# Testing through the night



## Saffysmummy (Aug 30, 2010)

Hi, I have a question which I'm quite worried about.

I keep reading about parents testing their children through the night and I just want to know if this is the norm? 
I test Saffron before I go to bed - about 11 - and then I don't test her again til she gets up in the morning and I'm wondering if I should be getting up at 3 in the morning to check her sugar levels? Her levels are normally between 6 and 15 at my bedtime, They've been low twice so I've woken her for a snack and checked they've risen before I go to bed but I haven't checked her again.

I just wanted to know what other parents do? To test or not to test?

Any advice greatfully recived, thank you for reading,

Sue x


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## Adrienne (Aug 30, 2010)

This can end up being quite a controversial subject, so hold on to your hats.......

I personally (this is my opinion) think that all parents with type 1 children should test overnight unless they know 100% that their child will wake from a hypo.  

One of my old dr's particular speciality was nighttime hypos.  She was very explicit that in all the studies she did that most of the type 1 children do NOT wake up when hypo.

I belong to the Children with Diabetes email list.  Most of the parents test overnight, most of the children do NOT wake when hypo.

Some consultants and DSN's say no need to test overnight.  Our standard reply is the same and something like this  :  'if they can 100% guarantee that my child will wake from a hypo and will be ok overnight then I won't test'.

I know some sad stories to back my answer up.

Have you ever had a CGM in your child?    My daughter was on mixes for years before Lantus/Levemir arrived in the UK and had a CGMS twice.   Once she was on Mixtard 30 and the other time Novomix 30.   Both times she was having hypos without me know, it was horrendous.

I just think its not worth not testing.   I stay up every night till midnight and then depending on that level depends what time I get up to test in the night.   My daughter has a sensor on with a pump so some nights I do not get up and rely on the sensor.   

When my daughter was on MDI I worked out a sliding scale.   Something like if she was under 9.0 at midnight I would have to give her some carbs to get her through the night, if she was over 11.0 I could leave her till morning but this was all if the day had been a pretty standard unenergetic day.   If there had been exercise of any sort then testing overnight was the norm.

You do get knackered.  I'm single so have done this for 10 years on my own and I am worn out sometimes as it all catches up every so often but you get used to it somewhat and I would rather be tired than anything else happen !

Anyway just my opinion and I know that others will differ greatly.


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## marynf (Aug 31, 2010)

I think it depends on so many things, as always with diabetes!

We don't routinely get up to test at night, although have on a few occasions just to see what was going on.  Luckily Sarah's levels seem to stay fairly steady through the night.  I'm not sure whether this is because she is still in honeymoon (10 months from diagnosis) or whether this is just her good fortune.  She had her 5th birthday recently. 

We like her to be over 8.0 before we go to bed, and she generally wakes up between 4.5 and 6.5.  When I have tested her in the middle of the night she has always been between 6.0 and 7.0.

We think her pancreas is still working a bit at night though, which gives us a bit of leeway.  Earlier on this year she could drop 15 mmols overnight (we didn't correct unless she was over 20) which was alarming until we realised that if she was, say, 10 before we went to bed she only dropped a maximum of 5 mmols.  

She has supper between 6 and 7pm and her Levemir around 8pm.  I test her at that point and make a judgement on whether she needs a quick top up before she cleans her teeth to get to around 8.0.   We then test her again before we go to bed around 11pm and, like Adrienne, have a sliding scale of action depending on what the result is.  If she is over 8.0 we can leave her, if she is between 6.0 and 8.0 we give her one frube (=6g and fairly slow release), if she is between 4.0 and 6.0 we give her two frubes (=12g) and if she is below 4.0 we get her to drink a few sips of full sugar ribena before the frubes.

Equally, if she is over 16.0 at 11pm we will tend to correct with a 0.5 unit of Novo which brings her down about 5 mmols.  We don't like doing this as I am not convinced 0.5 always goes in - it is just a droplet - and I don't like injecting her in her sleep as she always moves at a critical point!  We are getting better at ensuring that she does not go high enough for us to need to correct.

