Nighttime Testing: In Search of Balance and a Decent Night's Rest
Part 1 of 2
>Read Part 2 here
With the fear of nighttime reactions being a big concern, many parents -- if not the majority -- faithfully test their children every night. Scientific evidence shows that nighttime reactions do occur, and since we are asleep a third of the day, we really don’t know what happens with the blood sugar at night…unless you test.
The Education Team at the Diabetes Research Institute stated that how often you test your child's blood sugar levels each day and when, will depend on a number of factors that can change from day to day. As your child grows and matures, the rationale for how often to check may also change. Most kids with diabetes test their blood sugar levels before breakfast, lunch, dinner, and at bedtime. They may also check two hours after eating, especially if new foods are introduced, or the insulin to carbohydrate ratio is being evaluated.
Here are some tips on when you should test your child’s blood sugar level more often:
- When your child is ill.
- If you suspect your child has a low blood sugar level.
- If your child has been more active than usual. Increased activity during the day can cause low blood sugars many hours after the activity has ended and can cause lows during the night.
- Middle of the night, if your child had a low blood sugar level during the day, exercised more than usual, made a change in the insulin dose, has been ill, or is newly diagnosed and a stable insulin dose has not been established.
- If you are over 21 years of age and have been drinking alcohol, check blood glucose before going to bed! Over-night testing is highly recommended as alcohol can induce delayed hypoglycemia especially if not enough carbohydrates were eaten when the alcohol was consumed.
Nighttime checks are usually done before bedtime, two hours after bedtime and at 3:00 a.m. Keep glucose tablets, glucose gel, or a four-ounce juice box at the bedside to treat night time lows immediately if needed. Each family should have a Glucagon Emergency Kit available, and family members should be taught how and when to use it.
Dr. Robin Nemery, a pediatric endocrinologist at Joe DiMaggio Children’s Hospital in Hollywood, FL, said when asked whether she recommends testing, “Depends. There is a 'yes' and 'no' answer to that one. At times, we have patients do overnight checks – especially if there is a lot of fluctuation in the fasting blood sugars or any signs or symptoms of nocturnal hypo or hyperglycemia, but not consistently. That said, many of our parents are doing it anyway. The sensor is very helpful in this regard.”
Lynette Miller, co-founder of the PEP Squad, commented, “We have always believed it is necessary to test our daughter, Brooke (15 yrs., dx'd at 3 yrs.), during the night for several reasons. One is that we have discovered serious low blood sugars that occur randomly during the night. Another is that she is a very deep sleeper and often does not wake up to symptoms of hypoglycemia. Fortunately, we have technology that helps us manage her diabetes at night including a continuous glucose monitor that causes her insulin pump to alarm if she is running high or low and a monitoring device (Medtronic's My Sentry) that alerts us to abnormal blood sugar levels."
The DRI Education Team agreed that parents might want to consider continuous glucose monitors (CGMs), in addition to using blood glucose meters for their children. These devices measure glucose levels around the clock through a sensor the child wears just under the skin. CGMs provide audible alarms when levels get too high or too low. Your child's diabetes health care team will recommend an individualized target range for blood sugar levels. The general goal is to maintain as normal as possible blood sugar levels without causing frequent low blood sugar. Most importantly, find a routine that works for you and your child.
Gary Scheiner, a certified diabetes educator and person with type 1, says it’s important to find a balance between optimal safety and reasonable quality of life. That can be just as important as testing. He also believes in the importance of CGMs for overnight monitoring. (1)
Dr. Iri Hirsch, assistant professor and endocrinologist at the University of Washington and a type 1 parent himself, states that he finds it counter-intuitive that physicians don’t recommend CGMs more often. He also says, “I’m hoping that the promised improvement and better insurance reimbursement of CGM will both bring this problem to the forefront but also decrease the frequency of overnight hypoglycemia in many patients.” (1)
Please note that this information is for educational purposes only and is not intended to replace the advice of your doctor or health care provider.
Be sure to look out for the next issue of PEP Talk, which will focus on the emotional issues surrounding nighttime testing.
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SOURCES: DRI Education Team (Della Matheson, RN, CDE; Lory Gonzalez, ARNP, CDE; Amy Kimberlain, RD/LD/N; Gwen Enfield, RD, CDE)
Dr. Robin Nemery, Lynette Miller
1. AllisonN; Overnight Glucose Testing: Who Does It and Why?; DiabetesMine.com