# Hypo night question.



## hybriduno (Feb 10, 2013)

Hi, all......so i have a question that my nurse has not answered as such so need advice.
We have been told not to wake our son up at night (who's 8) to test him..... do you guy's test your children in the night?

He was diagnosed type 1     3 weeks ago but we was worried he may have a low in the night so we started checking him to find out he was  2/3 am every morning.

The nurse has adjusted his levimir and novorapid to try and calm thing's down (but only because we asked them as they have not been bothering to contact us at all.!)

The nurse then said if he has a low in the night his body will wake him up and/or his liver will kick in and release the stored sugars to bring his level back up......? is this true?
If so how come it doesn't do this in the day to some degree?

Enough from me

Awaiting your answers


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## pgcity (Feb 10, 2013)

The theory that diabetics can have an increase in blood glucose after a hypo in the night is called the somogyi effect.

If you look at the somogyi effect on wiki it describes it as a theory without much evidence to back it up. Us type ones probably sleep through most of our nighttime hypos and wake up due to dawn phenomenon where the act of get ready for the day increases insulin resistance. Most cases of type ones not waking up are usually to do with the impact of alcohol on the liver. 

You don't need to wake your son up to test him. It's you that will be missing sleep but continue to do this if you are worried he is hypo either because the basal isn't right or because of increased exercise.  I can feel hungover after a nightime hypo which makes the following day a struggle so I feel it is worth the missed sleep to avoid them.

You will start to see some stability and when you do you can decide to stop the nighttime tests.


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## Hanmillmum (Feb 10, 2013)

Hi

Well our experience is that my daughter doesn't wake when she is hypo, I have just found she is and sometimes rather low too - out of the blue. I couldn't be certain that the liver would kick in either, as it may not in some, so I personally couldn't risk this assumption.

You can test without having to wake the child, my daughter sleeps through. I will wake her just enough if hypo to gulp down some glucogel if needed so she doesn't choke, she fights having to drink or chew anything in the night. It's hard work!

Certainly whilst his doses are being adjusted and you have been finding him low - I would err on checking him, but it is your decision not your nurses'


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## bev (Feb 10, 2013)

Hi Hybriduno,

Absolutey yes I test Alex in the night - always at 11pmish and take it from there  - if a 'normal' night I test at 3am and are led by the numbers found. I have found so many hypo's and hyper's that show me that testing is needed - especially when a child has been active but also when they are growing and producing hormones which raise levels so corrections are needed. Diabetes doesnt stop because a child is asleep and I despair of teams that say nonsense like levels will remain stable through the night. If this was the case why does Alex (and many other children) have 6 basal rates going on? Basals change as a child grows and produces hormones - but this happens in three week spurts then all of a sudden it stops so you have to reduce the insulin - this cant be done unless you are testing. Yes it is tiring and it does frustrate me - but safety is the priority. No I dont believe somoghyi exists - there is no evidence to say that it does just hearsay and CGM has proved to many of us parents that the liver doesnt kick in and raise levels for our children. Try doing testing and you will get a better idea of what I mean - 'stable' levels in a child  are difficult to achieve - growth and the nature of a childs day interferes with levels. This is a difficult subject because some parents choose not to test (which is thier right of course) and dont understand why others do test - so it is entirely personal choice and what is right for one family may not be right for another - you have to do what is right for you and your child.Bev


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## trophywench (Feb 10, 2013)

Hear hear.

It is possible to have 'rebound highs' from hypos, which is normally when Mr Liver decides to kick in without asking for permission.  The trouble is he ain't reliable and he doesn't keep to a timetable.  He may kick in, he may not.  Nobody knows how much he will supply or when that will be.  Usually though these only become a real problem when your BG is see sawing from LO to HI on the meter because of summat else - eg panic attacks, and it doesn't happen immediately when you only have one of those either.  If it does happen then we all just have to 'fire fight'.

There's a lot of research going on right now trying to find out why diabetics lose their 'Liver Dump' reflex - so medics absolutely DO know we lose it but don't know why or when.

You treat your child's diabetes, not the clinic.  

He's not old enough to take ownership of it yet, so YOU have to for him.

You did not need to seek permission to reduce (or increase) a dose that obviously wasn't working.  I know you wanted to discuss it, I understand that perfectly and I know 3 weeks isn't long enough to expect you to take that ownership and be solely responsible for those decisions.  I think it's absolutely reprehensible of your hospital to expect you to, you should have easy and quick access to a 'wiser' person at this stage at least 7 days a week if not the full 24 hours a day.

I remember a work colleague with a T1 daughter coming and asking me about night-time hypos.  All I could tell him was I do wake up, as far as I know.  But I can't possibly tell you how many times I don't.  How would I know that?  So DO sneak in and test her.

Incidentally the difficulty with eating/drinking may not actually be because it's night and they've been asleep.  I know when I've had really bad hypos in the past - not in the middle of the night - and husband had to ring 999, I most certainly didn't want to swallow anything.  Esp with someone I didn't know trying to make me!  Is why I use Lucozade now, it starts working in my mouth and I can swallow it fairly easy.  As long as the person isn't actually low enough to be comatose and can sit up, so won't choke, liquid usually actually works very well.  