By 11pm we are pretty sure all the Novo has gone from her system and the Levemir is definitely working so in theory the figure we get is her basal rate.  At the moment this works for us, although I am quite prepared for/resigned to the fact this might change.  I think there is no 'correct' thing to do, and if on an occasion I tested at 3am she was hypo my routine would definitely change.  It is just that she has always been around the 7.0 mark in the middle of the night when tested and I have no reason to believe she is going hypo during the night: the only reasons she goes below 4.0 in the day is too much insulin for the food she had or lots and lots of exercise, neither of which is happening at night.

I hope this helps!


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## Ruth Goode (Aug 31, 2010)

Carly only been dx nearly 3 months now, I do check her at 2-3am she did go below few times.  I have slept through few times and felt bad, luckily she was ok so it's to ressure me to check her in the night. I find if she drank all her milk before she go bed her level stay up, if she don't it's more likely it will drop but you never know, I do it to ressure me and make sure Carly is safe


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## Becca (Aug 31, 2010)

Saffysmummy said:


> Hi, I have a question which I'm quite worried about.
> 
> I keep reading about parents testing their children through the night and I just want to know if this is the norm?
> I test Saffron before I go to bed - about 11 - and then I don't test her again til she gets up in the morning and I'm wondering if I should be getting up at 3 in the morning to check her sugar levels? Her levels are normally between 6 and 15 at my bedtime, They've been low twice so I've woken her for a snack and checked they've risen before I go to bed but I haven't checked her again.
> ...



Hey, personally we test at night and have a sliding scale to when we know what time to get up.  I just couldn't go 8 hours or more without testing and knowing what is going on.  Like Adrienne says, there is some sad stories and personal loss that we gone through and i think this makes us have strong feelings about testing in the night.

Rose also did the Artificial Pancreas trials, we were told that even the team were surprised at the results from other patients on how low they went and night and how many times they did need to intervene 

This is all my opinion though


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## grahams mum (Aug 31, 2010)

i think all the mum in the forum test their child i usually stay awake until 1.30 2 o clock test and go to bad only my few friends really knows how much there is to do with a diabetic child also at night


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## Saffysmummy (Aug 31, 2010)

Wow, thank you for your wonderful replies, its so good to have an insight into how parents do things.

I'm going to test Saffron in the night for a few nights to see whats going on. I think she is in the honeymoon period as her insulin doses are quite low, she's on mixatard 30, 8 units in morning and 4 units in the evening. So maybe her own insulin is still kicking in at night.

We did buy her a night hypo alarm when she was first diagnosed but it kept going off even when her sugars were high, so we haven't bothered with it since. We kept hearing this beeping coming down the stairs with a tired little girl saying 'I'm beeping again mummy!!!' Waste of ?70!!

I think night hypo is my biggest fear. 
I might just make her stay awake all night so she can let me know if she thinks she is low!! 

Thanks again, I love this place

Sue x


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## Adrienne (Aug 31, 2010)

Sue

Have you been told about the children with diabetes email group, no idea who I have told and who I haven't so ignore me if I have already told you or someone else has.

We have a website www.childrenwithdiabetesuk.org and you can join an email list from the home page.  There is a huge source of knowledge over there purely from parents of about 300 odd children with diabetes.   Lots of us here belong to that as well.


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## Ruth Goode (Sep 1, 2010)

Thanks Adrienne, I have joined


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## Saffysmummy (Sep 1, 2010)

Hi, thanks Adrienne, I have now joined 

Sue x


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## bigpurpleduck (Sep 1, 2010)

I was diagnosed at 3, so my parents took care of my diabetes for about 10 years. They rarely tested at night. However, I must stress that this was 18 years ago. I think it's probably a good idea to do it on a regular basis, for your own peace of mind if nothing else.

One thing I would like to point out is that I ALWAYS woke with a night-time hypo. Never slept through one once. However, my symptoms were worse - I was on some occasions physically sick, but not very often. Just wanted to let you know that some children DO wake up. However, it sounds as though I was incredibly lucky.

I think after some time you will become accustomed to your daughter's diabetes & BG. It will end up feeling like intuition - you'll just know if something's not right and you need to test.

Best of luck with night-time testing. Hope Saffron doesn't mind too much!


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## Monica (Sep 4, 2010)

Just to put a spanner in the works...

