Tuesday, August 28, 2012

"So, what do you do when you test their BGL in the middle of the night?"

This was a question asked during a lovely dinner at an old friend's house a few nights ago.

Before I answered her I had to ask myself whether this person really had any idea what she was asking, or, if she really wanted to know the answer to that question...

Oh, and of course, would I risk overstaying our welcome if I took the time to give her a complete answer!

You see, there's no simple answer!

On a good night, if their BGL is in a good range at their bedtime, I will test each of the kids at around 3am and then, after entering their BGL into their pumps and hearing that little sing-song alert to let me know that the pump is not giving them a correction, I will, hopefully, go back to sleep!

We don't get many good nights.

In most cases, the answer to that question goes kind of like this...

If BGL is lower than I'd like it to be at child's bedtime I will usually get them to have something to eat or drink, re-test in 15 minutes to make sure BGL has come up. If they've come back up to a "good" level I will go to sleep until the 3am alarm goes off.

If BGL is still a little low I will stay up a little later, maybe do some reading etc, and check again before I decide to call it a night. If all good, I will, hopefully go to sleep until the 3am alarm.

(it's almost 11:45pm here right now - a BGL of 1.5mmol/L (27mg/dL) at your child's bedtime is not usually conducive to a "good night")

(screenshot of actual BGL reading on iBGStar App)

If, however, they have done some kind of activity during the day that might cause BGL's to drop overnight (soccer, running etc) I will have to set the midnight alarm.

If a BGL is lower than I'd like it to be (but not too low) I will reduce the background insulin on their pump (since using the word "basal" would mean nothing at all to anyone not living with T1D), then check again in about an hour to make sure said child has come up a little - then, hopefully, go back to sleep.

However, if, after an hour, BGL has stayed the same or dropped - depending on how far they've dropped, I'll reduce background insulin again, and check again in an hour.

If BGL is too low (or has dropped to the point of being too low after reducing background insulin) I will wake said child and get them to drink some juice or a chocolate milk; stay awake until I re-test in about 15 minutes - if BGL has come up, I'll, hopefully, go back to sleep - BUT - will set an alarm for an hour later to check again to make sure child hasn't dropped again.

If BGL has not come up, or has dropped further, treat again, wait another 15 minutes and around and around we go.

So, all of that is based on BGL being on the low side.

The other side to T1D is the lovely HIGH BGL's! And on insulin pumps this is something that we have to be very careful about! We have to figure out whether a high BGL during the night has been caused by an incorrect bolus for dinner, excitement, start of an illness, hormones or a potential problem with the pump or the infusion set! 

If BGL is high enough to require a correction via the pump then I will usually set an alarm for an hour later to make sure BGL has come back down into range. And if it has, then, hopefully, I will go back to sleep!

(Screenshot of some of my alarms - gotta love this feature on iPhone)

If it hasn't come back into range after an hour, or if it has gone up I have to decide whether to do another correction via the pump, or - depending upon how high the BGL is, do a site change on my sleeping child! Yep, that involves a needle. Either way, I still have to set an alarm for an hour's time to check again to see what's happening. If all good and BGL coming back down into range, hopefully, I will go back to sleep.

If it hasn't - well, you get the picture.

Then, of course, there's the possibility that a High BGL, after a correction, will turn into a Low BGL - the dreaded roller-coaster ride. On those nights there's not much sleep.

There's one thing that you have to remember, though, when trying to understand all of this and trying to figure out WHY a T1D parent gets up so many times to check on their child.

Insulin is a potentially dangerous drug. 

When we are deciding, in the middle of the night, when we are exhausted and severely sleep deprived, whether we are going to give our child insulin we're not just thinking about numbers and about trying to get our child's BGL back into range. We're also thinking about the fact that we are giving our children a drug that has some incredibly scary side effects. Yes, it keeps them alive, but it also has the potential to do a great deal of harm very quickly.

And remember, I have two kids with T1D - so even if one child has perfect BGL's overnight, chances are, the other won't.

My friend did actually want to understand, and did take the time to listen, so, thankfully, I did not wear out my welcome. We had a lovely dinner and she told that she thinks my kids become more and more amazing each time she spends time with them. 

Of course, not much sleep was had that night after dinner with our friends, you see, the kids and I had run in the Pub2Pub Fun Run earlier that day. Nothing says "post activity hypo" quite like a 13km run along Sydney's Northern Beaches.

The kids before the start of the race.

Did I mention it was a soft-sand start!

(Screenshot of my Pub2Pub Run from Nike+ Running App)

Oh well, T1D may prevent me from getting any sleep, but I won't let it prevent the kids from achieving whatever it is that they want to achieve!

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