A Good Night's Sleep With Diabetes

| Aug 2, 2007

Parents of newly-diagnosed children with diabetes have something in common - they don't sleep soundly through the night. Anxiety soars in the darkness. When our son Danny was diagnosed at age seven, my husband Brian and I barely closed our eyes, and we set our alarm to check on him at least once every night.

And no wonder! There were nights when we found Danny sound asleep with blood sugar numbers as low as 40 or as high as 500.

No matter how carefully we monitored Danny's food and calculated his doses, we couldn't seem to control the outcome. Frequently Danny awoke achy, tearful, and exhausted from his nighttime highs and lows. Our doctor and diabetes nurse educator tried many insulin adjustments, but nothing kept him consistently in range.

After eighteen months of this, Danny's A1c (three-month blood sugar average) was 7.8%. Our medical team was pleased, but we had lived through his huge swings and were the worse for wear. We all needed a good night's sleep.

Searching for a solution, I looked at the bread, pasta, and potatoes that Danny sometimes ate for dinner and the crackers and cheese or big bowls of fruit that made up his bedtime snack. I realized that if we could limit his evening carbohydrates, he would need almost no short-acting insulin at bedtime. His dose of long-acting insulin-and later his pump's basal rate of Novolog-would carry him steadily through the night.

One evening at dinner, I explained my idea to Danny. "The goal is to have good blood sugars while you sleep so that your body can rest and regenerate. We want to see whether your nighttime blood sugars become more stable if you cut down on carbohydrates at dinner and before bed." I saw alarm on Danny's face. "Don't worry. You'll still have carbs at breakfast, lunch, and three snacks. And Dad and I will still eat the same food that you do for dinner."

Braced for a heated protest, I was taken aback by Danny's calm reply. "Okay, I'll go as low carb as I can." His only request was that he still be allowed ketchup and salad dressing. To my surprise, his sister Jessica said that she'd participate too. Suddenly I was feeling hopeful again. As with any chronic disease, you have to keep generating renewed enthusiasm; otherwise, you settle into ruts without noticing how lax you've become. Now at least we had a plan and, remarkably, no one was complaining.

I began by cooking lower-carbohydrate dinners such as chicken, vegetables, and salad, or vegetable soup, steak tips, and broccoli. For bedtime snack, if Danny's number was in range, he ate string cheese, almonds, or peanut butter and celery. If he were running on the low side, we would add strawberries or blueberries with whipped cream.

The results were stunning. Danny was going to bed most nights at a steady 120 mg/dl and waking up at a slightly lower number. Although we still couldn't stop all his swings during the day, he was stable for eight or nine hours at night. His two-week blood sugar average dropped from 180 to 140. And after three months of the lower carb evenings, his A1c dropped from 7.8 to 6.8%.

Our new plan required more forethought and creative cooking; some of our favorite meals, like homemade pizza and lasagna, were sorely missed. And we still set the alarm to check on Danny while he slept. But the new diet changed the quality of our nights. We had found a way to ensure that for one-third of every twenty-four hours, the whole family could rest.

Laura Plunkett is the author of "The Challenge of Childhood Diabetes: Family Strategies for Raising a Healthy Child", and can be reached at www.challengeofdiabetes.com.

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Categories: A1c Test, Blood Sugar, Columns, Diabetes, Diabetes, Food, Insulin, Kids & Teens, Low Carb, Personal Stories

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Posted by Anonymous on 22 February 2008

In response to the writer of the comments of Aug 23 and 28 ~ carbs may not be rocket science, but raising children with diabetes sure is. I'm glad you can manage your diabetes without using rocket science. Don't assume that parents of children with type one can get by with less.

We do everything we can to give our children their best possible childhood, and to avoid, delay or minimize long term effects of the disease. We are also constantly considering the significant and immediate short term dangers of lows on our children's health and survival.

Keeping a child's blood sugar in the target range during the day, when they may have more activities than you might remember, is quite an undertaking. And children get sick. They may have no other symptoms before a cold or flu than high blood sugar. Or lows. And during an illness ~ good luck with that.

One of the important differences between Type One and Type Two diabetes you may be overlooking is the age of most individuals with type one at onset.