I do NOT test C at night as a general rule. She tests at 8.30ish. We then decide whether or what she will have to eat. Tonight she was 6.7 and she only wants a handful of dry roasted peanuts.

When we are in bed, we all have our bedroom doors open. C shouts me when she's hypo, as she always wakes up. One night she even told me that she was wondering why she was awake as she didn't need a wee. It only occurred to her a few minutes later that she was hypo. Funnily enough when she is hypo, it usually measures between 2.7 and 2.9.

Naturally, when she's unwell or particularly low at bedtime and I'm not sure she had enough to eat or high, then I will test in the night.


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## Saffysmummy (Sep 6, 2010)

Well, I've tested Saffron a few times and she is normally around the 8 mark which I think is fine so still undecided to carry on night testing or not. She nearly always wakes up when I do it and asks what her sugars are.

I'm started nursing training in 2 weeks and am worrried I'm going to be too tired to concentrate and be falling asleep in class.
Obviously Saffrons health is paromount to me, so I think I'll just have to take it one day at a time and see how things go.

Thanks for all your replies,
Suexx


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## Copepod (Sep 6, 2010)

Or one night at time, Sue?!? 

Hope your nurse training goes well and you learn / experience all you need over the next 3 years. What branch are you doing? Should be a while before you have to do shifts, including nights, but getting the hang of sleeping when necessary is an art / science / whatever you want to call it - even without children


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## Adrienne (Sep 6, 2010)

Saffysmummy said:


> Well, I've tested Saffron a few times and she is normally around the 8 mark which I think is fine so still undecided to carry on night testing or not. She nearly always wakes up when I do it and asks what her sugars are.
> 
> I'm started nursing training in 2 weeks and am worrried I'm going to be too tired to concentrate and be falling asleep in class.
> Obviously Saffrons health is paromount to me, so I think I'll just have to take it one day at a time and see how things go.
> ...



Absolutely Sue, I totally agree with you, one night at a time.   The mother's gut instinct is a powerful tool so listen to that as well.   

So you don't really need to make the decision, some nights you will and some you won't.


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## Saffysmummy (Sep 6, 2010)

Haha, one night at a time definitely!!

Its all been good practice for my training, I think I'll excel at the diabetes class!!

I'm doing adult nursing, I found out I'd got a place 5 days before Saffron was diagnosed so its all been a bit of a whirlwind but settling down a bit now!
I really liked the childrens ward when Saffron was in hospital and I almost wish I was doing childrens nursing instead of adult but I would like to work with diabetes when I qualify, but got to get through the next 3 years first.

Not looking forward to the night shifts, I love sleeping too much!!

Sue xx


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## Mumlé (Sep 11, 2010)

*uh oh*

Hey I'm worried reading all these replies! I have NOT routinely been testing L in the night. We've only been home from hosp about 3 weeks and did for the first week, that's largely cos she was very unsettled and we thought we may as well do it when she woke up. But we haven't been doing it since she's started to sleep through again. As she is only 1 she doesn't show any signs of hypo really, when she is awake. So guess she would prob not wake if it happened at night. But I am reasoning that when she is asleep she's not using extra energy or running about or anything, so the levels should just chug along nicely. We had a few mornings last week when we did BG first thing in the morning and she was 4 or so, but wasn't worried, just gave her her brekky pretty sharpish. Now worrying that I need to be more concerned. Maybe you shouldn't read too much on the internet!


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## MeanMom (Sep 11, 2010)

it worries me too that others test during the night - our D team has never suggested we do this and it is only thro' forums like this that i have found out others do! K is very hypo aware during the day so I would hope she would wake up if she was hypo - we tend to run her a little high at bedtime just in case.
The problem with testing at night we have is that K tests herself (she wont let me!) so would have to wake her and so disturb her sleep - i wouldnt risk trying to test her in her sleep against her wishes. I do check on her at least once in the night (my bladder doesnt let me sleep thro' the night very often  )  
I have heard most night time lows 'fix' themselves - is this true? What are the signs (in the morning) that this has happened?


