There was a recent post on Diabetes Mine by Will. You can read it and all the great comments in response to it HERE (Link removed because I am suspicious the post was written only to generate page views and put money in Will’s pocket. Basically Will called our kids ‘spoiled brats’ because we do our best to keep them alive including checking blood sugars at night. If I’m wrong Will is welcome to leave his thoughts as a comment on this post.)
So last night I tucked my kids in with kisses and hugs and went off to read in my bed while I waited for my hubby to get home from Denver. He was due home within the hour. I hadn’t brought glucose meters upstairs with me since I’d planned to get up and visit with my hubby. Instead I fell asleep reading. (Not the books fault – I had been up till 2am the night before so I was exhausted.)
I woke up around 2am to find my dear husband asleep beside me. I realized my mistake and got up to get glucose meters. Both kids were slightly high at bedtime and I had corrected them before sending them off to bed. I had that panicky feeling that maybe the correction was too much. Checked kids – Sugarboy was within range. Sweetstuff was still a bit high so I gave another correction.
That panicky feeling usually keeps me awake for sometime and last night was no exception. I went back downstairs and played on pinterest for a half hour (I love the Geek category – those are my people) after being amused regarding all things Dr. Who I fell asleep on the couch.
Around 4am (I think) my dear daughter came down and gently woke me to tell me her pump was out of insulin and she was gonna fill it. I vaguely remember this.
Chad woke me when he came down to leave for work around 7am but I remained on the couch listening to his footsteps and wishing him a good day.
This is what I found on the table when I got up around 7:30am.
That additional correction I tried to give in the middle of the night – she didn’t get all of it and I didn’t hear the alarm on the pump alerting me. Turns out her pump didn’t have enough insulin to give her the entire correction or basal insulin for the rest of the night. It took 2 hours of alarms to wake my daughter so she could fix the problem.
She not only filled her pump with insulin, she checked her blood sugar and gave a correction. Score one for my beautiful daughter.
This was her at 8am.
Look I know not all parents of CWD check sugars at night. I don’t do it every night. Maybe I would do it every night if I went to bed when my kids do but I’m up till midnight most nights. I check them before I go to bed and the alarms I set to wake me are dependent on what their numbers are when I go to bed.
Below are my numbers and plans but honestly its like Bennet of YDMV says – Your Diabetes May Vary. My guidelines may not (and likely would not) work for all CWD – some kids react faster than others to corrections, some react slower to fast carbs, some go high/low depending on the cartoon print on their pjs. Please don’t use my numbers as your own guide. Now I’m worried I shouldn’t even share them. Shoot. Ok just promise you will not use my guidelines – mine are specific for my kids and how I know they will most often react. Seriously – these are kid specific – I don’t even use the same guidelines for both of my kids.
Sweetstuff –
Between 85-150 with no working insulin (no insulin given 2-3 hours prior) – do nothing, sleep soundly.
Under 85 – treat with fast 15 fast carbs – wait. check. repeat if necessary. If within range with no working insulin – I sleep soundly, if there is insulin still working I wait it out if less than 1 hour worth of insulin or set an alarm if longer.
Between 150-250 – check working insulin, if there is IOB (that’s ‘insulin on board’ – it’s a pump thing) I do the math – 1 unit will generally reduce my daughters BS by 50 points. If the working IOB will bring her into range I sleep soundly. If not I give additional insulin and sleep soundly (even with no IOB the amount of the correction is small enough I still sleep soundly).
Above 250 – check IOB and give correction if needed – I set an alarm. Anytime I give a correction of more than 2 units I get up. Insulin/hormones/the phase of the moon – these can all toy with diabetes and larger corrections make me more nervous at night.
Sugarboy is similar but I’m more cautious/conservative with him. He is more sensitive to insulin and 1 unit can drop him at minimum 100 points. He is also more active than my daughter, always on the go. He spends upwards of 2 hours a day on the trampoline and a good deal of that time is within hours of bed.
