# Managing Overnight Monitoring



## Gill P (Jul 15, 2017)

Hello all - I've already posted this Q on the Newbie section, but I'm hoping this forum might be more relevant. Mother of a 14 year old boy T1, diagnosed since 7.

I'm especially interested in hearing the experiences of other parents with overnight monitoring of BG. Some of the parents I know don't have an issue as they don't, they see it as low risk or their child wakes up anyway and tests. We couldn't go to bed without knowing for sure the bloods have stablised. His HbA1c is usually excellent as a result - but we are worn out with late bed times most nights. Does anyone have any positive stories of their experience or good tips?

Would be great to hear other's experiences. Thanks to anyone who shares


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## Northerner (Jul 15, 2017)

I'm not a parent, so can't answer your question from experience, although I do know that most of the parents who visit here do test during the night, just to be on the safe side. You say his control is good - what sort of levels does he normally go to bed on? What insulin does he use - is he on a pump or injections? What are his waking numbers like, and has he experienced night hypos that you've managed to catch and treat?

I've been using a Freestyle Libre recently, and find it so much easier to test my levels at night - just a quick scan instead of all the disruption of finger prick blood tests, plus, of course, you wouldn't need to wake him. They're not cheap, works out at about £25 a week, but they are extremely good for spotting patterns etc.

Hopefully, some of our Parent members will be along to share their experiences soon


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## Ditto (Jul 15, 2017)

Hello Gill. It must be such a worry. I can't even imagine it. This forum is a mine of information though.


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## everydayupsanddowns (Jul 15, 2017)

I know that we have a variety of members (and parents) whose opinion differs widely on the matter.

Some see routine overnight checks as essential, other see them as entirely unnecessary. 

I was diagnosed in my 20s, so my parents never had to face the issue directly, but as a not-so-young adult now I know that there ARE occasions where I feel an overnight check would be useful and helpful, but I certainly would not consider it to be a routine part of my self care. When I was first diagnosed, diabetes care was very different, and there is absolutely no way I would have even considered waking to check BG overnight. Nor did I choose to do that many years later when I went through a period of relatively frequent Severe Hypoglyceaimia overnight. And yet I survived.

From what I can tell, the main motivation for parent is to avoid severe overnight hypoglycaemia (and the tragic possibility of death overnight). When I've spoken to HCPs renowned in the field about my own position, they have been clear that these tragic events are extremely rare, and the fear of them (among HCPs and people with diabetes) is sometimes a little disproportionate. Of course they were talking about me, in adulthood, not as a child or teenager with raging hormones adding to the general BG chaos and 'fun'.

There are technological supports you can use (Libre/CGM/Nightscout/Dexcom Share/Guardian Connect) which allow you to monitor remotely without the need for intervention and/or to set alarms and alerts if levels reach a certain point. The Medtronic MM640G insulin pump can also predictively avoid hypoglycaemia if sensors are worn (my experience of this when I trialled it was that it reduced my hypoglycaemia by 90%). 

None of these options are cheap though, and NHS funding can be tricky to obtain.

As with so many diabetes things, I think it's a very personal decision. I guess partly it would be governed by your understanding of the relative ups and downs of your childs BG, how often you have found you have caught an unexpected low overnight, and whether you can spot patterns around those events to try to predict them ("Aha, 3rd Tuesday of every month is Mad Running Day... we'd better reduce insulin/add carbs before bed" etc)

Good luck with it. All parents of CWD (children with diabetes) are absolute SUPERHEROES in my book. Or rather, they are the supporters of superheroes - Pepper Potts to many Iron Mans... Alfred's to dozens of Batmen.


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## HOBIE (Jul 15, 2017)

Jello Gill P. I have been T1 since being 3. Now 54 & sill full- time employed. I bought one of the first Libres & it suits me fine. I did Scaf-Fell pike in my 50th year of diagnosis with perfect BG. Thanks to the info from a Libre. It was raining very bad & it would have not been possible with finger stick tests. £130 with 2 sensors, 24hr graphs & info while you child is asleep. You can also get an app on your phone to see what it is at school etc.  Good luck


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## Sally71 (Jul 16, 2017)

I'm a bit torn on the issue myself.  When my daughter was first diagnosed, all the doctors, DSNs, my mum (also T1) etc all said that night testing wasn't necessary, if my daughter did go low it would wake her up.  So I didn't do it, and of course she was fine.  It was only after an extensive period of night basal testing, trying to see if we could improve the hba1c, that I discovered that sometimes she went high at night and sometimes low.  After a lot of head scratching it eventually dawned on me that the lows coincided with nights when she went out to dance classes or Brownies after tea time, so I then started to put reduced basal rates on overnight on those nights.  Yay, problem solved, as long as I remembered to set up the temp basal on the correct nights... except that we would still occasionally get lows which did not coincide with the evenings out and made no sense whatsoever. And no, she doesn't wake up!

My daughter was part of the official trial to test the Freestyle Libre on children (the result of which was that it's now licensed for anyone over the age of 4, not just adults), it was a blind trial but we were allowed to look at the data afterwards.  That plus a lot more testing led me to see that if she's going to drop low, she'll do it during the early part of the night, it's extremely rare for her to drop later on.  So I've now fallen into the habit of doing just one test, somewhere between midnight and 2am, and if she's ok then I leave her alone until the morning.  My daughter is quite a deep sleeper, and I can quite happily finger prick her and feed her Ribena through a straw without waking her up! We now also have a Libre, which makes it a lot easier, unless she's lying on the arm which has got the sensor on and I have to roll her over to get at it 

You know your child best and have to do what's right for you and for their diabetes, although if you're having to test them every couple of hours every night then I would tentatively suggest that their diabetes is not very stable and perhaps you should have a word with your medical team about pumps and CGMs.  If you can't get any sort of CGM permanently perhaps they could lend you one for a week or two so that you could start to see exactly what is going on overnight and whether there are any patterns.


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## HOBIE (Jul 17, 2017)

I love the Libre. Talking from experience. As a T1 you know when you are heading low & every 2mins I was on my way up Scar-Fell U could check. You could do the same at whatever time of night or when he was at school. Kids are a big worry at times. My son has just been awarded "Sportsman" of the year with his school. He is not T1, he plays tennis & football for them. Good luck


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## HOBIE (Jul 17, 2017)

It also works through coats & clothing.


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