How low is too low at midnight, or 3 or 4am? In other words, where do you just go back to bed v. having a snack first? No CGM here, so looking for a guideline if my newly-Dx’d daughter wakes up in the middle of the night above hypoglycemic, but below … what?
I was diagnosed at 10. In the first years my mother used to check on me at night. Living with diabetes means being alert for lows at all times. I wake up automatically when I feel low. She should always check her blood sugar before she sleeps. She shouldn’t go to sleep under 140mg/dl.
Personally I would eat something if I’m under 100 mg/dl at 3/4 am. But as a child my A1C’s were high and I never really experienced a lot of hypoglycemia.
Always keep juice at home for hypos. Don’t skip meals, don’t drastically change sleep patterns.
The hypos at night usually happen on irregular days, like having to much exercise, being sick, or recovering from high blood sugars. At those nights you should check your daughter at 3 am.
Don’t forget to log her blood sugars. For further information consult to your doctor, these advices are based on my experiences alone.
I am an adult and I will only take carbs under 80, otherwise back to bed.
safer numbers for kids is higher and a matter of opinion. it matters a lot how much insulin is on board, IE - had a big shot for dinner to cover cake, then I would treat under 120/140 as well.
Snacks with protein have a way of absorbing slowly, peanut butter and crackers were my fav. for before bed, and it can help in the overnight. please also get a doctor’s opinion. good luck!
How old is your daughter?
She’s 6, almost 7.
CDE says it really depends on the person, and we should “follow the numbers,” meaning just track for awhile and see. So far, she’s only woken a few times. At 70s and 80s, I gave her a snack (peanut butter & crackers, maybe 20g), and her pre-breakfast sugars came in at 130-140. Based on those experiences, the night she was 95 at 3am, I told her to just go back to sleep, and she woke up the next morning at 111, so I felt like we made the right call there.
I was just thinking we’d figure it out faster if I had a better sense of where others draw the line.
95 at 3AM and 111 in the morning is perfect control. perfect blood sugar is above 65, below 100 mg/dl and no spikes above 140. she’s as close to normal blood sugar as she is going to get. The trouble starts if there is a low somewhere in the night, this is why all ped endos will want her target to be higher.
The other thing of concern (to me) is your daughter may be making her own insulin since she’s recently diagnosed. if she is, then once her body stops making insulin you will find sugar “harder” to control: more random, more sensitive, and more swings (highs and lows). This is where the overnight gets harder and it may pay to move the target to the 120-140 range and add a bedtime snack of some long lasting carbs. When the insulin requirements rise, you’ll be prone to more and more severe hypos, which can be dangerous.
you’ve already guessed it. you are the primary doctor, you are making the minute-to-minute decisions. The endo and nurses are more like “consultants” now. You will be the first to react to and the first to respond to the changes coming. you are doing a great job.
Our endo actually had us on a wider range at that age (80-180), but didn’t correct until 200. Especially early, we always erred on the side of having her be a little higher than that range for peace of mind overnight. Early on, because the pancreas still helps, it is sometimes harder to predict what direction the sugars will go.
We are 3 years post diagnosis, and her ratios are smaller, and more predictable, so it’s less of a calculation. She would normally do a 15mg snack at bedtime no matter what, but her meal shots were a 1:15 ratio, which it was just one unit’s worth of food unaccounted for. 15 carbs was not enough to push her to the high end of in range. Ie, she’d be 100 at bedtime, ate her snack and the next morning she’d be between 90-110.
Now she’s on a 1:5 meal shot ratio and the bedtime 15 would be like her missing 3 units, which is a lot for her. So we came up with our own formula: if she’s 100 or below she can have the full 15. 100-150, she can have 10 carbs. If she’s 150-200 she can have 5 carbs. Over 200, no carbs.
It basically is her correction ratio in reverse.
I always err on the high side for overnight, then use that data to determine what needs to be done the next day based on where her numbers are.
This is a tough call without a CGM. I thank God for that thing every day!
For us, 70 is OK as long as the trend is level or rising. If it is dropping he’ll get some Gatoraid. If he’s 160 rising, he gets some insulin. If he’s level or dropping we let him sleep.
My son is 11yrs. This is a huge cause of anxiety for me as I’m sure it is for everyone else.
What range to you recommend for bedtime?
I don’t like him going to bed if he’s 140-150.
My ex lets him go to bed at 120.
Our CDE said no lantus at bedtime with out a snack if less than 100.