Also something to note – I recheck any reading over 300. You may have heard about the Strip Safely campaign. Basically current glucose meters can have a 20% variable. That might not mean much if a PWD number is within range – a 100 could be a 90 or a 110. However once those numbers are upwards of 300 that variable can be scary. 300 could really be 240 to 360 – Considering those 120 points mean 1.2 units of insulin and my boy drops 100 points per 1 unit – well it can get scary once the BS gets really high and I am dosing insulin based on a number that could be WAY off.
Click HERE to find out more about how you can help with the Strip Safely campaign – your support can help us all stay safe.
Ok that last bit about Strip Safely got me a bit off track but its an important message.
My message this morning is don’t let anyone tell you that night-time blood sugar checks are unnecessary or that you are taking on too much or that you are spoiling your child. Night time blood sugar checks are a personal family decision. Of course you should talk to your child’s doctor about night-time checks but also follow your gut. My son’s endo told us we only needed to check at night for the first two weeks after diagnosis. My son was 2. He was using Lantus for his basal insulin. Every night for over 4 months he would be in the 40s by 2am – despite decreasing his Lantus dose multiple times. It was not the fault of the Lantus – he was just very sensitive to insulin and still is. What if I had stopped at the two-week mark?
When our daughter was diagnosed we were told the same thing, she too dropped low every night.
The other side of the coin – don’t let anyone scare you into doing night-time checks if not doing them is working for you. Trust your instincts. I have yet to meet a parent that normally doesn’t do night-time checks that would send their kid off to bed after a huge correction without either staying up or getting up to check. Do what works for your family and trust your kids too. We’ve been lucky that my daughter will normally feel a low and get up. My son has never woken up when he was low to alert us.
I am very proud of my daughter for being so independent last night. It is a great relief (but not a surprise) that she is able and willing to do what she needs to do to take care of herself even in the wee hours of the night/morning. I will tell her this as soon as she gets out of bed – it after 11am and yes she is still in bed – yea teen years and summertime.
Thanks for getting through all the babbling and long stints of text. Here is cute cat picture as a reward.
PS- I really hope the FDA approves the Dexcom G4 CGM for kids soon. My kids both participated in a study with the Dex G4 and it was the best week of sleep I’ve gotten in over 7 years. I’m not saying I didn’t have to get up – but when I did get up it was because the Dex alerted me. I slept soundly otherwise. Our current insurance will not approve anything that the FDA has not approved thus no Dex for us until FDA says its ok for kids. (Although we all know it is as effective with kids as it is with adults and a great deal of kids use the Dex)
Stick With It Sugar 
I loved your remarks on Will’s post. You go Sister!
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wish he would reply to all the comments. Thanks.
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Woot – way to go!!
Our sugarboy is also really sensitive (1:300 correction, same as 4 years old as at 1 year)- thanks for the sanity check. 🙂 Embarrassed to say we have a Dex, due to all the ER visits early on. (I’m sure you’ve been down that route, but documented lows/ER visits were what got us approved.) FDA needs to move on approving it for peds – kids need it!
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Kristin – Thanks for visiting and commenting as Meri says “comments are love’ or something like that.
I hopped over to your blog – thanks for using your url to comment helps me figure out who new people are.
You’ve been blogging for quite awhile. Ill need more time to catch up so I haven’t commented yet.
We never had to go to the ER for any lows (knock on wood – now that I write that I must remember to google why we say that)
We did have to take daughter to ER once when she had the flu and I couldn’t get everything worked out with sick day stuff.
I did read the ‘about’ you page and Im so glad your husbands co-worker helped with recognizing symptoms. It always amazes me how easily general practitioners can miss diabetes. I still believe all doctors exam rooms should display a poster with simple illustrations that identify the symptoms of Type 1. I think if everyone everywhere read a poster like that at each doctors visit there would be little to no deaths due to missed diagnosis’s – but thats another post.
It would be fantastic if we were all offered CGMs as a party favor upon leaving the hospital or doctors office with a newly diagnosed kid.
hope you’ll visit again sometime. Im on twitter @momof2t1s – maybe Ill see you there sometime if you tweet.