Parents risk dangerous lows while children are away from home if they become overly preoccupied with good looking numbers.

Is their blood sugar perfect when they leave to go to dinner with a friend's family, and the friend's parents decide to see the movie *before* dinner? That meal doesn't come soon enough.

Or maybe the kids play a rousing game of basketball before they sit down to eat. Whoops ~ a meal doesn't raise blood sugar soon enough or fast enough.

Negotiating with preteens and adolescents in planning a reasonable approach to good control gives them plenty of room to make choices that might not always be from your playbook.

Children and teens are not trainable pets or prisoners in the home. We keep open lines of communication so that their mistakes, negative choices and misbehavior are not the only forms of expression that make a difference.

Children with diabetes must learn very young that every day is a new day. No matter what they give up or how good their decisions, things will occasionally go wrong because type one diabetes is a monster.

There will be good days and bad days no matter how hard the whole family tries to support the child, no matter how responsible beyond their years the child might be. There's no reason to make them feel like superstars with good averages or amazing A1Cs when next time they will feel like failures because of circumstances beyond their control ~ or a period when their own self control failed them.

I also believe that you have very little understanding of the differences between type one and type two diabetes ~ children are not the 'lucky ones' who do not have to "suffer through" the effects of overindulgence because they MUST have multiple injections of insulin every day.

You mention

Parents do know all about stunning results that occur even with the best intentions we operate from for our children. Until you have found a child semi-conscious, having seizures, or completely knocked out, you will not understand how stunning an unexpected low can be.

Balancing the effects of daily activities, sports, play, running in from recess, insulin, meals, snacks and other issues that can change a child's blood sugar significantly means that sometimes we let blood sugars run higher during the day to avoid dangerous or fatal lows.

If your beloved child had demonstrated that his blood sugar could fall 100 points in half an hour, would you want to make his target blood sugar reading 100, or 150, or 180? Believe me, it would not be 100.

Have you practiced using an emergency glucagon kit? It's much different when your child is having an emergency that requires using one.

Keep on doing what is best for you to be healthy and stay as healthy as you can be with type two diabetes.

But read up a little bit more on type one before you start lecturing parents who rely on rocket science and more while we are waiting for ~ and working for ~ a cure.


Posted by Barbarah on 22 February 2008

I am not a type I diabetic but follow a lot of the ideas in this article for healthier control of my type II.
While in Italy recently,I ate so many things I do not normally eat but I walked everywhere and checked my blood sugar often and found it good!!

Posted by Anonymous on 24 February 2008

I agree wholeheartedly with PW's reply on Feb 22!!

My daughter has been type 1 for 3 years now, no glucagon emergencies, most recent a1c of 6.7 (started puberty recently, too - she has been as low as 5.9!), loves pizza, lasagna, breads, pasta, fruit, and is very athletic/active. She is on a pump which has helped with the swings, but I still have to figure how much and for how long to reduce the basal rate after 2 basketball games back to back in 1 evening so she doesn't drop to the 40's! Or figure out how many carbs she needs before each game so her BG doesn't drop while she's in the game!!

When someone can tell me what will work each and every time for her to keep her numbers in ange, and prove that it works, then maybe I will consider going completely low carb. But until then, I will let her eat what she wants in a balanced diet, increasing carbs as needed for activity, decreasing for couch potato/lazy days, AND LET HER BE AS NORMAL AS POSSIBLE, because childhood only comes around once, it goes by too fast, and I want her to have as few regrets as possible when she looks back, 20, 30, 50 years from now, God willing!!

Don't judge us type 1 parents until you have walked at least 100 miles in our shoes and dealt with everything we do on a daily basis for our children to live healthy, happy and somewhat normal lives.

Having said that, I'm off to try to get at least 6 hrs solid sleep, having already checked the BG at midnight - 148 after an intense basketball game at noon, candy immediately following, then fruit, veggies, fried chicken, pasta for dinner; cake, ice cream, and more fruit and a juice box later! And that's with a temp basal of -30% for 4 hours (started 2 hrs post game) then 60's & 70's around dinner, thank you very much!!

Good luck to all of us type 1 parents! WE ROCK!


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