I found out last month that my four-year-old daughter has diabetes. For about two or three days, she hasn’t had a fever, but she sounds like she has a cold. She sneezes a bit and coughs every now and then. Sometimes her nose is stuffed up. She says she’s fine. She has no pain, but her bedtime blood sugar levels have been higher then usual. I check her sugar levels two or three times at night when she’s sleeping. One of her endocrinologists tells me to check her only once at night. The other advised me to check her less but she said she knows I won’t. Then again, they told me I didn’t even have to check her at 3 a.m. that at the hospital they did that because her insulin was at it’s peak! Here or there, her insulin was still be at it’s peak. Three nights ago, I checked her at 3 a.m. and her sugar level was below 4 mmol/L [72 mg/dl]. Once, at 1 a.m., she was 3.8 mmol/L [68 mg/dl], so, imagine what would have happened it I had waited until 6:45 a.m.!

Right now, she isn’t taking her NPH at night because 0.5 made her drop too fast. The doctor says she’s in her “honeymoon stage.” Isn’t it better to be “safe than sorry?” Does it hurt anything to check her as often? Her doctor told me the other day that even if she doesn’t take insulin at night, her sugar level could go down way down depending on how active she was that day. So, when do you think I should check her? Will she be safe if I check less?

Her doctor only wants me to call if her sugar level is over 17 mmol/L [306 mg/dl] with 0.6 or more blood ketones because everything is okay if she has little or no ketones.

I think that while there are lots of wrong ways to care for children with type 1 diabetes, there is NO SINGLE RIGHT WAY.

How often one checks glucose levels depends upon so many things, including type of insulin and the timing of insulin injections in relation to meals and exercise; other medications; concurrent illnesses, and many more.

It is EXTREMELY important that YOU (and eventually your child) understands how different insulins work: when they start to work and when they have their maximal (or “peak”) effects and how long they generally stay in the system. NPH is an intermediate-acting insulin with an onset of action about two hours AFTER the dose, but a PEAKING effect about six to eight hours after the dose.

Regular insulin is a short-acting insulin with onset about 30 minutes after a dose and a PEAK about three to four hours after the dose. Rapid-acting insulins, such as Humalog or NovoLog, have onset within 15 minutes after the dose, but PEAK in about 90 minutes afterward.

Your own Diabetes Team should give you the advice and you should follow it. If you have questions, then you should feel comfortable in maintaining a dialogue; if you don’t understand the reasons for any recommendations, then ASK!

Personally, I rarely ask for ROUTINE middle-of-the-night glucose checks at home. You need sleep, as does the patient. In the hospital, a couple of reasons to check middle-of-the-night include that one is learning just how sensitive the patient is to insulin. Plus, the night staff are awake anyway! During illness, or if the glucose is low at bedtime, it may be certainly appropriate to check 2 to 3 a.m. glucose levels.

Given your basic questions and that you are so new to this diagnosis, please DO NOT make insulin changes without the input from your diabetes team (the endocrinologist or their diabetes nurse specialists). HYPOglycemia can be devastating. Your child probably IS in the “diabetes honeymoon.” If the half unit at bedtime made the glucose drop too quickly, then either the dose needs to be decreased OR it could be moved earlier in the evening. TALK with your diabetes team!

As for harm from checking too much, there is probably little physical harm, except sore fingers. But, maybe you are using alternative sites. There can be psychological harm to YOU, YOUR SPOUSE, and, perhaps, the CHILD. Think of your child as a KID FIRST and a “diabetic” SECOND. Focus your energies wisely. Your child should have a life (and a lifetime).

DS

[Editor’s comment: As a parent of an older teen with diabetes, I have found nighttime testing to be extremely helpful and important. CWD has run polls about nighttime testing and over one-third of respondents to our March 2006 poll indicated that they test every night.

It is particularly difficult to figure out why your child has a certain “wake-up” blood sugar if you have done no nighttime testing. Many parents find that the testing becomes even more critical as your child grows, eats meals elsewhere, participates in athletics, etc. With that said, if you find that nighttime testing makes it impossible for you to function as a worker or a parent, you have to have an alternate plan. That could include having someone else help with the testing or doing the nighttime testing less frequently, such as only on nights when she has eaten poorly, feels ill, has been out with friends/siblings, etc. Whatever you end up doing, you should not be judged a bad parent. You will do whatever you do to keep your child healthy.

Finally, be sure to discuss the use of a non-peaking basal insulin, such as Lantus, with your child’s diabetes team.

BH]