Cheers.
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“Score one for my beautiful daughter.”
Yes. Exactly.
Now if only we could get the Dex approved for kids. I wonder where it is in the “process”. Is it somewhere in an 18-month review cycle? Has a review even been requested? Would data supporting the need help things?
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Thanks Scott. It is in review – they have already audited the study the kids participated in and that study had great results. Hoping I can call them Christmas presents (for me not the kids although they are both waiting with great anticipation)
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Yea for her!!! And YOU!!! That is awesome. I have alarms set throughout the night. Yes, I was told to check around 2am..but if I did that and only that, it is scary to think what might have happened already. I stay up late, too. I have a 12:30 alarm set in case I do fall asleep, a 2:00, a 3:00, a 4:00 and a 5:30. Yes, really. I do have the advantage of the Dexcom G4. Unfortunately due to the layout of my house, I can’t put her monitor on my bedside table. So I put it as far from her and as close to me as it will work and place it in a glass so the vibration will ring the glass (thanks, Kerri!). So, when the alarms go off, I check the Dexcom. If she’s in range and has been in range and is not dropping, I go back to sleep. If she’s off I check with the meter (and if they don’t match I wonder which one is right:)). Sometimes I stay up and watch if she’s on the rise or dropping. Maybe I’m paranoid. I can live with that. She is similar to Sugarboy…very sensitive to correction and is active and any variable can affect how she does overnight. And she SLEEPS! She doesn’t even wake when I’m feeding her candy or applesauce packets during the night.
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aww Karen. You have to do what you feel like you have to do and no one should judge. My only advice – make sure you are doing what you can to take care of yourself too. Maybe getting up is what you have to do to take care of yourself, maybe taking care of yourself involves naps (I like naps – they’re nice).
Dex G4 is in review with FDA – audits of various studies have been completed and results looked good – just a waiting game and then more waiting/begging with insurance company. I wish you were getting better range. When my kids did the study I kept the recievers in my room = over 50 feet from my daughters room and 25 feet from my sons. they did great but every house is different. I am no tech expert but I would trust meter number over Dex number if they differ greatly. If the difference is within the 20% variable its hard to say.
Never tried the applesauce at night, just juice for sugarboy and fruit roll ups for daughter cus she doesn’t like juice and I have to wake her regardless.
Keep on keeping on.
Life’s a garden – dig it.
(I love the movie Joe Dirt)
(totally random)
(I like parenthesis too)
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Weird, but any time we have given juice it would not bring up the low. So, gave up on that. The applesauce was a new spur-of-the-moment thing to try this week…just didn\’t want to give her candy. Worked for her. Why the sauce worked and not the juice…who knows? YDMV and all that. Had to come back bcs I read Will’s post AFTER yours. Wow. As I told my sister when I was explaining my lack of sleep and she asked why I had to get up..didn’t the pump take care of everything?…..was I just paranoid? (asked in a sweet, sisterly way:)) I explained how kids die in their sleep from hypoglycemia and her blood sugars are so variable and if she DIED because I was ASLEEP??? Unthinkable. So…yes, maybe I am paranoid, maybe I do too much, and all that. But I want her to live and live as well as possible. I think it is more knowledge that requires more of us now. Maybe 50 years ago it was OK and understandable if a person lost a child to this disease. Now we know more and have more tools to prevent this kind of tragedy. So we use them. Liken it to car seats…50 years ago people drove with their kids in their laps. Now we know better and have the restraints to keep them safe in a vehicle. Fewer kids die. Is it more trouble? Sure it is! But we do it to keep our kids safe. Yes, thank you:)…I know I need to get more sleep:) And I do from time to time. I’m sure Will would blow a gasket if he heard this…but I have been homeschooling her since her diagnosis a year and a half ago. Long story. But..she will be returning to public school which begins in a couple weeks here. So, I’m planning to indulge in a few naps the first few weeks and catch up! I thought your reply to his post was great! I haven’t seen Joe Dirt…I’ll have to look it up! (sorry this is so long!!)
