Toddler - Type 1 overnight question, Please Help!

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cls410
Regular Member


Date Joined Feb 2006
Total Posts : 64
   Posted 3/20/2006 2:29 AM (GMT -7)   
Hi--


I'm visiting from another forum but had a quick question. My friend's little 2 year old was recently diagnosed with Type 1 diabetes and the management of it overnight seems awful. They wake her up every 3 hours to check her blood sugar. She is often low and they need to feed her overnight. Obviously this is wreaking havoc on her sleep pattern as well as her parents'. They are very afraid that she may go into a hypoglycemic coma without them knowing. Does this sound familiar to anyone? Have any tips for doing this with kids overnight? Does everyone with Type 1 have to do this?



Thanks for your help!
=====
(I've edited your subject to get more reader support.)

Post Edited By Moderator (Jeannie143) : 3/23/2006 10:05:52 AM (GMT-7)


Jeannie143
Veteran Member


Date Joined Apr 2004
Total Posts : 6056
   Posted 3/20/2006 10:22 AM (GMT -7)   
I have contacted one of our Type 1 parents and am hoping he will show up soon with some help. In the mean time I would ask all diabetes forum members to please post their email address in their profiles. They are protected there from spam spiders and it certainly helps when we need your expertise on some part of diabetes and you may not have visited the forum in a few weeks.

Just click on the 'control panel' button in the blue bar at the top of the page and edit your profile.

Thanks!
~ Jeannie

"People are like stained glass windows: they sparkle and shine when the sun's out, but when the darkness sets in, their true beauty is revealed only if there is light within."

- Elizabeth Kubler-Ross


cls410
Regular Member


Date Joined Feb 2006
Total Posts : 64
   Posted 3/20/2006 11:12 PM (GMT -7)   
Thanks Jeannie!

Jeannie143
Veteran Member


Date Joined Apr 2004
Total Posts : 6056
   Posted 3/23/2006 10:06 AM (GMT -7)   
bump
~ Jeannie

"People are like stained glass windows: they sparkle and shine when the sun's out, but when the darkness sets in, their true beauty is revealed only if there is light within."

- Elizabeth Kubler-Ross


Sunday
Regular Member


Date Joined Mar 2006
Total Posts : 59
   Posted 3/23/2006 4:28 PM (GMT -7)   
I'm wondering if your friend's child is cared for by a pediatric endocrinologist.  While I've been diabetic since childhood, (over 40 of my 48 years), I hesitate to comment because this is a very complicated question you've asked, and it can really only be answered by the child's doctor.   Hopefully they're using an endo and not an internist or worse, a GP. 
It's easy to take guesses (like the basal dosage is too high or the parents aren't talking to the doctor about the night-time regimin or the lows, etc) but it's all pretty circumspect.  Maybe the doctor is collecting data for just a few nights.  It's highly unlikely that this regimin is part of an endo's long-term plan.  
You're right to be concerned about your little friend, but I'd suggest finding out how involved the physician is.....something doesn't sound right.   Let us know what you find out.  Hopefully everyone in that household will be sleeping soundly and safely through the night very soon!  smurf
 

cls410
Regular Member


Date Joined Feb 2006
Total Posts : 64
   Posted 3/26/2006 12:09 AM (GMT -7)   

Hi Sunday--

Yes, she goes to a pediatric endocrinologist.  And they've been doing this since she's been diagnosed which is almost 3 months now.  about 50% of the time they need to feed her at one point during the night.  The endocrinologist has revised his recommendations about feeding her--now they only need to feed her if she's under 70.  But it all depends on what the slope of her numbers are overnight.  If she plummets down then she definitely needs to be fed and they need to check her even more frequently.  If the numbers go to 70 and stay there, then they need to check her levels every 30 minutes to 1 hour!

Last night, I went over to take care of her and these were her numbers:

8:30PM (right before bed): 104--they fed her about 10 grams CHO to bring up her number

10:30PM: 141

2AM: 74

2:30AM: 105 (huh?!)

5AM: 81

don't know her wake up number--as I left. 

So luckily I didn't have to feed her and she didn't wake up any of the times I stuck her but it broke my heart to interfere with her so much!  But about 50% of the time, she goes under and they need to feed her.  Maybe with the new low of 70, they might not have to feed her as much.  But is there really a risk of her going into a hypoglycemic coma overnight?  Does this make sense to anyone else?

Thanks so much for your help!


Sunday
Regular Member


Date Joined Mar 2006
Total Posts : 59
   Posted 3/26/2006 9:28 AM (GMT -7)   
You are an incredible friend and the world is a better place for that friendship!

That said, I'm humbled by what's going with your friend's child. Sounds like a difficult road for awhile.

I'm not second-guessing the pediatric endocirnologist. My opinion and anyone else not a board-certified endo -- is unqualified and anecdotal. From personal experience, I will tell you If I were her parent, however, I would ask the endo about a lower dosage of her long-acting insulin, which I hope is Lantus. Lantus doesn't peak in the same way Humalin L or other long-acting insulins do.

An endo I saw as a young adult while living in Alaska had a great metaphor; one I've never forgotten. He said that managing juvenile-onset Type 1 was like paddling a canoe. Paddle too hard or too fast on either side and you loose your balance and tip it over.

While insulins and tools have changed a lot over the past several years, the disease itself is unchanged. For me, balance sometimes requires backing off after I eliminate the lows. Job #1 when this kind of diabetes is out of control is always to eliminate the lows and once that's accomplished, seek to lower the numbers into the desired target range.+

The parents are right to be concerned about nightime insulin reactions. "Under 70" is safe only if it's heading upward instead of downward. It's the direction and speed with which it's moving that matters. I think the 105 reading is because there's just too much insulin on board through the night.

There's also a "bounce factor" although it's debatable. (I've moved around the country a lot and of the 6 endocrinologists who have cared for me, four of them subscribe to the concept). "Bounce" means that after a reaction, blood sugars can surge before they stabilize.

I wish you and your little friend sweet blessings and hope her canoe is a smooth ride very soon!
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