PS after a really bad hypo as I start to come to, I go freezing cold, shortly after I'll be boiling hot and really sweaty.  And then need to sleep the sleep of the dead.  I am the same coming round from a general anaesthetic, must be summat to do with the brain turning itself off to conserve glucose to use to make your heart beat or something.  And after both - projectile vomit ......


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## Amanda102 (Feb 10, 2013)

I usually test Hannah before bed about 11 and if we are in a fairly steady phase then I leave her if her levels are ok. Sometimes though, when we go through an erratic phase (like we seem to be coming into now!) I test every couple of hours until I am happy with the level she is at. Luckily my husband comes in from work about 12.30 am so he takes over that test and only wakes me if there is a problem. I never wake her for a test and usually she just sleeps through it. Last night I actually had to give her an injection through the night with her pen (she is on a pump) and she didn't wake then either. It is case of doing what you think is best, but I am not sure I could continue to function at work if I was testing through every night!


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## trophywench (Feb 10, 2013)

Well you'd have to if she was otherwise ill, wouldn't you?  There's lots of things you have to do as a parent that you'd really prefer to sleep through LOL

What's the erratic phase - the monthlies or something else you can easily expect and identify, or not?


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## Lauras87 (Feb 10, 2013)

Hi.
I know this may not help with what I have to say but I'd try to test him in his sleep to check if you are worried.

I've had hypos in my sleep & not woken up from them. Thankfully my mum was there to call for an ambulance.
I don't trust the theory that the liver will kick in to provide glucagon, I've hit 0.6 in my sleep & had to have medical help.

Maybe a snack at bed might help make sure his bloods are slightly higher?

Hope it gets sorted, I know how mum worries about me in my sleep & I live alone.


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## Tina63 (Feb 11, 2013)

Hi Hybriduno

My lad was 15 at diagnosis, and no-one ever mentioned night time testing.  I must be thick, but it wasn't until I discovered this website some months after his diagnosis that I even realised people test at night   So, shockingly, we never have.  Even in hospital he was left from 10pm to 6am without testing (big as he is I stayed with him 24/7).

He has only ever knowingly had one night time hypo and woke from that.  I heard all this crashing and banging about and he was going downstairs (admitting afterwards he nearly fell)  looking for food and drink, despite having supplies in his room.  Showed how he couldn't think logically about it.  He was pouring with sweat and it was obvious to me something was wrong.

As a side issue, I am appalled at your team's lack of support.  My son was so much older, but we were under the children's team and we had amazing care at the start.  Home visits from the nurse and dietitian for several weeks (and the nurse even came a few times much later in the first year) and we have always had 24 hour phone numbers for emergencies.  The first few days home we had twice daily phone calls if we didn't get a home visit, then they weaned us to a once a day phone call, then every other day, then at least once a week for quite a while.  Each time we had a home visit we were educated a bit more, with reams of paperwork left with us, but in dribs and drabs so we could take it all in at a gentle pace.  Our nurse gave us her office number and that of other nurses on the team but with specific days and times each nurse would be available for a non-urgent chat, and we have email addresses too.  I really can't fault that side of our service, in fact I have nothing but praise for them.  The initial 'training' was done in hospital by a different nurse as our DSN was on holiday at the time, and to this day the one who saw us first remembers us and ALWAYS makes a point of coming over to talk to us at clinic if she is there.  I always think how lovely that is.

Anyway, back to the night time testing debate.  What I would say is that it's obviously causing you some anxiety, so certainly to address your anxiety alone I would say yes do go and night time test (certainly if you are awake anyway to put your mind at rest a little).  I used to worry about my lad if I was lying awake in the night for any reason (I am an erratic sleeper anyway) yet NEVER considered going to test him!  I can't believe I didn't ever think of that in the early days.  It consumed my every waking thought, yet I never thought to go and test him.

The one thing I would ask others generally though is "Do you still test EVERY night?  And if not, at what age did you stop?"  There are plenty who live alone, and there comes the time your 'child' goes off to uni, what then?  I do understand with growing children hormones play a massive part though, so maybe once adult it all settles down a bit.

Sorry, I diversify!  Hope you are getting on ok with it all though, it's so overwhelming at the start.  I think you get on this rollercoaster and at the start it's one hell of a ride, but things do start to get a little easier with time, though it's a long time before it doesn't dominate your every waking thought.  Hope you are all doing ok though.

