Jo Ann Ahern's Response
First let me say that testing at a parents bedtime (11-12 PM) is normal. Most parents do this. I do not consider this testing at night. I'm talking about multiple tests throughout the night leading to sleep deprivation in these parents. Children need parents who are well rested during the day as well. I'm also not talking about testing at night when there is a reason to do so. If a child was more active during the day or isn't feeling well or didn't eat the same as usual or if they were corrected at bedtime. These are all reasons to check during the night (12-5 AM). I'm sure that 30% of our patients' parents check every night depending on what you consider night. I'm also sure that your other statistics apply to our patients as well. There are usually reasons to check during the night occasionally (adjusting basal rates or insulin doses for morning highs or lows). I simply want the kids to live as normal a life as possible. How can they sleep at their friends houses if they need to be tested all night? How can they attend camp where someone is not going to test them all night? Most of our patients are treated with the insulin pump (550 out of 950) patients. With this method we have very few severe hypos any more.
I do actually live with diabetes most of my life. I take care of children with diabetes all day (10 hours/day) for the past 25 years including 24 hour call, and my husband of 32 years also has type 1 diabetes (he does not check during the night unless he is low). He has had some severe hypoglycemia. Some parents do become obsessed with testing glucose levels. We have some that do 16 glucose tests/day. I don't believe that this engenders a normal life for the child or the parent. Of course parents all have a choice and must do whatever they are comfortable with but they should not make parents who don't test at night feel guilty either. They are both choices that parents can and do make. I have not seen a difference in hypoglycemia in the parents that test during the night and the ones that don't. I also have not seen a difference in HbA1c values of those that check at night and those who do not. I have also had many parents crying that other parents made them feel terrible about their choice not to test.
In the end it is a choice that parents make. We do not recommend routine testing at night for our patients but certainly if there is any doubt, they should check.
I have also answered several e-mails that I received directly. Obviously, all parents feel that they are doing the right thing or they wouldn't be doing it.
Jo Ann Ahern, APRN, MSN, CDE
Coordinator of the Yale Program for Children with Diabetes
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