From Jerusalem, Israel:
Our 13 month old daughter was diagnosed with type 1 diabetes two weeks ago, and we have read that it is not a good idea to prick her in bed so that her bed remains "safe." This has the ring of wisdom to it. On the other hand, we test her at least once and often twice at night while she is asleep as she is still highly unstable. She often will sleep through the test if we do it in bed with out moving her too much. We don't know what is better to preserve the bed as "safe" or to minimize the disturbance. Should we take our daughter out of bed to test her glucose levels and/or inject her with insulin?
Personally, I believe if she is undisturbed by nightly checks then they do no harm. She is not tense and anxious and therefore may have a more reliable reading.
Additional comments from Jane Seley, diabetes nurse specialist:I think it would be much more disruptive to take your daughter out of bed in the middle of the night and almost certainly awaken her than to test her in bed. I worked in a camp for children with diabetes last summer, and we tested all of the kids in their beds during the night if needed. Most never remembered that I had tested them at all!
Ask your health care provider for some guidance about meters that can be easily used in the dark and with alternative sites such as the forearm, which is less painful. This might make it easier for you to test her sugar without awakening her during sleep.
Additional comments from Dr. David Schwartz:Yes, there is a certain comfort that being in bed is "safe haven", but I think that really only matters if the other blood glucose sticks are horrendous experiences for her. They need not be what with the availability of meters whereby you can get blood from the forearm, thigh, heel of the hand and other "alternative" sites other than fingertips. Those meters tend to require the smallest amount of blood so that the poke can be virtually painless.
In addition, you have to do what you have to do anyway. There will be times that you are directed to check her glucose at nighttime. Better for her to sleep through than awaken her and make a "big deal." Some nights, she may be ill for other reasons (flu, vomiting, etc.) and bed won't be "safe" anyway.
Additional comments from Dr. Donough O'Brien:The idea that 'bed is safe' has been quite widely expressed recently, but neither I nor our very experienced Medical Social Worker really agree with this theme. What seems to be important is to make it clear to the child that both you and your wife feel that whatever you are doing is fine.
An alternative on which there are mixed opinions would be to see if you get a meter that employs alternate site testing (AST) in Israel.These devices are essentially painless though they do involve some local pressure on the arm.
Additional comments from Dr. Tessa Lebinger:There is no perfect answer to your question. Although it is nice to keep your child's bed a "safe" place, it may be more disrupting to her and the family to take her out of bed to test. If she doesn't usually wake up, you are probably better to just test her during sleep. She is so young, she may think this is just "normal routine". If she gets upset, especially as she gets older, you can change the routine.
When the children are old enough to understand, I recommend that the parents ask the children if it is okay to test them while they are sleeping. This way if the child wakes up and gets upset, the parents can honestly say that they had the child's permission to test them in bed while they are sleeping. Most older children prefer to be tested in bed while they are asleep.
Although your daughter may not understand yet, it couldn't hurt to start telling her every time you test her blood while she is awake that you are testing her blood because you love her and you don't want her to get sick. You can even kiss the finger after you are through. When she goes to bed at night, you can tell her that you are going to test her blood during the night while she is sleeping because you love her and you don't want her to get sick. You can even kiss her finger after you are through during the night--even if she is asleep. Eventually, she will understand and she will hopefully associate the blood sugar testing with hearing how much you love her and getting a kiss.
Hopefully soon the GlucoWatch will be available and affordable for young children. This is a wrist watch that takes the blood sugar every 10 minutes automatically and you can set an alarm to go off to warn you if the blood sugar is low. It is now available to purchase, but is still very new and I do not believe it has been tested on very young children. I would still be concerned that it might not be reliable on very young children as it may be too big for their small wrists or they may sweat too much. Hopefully soon, we will have more information and it will be an option.
Additional comments from Dr. John Schulga:I don't think there are any hard and fast rules about whether to test when a child is asleep. A lot of parents will do this especially if a child is very young. I think if it is not causing any problems, then ensuring your child is safe is the main priority.
However, it would be worth knowing what the reasons are for your child being so unstable. It is not unusual for a very young child to have quite variable readings for good reasons, but it is worthwhile ensuring that there are certain parameters you are trying to work within. It is worth discussing this with your diabetes team.
Additional comments from Dr. Stuart Brink:You should discuss this with your diabetes team because the real answer depends upon how much information you need to get overnight. The more difficult to control the blood glucose levels, the more erratic the insulin effect on a day to day basis, the more you will want such information. Fortunately, while there are many times when you will need this information, most youngsters sleep quite soundly through night time testing so we have not found this to be a major problem.
Original posting 1 Oct 2002
Posted to Blood Tests and Insulin Injections
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