Q: We regularly check our son's blood sugar in the middle of the night, but have heard other parents don't do this. Is it necessary?
A: In most people, blood sugar tends to naturally be at its lowest between the hours of 2 a.m. and 4 a.m. For children and adults with type 1 diabetes, a "perfect storm" of sorts can occur when the sugar-lowering effect of injected insulin collides with other factors, such as recent physical activity or reduced food intake during the day. At night, when blood sugar tends to be at "low tide" anyway, these conditions may result in a low reading.
Perhaps you decided to join the "3 a.m. club" because your child experienced low blood sugar one night -- or you heard about this happening to someone else's child. Being a nocturnal blood sugar checker is a noble and selfless act, but this kind of behavior can also take a dangerous toll on the health and mental well-being of caregivers, beginning with sleep deprivation, chronic stress and anxiety, and even problems with marital relations.
Yes, there are going to be nights when checking blood sugar outside of normal testing times is needed, especially if a child has been sick or has exercised a great deal over the previous 24 hours, or for some other reason. But checking in the middle of the night every night -- even when no signs point to anything being different -- is usually not necessary.
The final decision about how often you test is, of course, completely up to you and your doctor. However, if quitting the 3 a.m. club sounds like something you want to do, there may be ways to do it without sacrificing your child's health. For starters, carefully review insulin doses taken in the evening. Different insulin types vary in when they peak (work strongest) in relation to the time when they're injected. If peaks are happening in the middle of the night, talk to your diabetes healthcare provider about how to adjust evening insulin doses to avoid this. He or she can also explain how to add long-acting carbohydrates (like whole grains) to a bedtime snack in order to provide a steady source of sugar overnight.
There are some hardware options that can help as well. If your child uses a pump, talk to your diabetes care team about nighttime insulin settings that may help your child avoid lows. Continuous glucose monitoring (CGM) sensors measure blood sugar levels every few minutes and have alarms that go off at night when sugars start to trend too low or too high. CGMs do require a level of commitment by the family and child to wear them consistently; they're also pricey and require a doctor's prescription. But they can be a good option for some parents who want greater peace of mind -- and more sleep.
--Stephen Ponder, M.D., F.A.A.P., C.D.E., is a board-certified pediatric endocrinologist in Temple, Texas. He has had type 1 diabetes since age 9.
How Other Parents Deal
"Our diabetes educator showed me how my son's management plan is constructed to prevent overnight lows, and what signs to look out for that mean we should set an alarm to check overnight. I've read all the same stories that keep other parents up at night, but I refuse to be motivated out of fear or anxiety, and try to make decisions based only on facts about my child."
--Suzanne C., mom of Andrew
Disclaimer: The information in these articles is not intended as medical advice. Families should check with their healthcare professionals regarding individual care.