep is well worth the peace of mind in knowing that our daughter is going to avoid a hypocemic event in the middle of the night again.
     I am just so grateful to have a place for us to go to like Medhelp and JDRF to voice our opinions and hear from others, as topics such as this are effecting all of us daily and bear great importance in the mission of finding a cure for diabetes.
I would like to encourage everyone who has learned something from this forum, to join the effort in finding a cure for diabetes.  Everyone of you can make a difference!  Thanx for listening!

[Annalise]

My seven-year-old son was diagnosed in June, 2003 and is still in his honeymoon. Despite every effort to keep things under control (and believe me, I am a Type A when it comes to my son's diabetes), his numbers still fluctuate wildly. He started day camp this week, with lots of outdoor activities, and his readings have ranged from 30 to the high 200s. My son's A1C test results have been excellent, so I don't particularly worry about the fluctuations. Having said all that, I do test him once a night because he is low at least twice a week despite having a Glucerna shake and a big serving of cheese right before bed. Granted, I get up at 3 a.m. to get ready for work anyway, which makes it easier on me than other parents. But we also test him on the weekend. Like one of the other parents said, I'd rather be safe than sorry.

[JDRF TEAM ES]

First of all, it was difficult for me to even consider responding to this question and the parent comments. I became Diabetic at the age of 13 and was able to communicate my needs and learn how to manage my diabetes, in so far as it could be managed at that time, 39 years ago. Even so, my parents were a wreck all the time, constantly worried about me and my disease. So my heart goes out to parents of very small children who must manage a very difficult disease with all the technological tools that are now available, but still no perfect formula and no promised outcome. I do hate this disease and hate what all of us have to go through on a daily basis to survive.

And it is because of this that I must speak for the voice of moderation, even on night testing. The challenge of living with Diabetes is not only about managing our disease, but it is also about learning to live a full and meaningful life with a chronic disease. What you teach your kids about LIVING with Diabetes starts early. Your anxieties,your concerns, your limitations and fears will become theirs. Every child is different and it is important to know your child's nature and to deal with their diabetes in a way that is consistent with how they are most likely to approach it as they get older. It is so impoprtant to pay attention to all aspects of your child's response to this disease, including their emotional response.

Please understand that I am not saying not to test at night and I am certainly not advocating poor control or sloppy treatment of Diabetes. What I am suggesting, and what I think the article is suggesting, is to use blood testing as a tool to monitor, to learn about your patterns and to change behaviors to improve control. If you know your child has hypoglycemic night tendencies, test before they go to bed, provide a snack and test once or twice for a few nights to see if it works. If it does, keep up the pattern of before bed testing and snacks. If your child needs to go to bed with 150 blood sugar in order to avoid a hypoglycemic attack, then either give him/her a larger snack or lower their night insulin. If exercise causes hypoglycemia, then add a snack. There are going to be days when you break from your normal routine and may want to test a little more than usual. But it can be very hard and depressing to keep up a rigid schedule of blood testing all day long and nighttime too.

Obviously all this needs to be checked out with your physician, as I am certainly not qualified to give medical advice. What I do know is that the ability to test blood sugar has led some of us to believe that our blood sugars must be a perfect 90 at all times or horrible things are going to happen. It would be nice if it were possible, but it's not, even if you test a hundred times a day. Fortunately, HA1C is the measure of success in Diabetes control and you can have a very good HA1C without having a perfect blood sugar every time you take it.

Hypoglycemia is very scary to everyone involved and I do appreciate that. I guess I advocate for finding other safe, reliable means for dealing with this issue other than getting up every single night 2 o 3 times until your child is old enough to tell you to leave him alone. It is so very important to give your child all the tools he or she needs to live with Diabetes and I know personally so much of what you need to live successfully is the ability to make choices, to be flexible, to not have to be perfect and to ultimately find a way for Diabetes to live in the life you want to have rather than having Diabetes define your existence. The tools we have really make this possible, but at the extreme, they can also be another source of the torture and burden of living with Diabetes. Finding the right balance for you and your child is the key. Good Luck to all.
es

[CGTMHI]

It would be really helpful if you could place hyperlinks to the article in this forum.

That said, I agree 100% with what Carol posted above! My wife and I test our daughter twice each night, unless she has had a lot of physical exercise that day. In that case, we test 3 or 4 times each night. We would not THINK of taking a chance with her health and well being!

Mike

[cindymhi]

I read both the article by Joann Ahern, RN and the response from Yale and I still think that I'd prefer to err on the side of caution. This is MY BABY we're talkin' about!! So my husband and I lose a little sleep - at least we know we will see our son's smiling face in the morning!

Carol

[JDRF-Team-wak]

My husband and I usually have our daughter check her blood when she goes to bed.  If her number is under 200, we leave her alone and do not test at midnight or 3 am, but if she is low or too high - we usually re check at midnight and we occasionally check at 3am.  If something changes in her schedule where she is going more activity, not feeling well or change in basal rates I check at least at midnight.

The week before we see her endocrinologist we always do midnight and 3 am, so we can have a record for the doctor.