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August 21, 2000

Insulin Pumps

Question from West Dundee, Illinois, USA:

What is the reasoning behind testing at 2 am? My two year old son was diagnosed at 15 months. I do check him two to three times per night because he often goes low, but, many times, at 2 am, he hasn't "bottomed out" yet. When I check him an hour or so later, he will be much lower. I worry that I should treat that initial reading at 2 am, but, the problem is he'll skyrocket as the evening goes and wake in the 200-300 mg/dl (11.1-16.7 mmol/L) range. I'm at a loss for middle of the night readings/treatments. We're more than likely putting him on the pump in the next month. Will that help us in the middle of the night?

Answer:

here are many solutions to nocturnal hypoglycemia (low blood sugars at night). One solution is a bedtime snack with starch — the commercial product is called Night Bites. These are available at most large pharmacies — and your pharmacist can order this for you if you have difficulty finding it. The starch is slowly converted to sugar through the night and should help to keep blood sugars in a normal range. In addition, frequent lows at night may mean that your child would benefit from changing his insulin dosage to better meet his needs — if this continues, I would suggest reviewing blood sugars with your diabetes team.

It is unreasonable to expect parents to check middle of the night blood sugars every night. Rather, I would suggest fixing the problem that is causing the nighttime lows as I suggested above — and then occasionally checking a middle of the night blood sugar to help ensure that no further problems are happening at night. In addition, caring for a 2 year old with diabetes requires a great deal of “creative flexibility”.

Keep up the hard work!

MSB