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love long comments. Can’t wait for school to start to resume naps. I have lots of friends that homeschool. None of them choose to homeschool because of diabetes but again – all families are different and if it is what you needed to do at the time than all is well. 😉
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Wowzers–way to go, girl!
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Glad it inspired you to share – yours cracked me up – “make out” too funny.
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Ha! I wish I had a website to post.
Hurrah! for dd! Great job! You’re awesome!
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THanks Ivy. Let me know when you have your blog up. 😉
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Hi Christina, I have read your and Meri’s blogs on this issue. I do not have a T1 child, but I sure do remember my early childhood with T1. No meters for testing, and no other devices made it very difficult. I certainly agree with everything you and Meri have said. I even test myself at 1, 4 and 7 AM…and I am a big boy now, age 73. lol
Thanks for the picture with you, Christel, Suzanne and….woops, I forgot the other lady’s name. that pic is currently my cover photo on Facebook.
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Saw you used the picture – I couldn’t be more honored to be on your page.
Your big boy comment cracked me up.
LAHA
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OOOOHH!! I LOVE this! The nighttime checks are not for the “spoiled” child or for the “obsessive” parent but for keeping the best levels possible to stay as healthy as possible…so our kids can be big boys and girls of 73+! Thank you!! Looking forward to reading your book:)
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book? Did I recommend a book? I really need to stop posting with half a brain – oh speaking of half a brain wouldn’t it be cool if we were like dolphins so that half our brain could sleep while the other keeps us swimming.
I have spoiled my kids but it ain’t diabetes related. Their sense of entitlement comes from my poor parenting early on – wanting to give them the world that I didn’t have. Turns out what I considered a less than optimal childhood made me stronger and encouraged hard work and dedication. oops. I broke my kids.
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I am very proud of Sweetstuff. She may be spoiled but that’s because you take her to Chick-fil-A at 9:45 PM not because you do everything you can to keep her alive.
You’re a good mom!
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Fair enough and thanks – although you forgot that after Chic-fil-a we went to target where I nearly bought the kids ice-cream for dogs but instead got mini drumstix.
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Kudos to Sweetstuff for doing that herself. Props to her! Hell, there are many times when I don’t have the ability to get up in the middle of the night to do that myself… Great job! Here’s hoping for Dex approval for pediatric use before long, too.
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Thanks Mike – shared with dd. And yes – please FDA get Dex G4 approved so I can get some better sleep.
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Christina, I don’t understand why the G4 sensor is allowed for adults, but not for children. The Dex 7+ sensors were used by children, so why not the G4? I am wondering if there is something different about the G4, something unknown to me.
I cannot ever use the new G4 system. My present insurance does not cover CGM’s. I did use the Dex7+ sensors, but had very little success with them (different insurance back then).
I feel that the G4 will certainly be approved for kids. The FDA always seems to drag their heels.
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As far as why the G4 is not currently approved for kids – it is my understanding that companies first get approval for adult use. Betting approval takes a great deal of money and time on behalf of the company. Trials must be completed first obviously and different trials are required for adults and children. Currently even the 7+ is not approved for kids. Yes many still use it for their kids and most insurance companies will approve it and the G4. Unfortunately our insurance will not approve anything for use that is not FDA approved. Period.
Im sorry you are not able to get insurance help for CGMS and equally sorry you didn’t find success with them when you did try them. My kids both participated in the Dex G4 trial that will eventually receive FDA approval. hopefully when that happens our insurance will approve them as well. Our insurance will approve other CGMS but not the ones my kids want to use. Since we have not tried the other CGM on our own I am not able to share our opinions regarding the other manufacturer’s product.
Heres hoping everyone plays nicely sometime this year and we can all sleep better.
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Thanks Christina, I understand now why the FDA has not approved the Dexcom for children. I am glad children are still able to use them. I guess it depends on the insurance company just like it does for me.
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