6 Tips for Checking a Child at Night
Take back your rest while preventing overnight blood glucose lows
We hear it from parents of children with diabetes all the time: They’re running on too much worry, and too little sleep, because of monitoring their kids’ nighttime blood glucose levels.
Nocturnal hypoglycemia (low blood glucose levels during nighttime sleep) is dangerous. Sometimes an episode of hypoglycemia wakes a person, but sometimes it doesn’t. Ideally, the person will be awakened by symptoms and treat by eating fast-acting carbs such as glucose tablets or gel to get glucose levels back to normal. Without treatment, undetected hypoglycemia can lead to seizures and/or coma.
Parents, especially those of kids newly diagnosed with diabetes, often express worry that a low won’t be noticed until it’s too late. “It’s the longest period of time that [kids] aren’t observed by an adult,” says Marilyn Clougherty, RN, MSN, CDE, director of the diabetes program at Children’s Hospital of Pittsburgh. “Our suggestion is parents should always be looking at the numbers [overnight].”
In search of a balance between safety and a decent night’s rest, we asked the experts: How often should parents check their kids’ blood glucose levels at night, and how can overnight lows be prevented?
When to check. Start while he or she is still awake. “Every single night, without fail, there should be a blood sugar check at bedtime,” says Daniel DeSalvo, MD, a pediatric endocrinologist at Stanford University. “I would say that’s the most important blood sugar check of the day for safety reasons, and also for looking at blood glucose patterns and trends.” So, right before bed, test. DeSalvo recommends that a child go to sleep with a blood glucose level of 100 mg/dl or higher, but ask your child’s health care provider to establish a safe range specifically for your child and his or her age, activity level, and medication and meal plan. Remember that extra activity and illness can affect blood glucose and may require different treatment. If testing shows the blood glucose level is too low, your child will need a snack (see “An ounce of prevention,” below).
Middle-of-the-night checks. Clougherty says that after diagnosis parents should check every night, both two hours after bedtime and about 3 a.m. After a “stable dose” has been established, she adds, parents should do the 3 a.m. check about once a week and anytime a child changes insulin dosing or diabetes medication, or has had a day of extra activity or exercise. Out-of-the-ordinary meals and sick days are other reasons for extra nighttime checks. Keep glucose tablets or gel at bedside to treat nighttime lows immediately if needed.
An ounce of prevention. If a child’s blood glucose level is between 70 and 100 mg/dl at bedtime, DeSalvo recommends a snack with 10 to 15 grams of carbohydrate, along with some fat and protein, to keep blood glucose levels stable through the night. He suggests cheese and crackers, or even an ice cream sandwich. In fact, he says that in studies at diabetes camps across the country, on nights when kids ate ice cream sandwiches for bedtime snacks, there were “virtually no lows, not just because of carbohydrates but because of fats and proteins,” he says. Check with your child’s doctor to see if a bedtime snack is appropriate for your child’s regimen.
Adjust insulin right away. If a child has had an episode of hypoglycemia at night, Clougherty suggests making changes the very next day. She recommends lowering insulin doses slightly, assuming the child is already on a suggested meal plan. Of course, talk to your health care provider before making any changes to your child’s diabetes care plan.
Don’t worry, be happy (and prepared). Some parents may want to consider continuous glucose monitors, or 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, and they provide audible alarms when levels get too high or low. Yet, Clougherty notes, kids with diabetes and their parents can sleep through an alarm.
Also on the market is the Medtronic mySentry, a system that shows blood glucose levels and sounds alarms for lows, highs, and rapid fluctuations at a receiver in another room. So a child wearing a sensor can sleep in his or her own bed while parents can keep the receiver by their bedside. This product is not typically covered by insurance. “For some parents, this really gives peace of mind,” DeSalvo says. “For others, it has been more of a nuisance or caused more worries. It can be too much information.”
Glucagon to the rescue. Every home should have a glucagon kit, and parents and guardians should know how to use it in case of severe hypoglycemia. Glucagon will quickly raise blood glucose levels when a person with diabetes is unconscious due to hypoglycemia. The powder must be mixed with the liquid in the glucagon kit right before injecting it. Safety note: Glucagon can induce vomiting, so if the child has recently eaten, protect the airway by keeping the head turned to the side until the child is conscious. You may never have to use the glucagon kit, Clougherty says, but it’s important to have it, just in case.