Tina


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## FinleysMum (Feb 11, 2013)

My son is 3 and was diagnosed just over a year ago. He is currently on mixed insulin and no matter how much we adjust his teatime dose he hypoes most nights between 3 and 4 am. I also stay up until around 11:30 to test to get a feel of how his levels are. However, even if he is really high at 11:30 there is no guarantee he won't hypo. Last night at 11:30pm he was 16 (unusually high) and by 3am he was 4.2.
I would never leave him 8 hours in the day without testing and he portrays physical signs during the day time whereas in the night we have no idea what he is doing despite the baby monitor. 
He has NEVER woken from a hypo and is now accustomed to eating jelly babies in his sleep  - yes it's knackering but if anything were to happen to him because I hadn't checked at night then I would never forgive myself and so my tiredness is a very small price to pay. 
I can honestly say my body has become used to the sleep pattern now and I am not half as tired as I was at first
Thankfully we start pumping on Thursday so I am hoping this will resolve some of the night time issues for us.
x


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## novorapidboi26 (Feb 11, 2013)

My own diagnosis was at 15, so there was no involvement form my parents at that stage. I also have had many hypos where my liver has recovered me, however the effectiveness of that glucose dump can depend on many things like how long you last had a meal/digested food, was there a recent hypo prior etc........if the conditions are right, which most of the time they will be, the liver will respond.....


However....

If I was a parent of diabetic child, which may still happen, I would be testing through the night, or at least at the same time every night, say 2 or 3, just to monitor patterns and to account for their growth/changing hormone levels....

You may spot behaviors in his BG that might help you sleep better at night...


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## fencesitter (Feb 11, 2013)

We don't routinely test at night, but we would/do if William is under the weather or if he wakes up feeling strange. We would also do it if his morning levels were off kilter more than occasionally. He seems fortunate because at the moment his basal keeps him nice and steady overnight, but I'm well aware that all that can change  
If you are concerned, do test at night, as you'll only lie awake worrying anyway. If you find steady levels at night you'll be able to relax a bit and start leaving some nights out. If you find hypos/hypers you'll be able to look for patterns and plan what to do. You are new to this but you'll very quickly become experts!


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## Fettuciniuse (Feb 11, 2013)

Interesting one this - and an issue that worries me almost more than any other.  (apart from giving the wrong type of insulin by mistake, impending puberty, alcohol, leaving home blah blah etc)

We give Lantus at around 9pm, then luckily as we both go to bed late, one of us will test Oliver then.  If he is between 6-8, we drag him from his sleep to give him about 100ml of milk.  He doesn't even remember being woken up, usually.  He is rarely below 6, although could be with a physically active evening (swimming for example).  Then I will get up and check him at around 3am as well as giving milk.  Since I have rarely slept a full night since he was born, what's another 10 years??!

I just do not think it worth the chance that his body will 'right itself', since it has proved bloody unreliable by allowing his pancreas to pack up in the first place.

So we will always check, and I think it worth the cost of a disturbed night.


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## XandersMum (Feb 11, 2013)

Hi

My son is 8 and was diagnosed on 27th Dec 2012.  We test at 8 and give his Lantus (3 units) at this time also, regardless of the reading I give him a carby snack i.e. crackers and cheese/digestives etc.. although give more if its below 5.  Some mornings he does wake at 3 but most mornings at 5 ish and I never test during the night.

Unfortunately, its not an exact science and its a continuous tweak here tweak there 

I am still learning though and don't think that ever stops !


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## Amanda102 (Feb 12, 2013)

trophywench said:


> Well you'd have to if she was otherwise ill, wouldn't you?  There's lots of things you have to do as a parent that you'd really prefer to sleep through LOL
> 
> What's the erratic phase - the monthlies or something else you can easily expect and identify, or not?



You're right and I have had times of testing throughout the night.  You just do what you've got to do!

I'm not quite sure what is causing the erratic phase. Last October she had a week or so of really high readings and then came back to normalish. About 3months later (January) she had her first period, but with no discernible change to her bgs.  Now, a month later when she would normally be on her period (but not regular yet) she is high again, but it is up and down so hard to cater for with temp basals!  We're just going from test to test and day to day and hoping it will settle down again soon!

I think the real cause is probabaly me making the mistake of saying a few days ago that we had had a really settled period for the last 3 months!!  Me and my big mouth!!


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## trophywench (Feb 12, 2013)

Daft question maybe but are you keeping a note of all the madness that happens on a monthly basis - I mean OK it hasn't settled yet but it's all useful for when it does settle, to know what it is that's likely to happen to BGs.  She may well not actually ovulate or menstruate at the mo, but some hormonal action will be at play, you can bet your sweet bippy.

Mine never happened regularly till I was about 35 .........


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## Ruth Goode (Mar 17, 2013)

C had hypos at night time before, I usually checked her at 3am and test her while she is sleeping. On Friday night my cat woke us up at 2am C was 2.6!! And the answer is no they don't always wake up with hypo, it's best to check for our peace of minds


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## XandersMum (Mar 17, 2013)

Hi

My son was diagnosed 10 weeks ago.  We test at 8 o clock (shortly before bed), he has his Lantus ( same as Levimir I think), then regardless of the blood reading he has a carbs snack, usually cheese and crackers or tea and a few digestives.  I don't test at night, although prob will at times if illness etc..  Thing is there is no exact science and what works for one doesn't work for others 

?ndree x


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