Tuesday, June 24, 2014

Why I do nighttime checks.

In some circles, it’s a stigma attached to parenting a child with diabetes.  If one admits to doing nighttime checks, one is fear mongering, and working from a state of unreason. 

And in some circumstances I've seen it serve as a dividing line between parents in the online community.  Today I would like to set differences aside and outline why I often find myself doing the nighttime check. 

(Other than the fact that I have three boys with Type 1, which gives me triple the reason to get up.  Obviously.)

ONE:  The A1C.  Nighttime is half of my boys’ lives.  It is much easier to control their blood sugar at night when they are still and not eating, than it is during the day when they eat, run, feel, and generally rule the world.  Is it easy to keep numbers in check at night?  Not necessarily…when they are growing, or when they swam hours before, or after a big dinner at a Chinese buffet, but it is a hell of a lot easier than during the day.  If I can keep them in range during the night, that is half the battle won.  My boys have A1Cs that are way better than they should be.  The reason they are that way is because for half their life, I’m in control.

TWO:  Waking up with a good number changes everything.  It catapults the succession of numbers for the rest of the day.  If they wake up high, it generally takes until lunch to sort things out, and then guess what?  They eat and we start over playing catch-up.  If they wake up low, they EAT, and often under-bolus and everything goes wonky.  That’s on me, I know. But it’s hard to negotiate just what they need and when they need it.  I’m not magic.  In another vein, I’ve had to learn to let go on nights I really need sleep.  Putting my needs above my boys has been a hard pill to swallow, but in some cases, necessary.

THREE:  Unpredictability.  I can count on one hand how many times I have done the nighttime check and have not given insulin or food.   An argument can be made that if blood sugars are always off, and you always have to do nighttime checks…then something is wrong with the basal insulin amounts.  That is a very true statement.  But only applicable when things are routine.  I’ve learned the hard way that our family falls into routine only about 50% of the year.  The other 50% there are extenuating circumstances.  Like Pizza.  Sleep overs.  Field day.  Illness.  (Some colds last for weeks.  They change everything.) Growth spurts.  Getting back from scouts and realizing the boys didn’t bolus for the treat given there…or sometimes, over-bolusing for the treats given there.  Sometimes they spend the evening at grandmas house, and they do their best at carb counting but they don’t know all the extra math I do in my brain to come up with the numbers I do.  Being at a friends and having Nerf Gun fights that put them in a spiral of lows.  A kinked set.  Bad insulin.  Life isn’t static.  Neither are the circumstance contributing to nighttime numbers.

FOUR:  Your diabetes may very.  There have been many many nights when one or two of my boys just don’t need to be checked.  I admit, I’m unique in my circumstance so comparing you and me is like comparing apples to oranges in some respects…but…you can bet your bahookie that if I’m up checking one, I’m going to check them all.  In the past 15 years working with diabetes there have been too many times I’ve been up to check one, courteously checked another, and found a low or a high that was completely out of left field.  

FIVE:  Insulin pumps fail.  This may be the fearmonger in me…but if my boy goes to bed in the 300’s…I need to know he is going down before I lay my head down for the night.  I need to make sure that pump set is working, because we all know what happens when someone doesn’t get insulin for 8 hours.  It isn’t pretty, and yes, it can be dangerous.  It’s not why I check.  But sometimes it is a contributing factor in my decision-making.  I need to know my child is getting insulin before I let things go.

Now here is my disclaimer:  Nighttime checks for me usually entail a check between 11 and midnight.  The 2am check is reserved for special circumstances which, as stated above, do happen frequently.  I gauge each night, and the events leading up to it and decide what is appropriate for my children in that moment.

***What is appropriate for MY CHILDREN in that moment.***

I understand some children don’t need nighttime checks.  I understand some absolutely do.  I also understand that adults with diabetes don't have all the contributing blood sugar factors that children with diabetes do when it comes to the nighttime.  I’ve been able to see a real-life example of Your Diabetes May Vary just by living with my three boys.  I can’t do for one what I do for the other.  J’s diabetes is a completely different animal than B’s diabetes.  B’s is far and away different than L’s.  That is why blanket comments like, “You don’t need to do nighttime checks,” or “You must do nighttime checks or you are a neglectful parent,” hurt my heart.

Isn’t it ok for us all to do what we feel we need to do? 

We each need to take stock of our own psychological impulses and decide if what we are doing is necessary or unhealthy.  After Ryan passed, I had an unhealthy impulse to check the boys multiple times during the night whether they needed it or not.  I was terrified of losing another love in my life.  Those were demons I had to conquer, and for the most part, I’m proud to say I have.

I have bad nights now and then, but I almost always get enough sleep to live a happy, full life.  If nighttime checks are affecting your life in a negative way, than a heart to heart with your endo is needed, absolutely. 

The bottom line is do what is right for you. 

Please don’t construe my words as judging or lecturing in anyway.  I just thought it was time to lay it all out on the table in hopes that I will be afforded an extra measure of understanding, as I try to extend that same understanding to you.  
I have slept through too many alarms to count and yes, my children were alive in the morning.  But that feeling in my throat as lean against a bedroom door jam, waiting for their chests to rise and fall in the morning is a terrible feeling.

I know you know that feeling.

It isn’t catapulted by fear as much as it is love.

We aren’t so different, no matter what our beliefs or circumstances.  We all love our kids.  And that’s all that matters.


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