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## bev (Sep 11, 2010)

carolynsurry said:


> it worries me too that others test during the night - our D team has never suggested we do this and it is only thro' forums like this that i have found out others do! K is very hypo aware during the day so I would hope she would wake up if she was hypo - we tend to run her a little high at bedtime just in case.
> The problem with testing at night we have is that K tests herself (she wont let me!) so would have to wake her and so disturb her sleep - i wouldnt risk trying to test her in her sleep against her wishes. I do check on her at least once in the night (my bladder doesnt let me sleep thro' the night very often  )
> I have heard most night time lows 'fix' themselves - is this true? What are the signs (in the morning) that this has happened?



I think if you start testing ocassionally then your little one wont even notice. I check Alex (12) at 3am (not every night - but most nights) and he very rarely even opens his eyes now.
Most hypo's dont fix themselves (some of them do - but most dont) - this is untrue unfortunately. The most dangerous time is 3am as this is when the body naturally lowers glucose and this is the best time to check. It has been proved by using cgm's that a lot of people do not wake up when hypo. I never used to test during the night until I did a little bit of research and read some really awful things - so now I check probably 4 out of 7 nights a week as we also use sensors on the pump which alarms when high or low.

If there has been a hypo during the night (and the liver has kicked in) there will be a rebound effect and levels will be a lot higher than normal - some people wake with a headache.Bev


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## bev (Sep 11, 2010)

charlotteking2001 said:


> Hey I'm worried reading all these replies! I have NOT routinely been testing L in the night. We've only been home from hosp about 3 weeks and did for the first week, that's largely cos she was very unsettled and we thought we may as well do it when she woke up. But we haven't been doing it since she's started to sleep through again. As she is only 1 she doesn't show any signs of hypo really, when she is awake. So guess she would prob not wake if it happened at night. But I am reasoning that when she is asleep she's not using extra energy or running about or anything, so the levels should just chug along nicely. We had a few mornings last week when we did BG first thing in the morning and she was 4 or so, but wasn't worried, just gave her her brekky pretty sharpish. Now worrying that I need to be more concerned. Maybe you shouldn't read too much on the internet!



If 4, I would give a tiny bit of glucose as levels could be about to plummet. If you give food there is a danger that the glucose in the food is a slow release and might mean levels drop before the glucose hits.
Although the child is sleeping and not using any energy, it is the cumulative effect of the daytime exercise and activity that is important. Remember that if there has been a lot of activity that it can take over 24 hours to show any effect in the levels.Bev


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## Mstarsmom (Sep 11, 2010)

My daughter Miss Shannon was just dx a little over a month ago type 1 We test at 2 am.  It makes for a long day but it is a nice piece of mind knowing her level is ok.  If she plays hard the day before it tends to drop in the night among other causes.  If it wasn't for the night test things could be much worse for her.
I do think every one is different.


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## Ruth Goode (Sep 12, 2010)

When Carly was dx in hospital, I was told to check her every few hours in the night esp at 3am, now 3 months since I still do it most nights for my peace of mind to know she is ok as her level DO drop through the night.


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## ruthelliot (Sep 12, 2010)

This I think is a debate which will not doubt run between diabetics/parents/healthcare professionals till the end of time and yeah I guess everyone does what works for them. The hospital we were with initially told us even though they knew Ben was having night time hypos that they wouldn't advocate testing - why I have no idea - how could any parent sleep anyway knowing there was a high chance there child was having a hypo. Since we switched hospitals and Bens care has improved he has far fewer hypos but we still check - every night at midnight and sometimes around three (generally unless we've had to feed him at midnight or he's running high) Ben has never shown any sign of waking with a hypo - we've got as low as 2 and I could barely rouse him - he could swallow but that was about it. My worry then was he was having so many hypos in general that his liver reserves would also be depleted. Anyway as I said we each need to do whats right for us but I will always be grateful to the people here who switched me onto nightime testing.


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## Ruth Goode (Sep 17, 2010)

Just want to say that Carly was hypo at 3am this morning so Im so glad I checked her, I was able to treated her by giving her 100ml orange juice so I don't want to offend anyone but it is better safe than sorry


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## MrsBoyle (Sep 24, 2010)

I dont test every night only if i think he needs testing if he is up alot or unsettled.
Every time he has had a hypo at night he has always told us.


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