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From Sudbury, Ontario, Canada:

Our daughter has started kindergarten this year and no longer has an afternoon nap.This has brought her pre-supper number closer to her target range. However, both my wife and I work late, and it is difficult to get supper going and over with soon enough to get her to bed early and still get an accurate bedtime reading.The mornings are a trial because she is tired. What can we do to get her to bed early and still have some control over her morning numbers?


Most of our young patients with this type of schedule do fine with an extra snack around 5:00 pm, a later dinner nearer to 6:30-7:30 pm, and then no bedtime snack needed at all. Many in Europe eat this way quite nicely. You should be able to work this out with your daughter's diabetes team.

Take your best guess about how to adjust the insulin and then do a lot of blood glucose readings to fine-tune your results. With sufficient fat content in the dinner meal, this should get her through the night quite nicely.

It may also depend upon which basal insulin program you are using: Lantus vs overlapping NPH doses, etc. If the food from dinner is not lasting long enough through the night, then a desert of ice cream (high fat) also works quite nicely many times as well. Most importantly, go back and discuss with your daughter's diabetes team so that they can provide specific information looking at the blood glucose readings with you, problem solving together and having the benefit of actual insulin dose details.


Additional comments from Dr. Donough O'Brien:

I think that you are going to have to make a compromise here between blood sugar monitoring needs and sleep requirements. As to the former, perhaps you should talk to your daughter's doctor about switching her insulin, if you have not done so already, to the long-acting Lantus at bedtime with Humalog right after meals, adjusting the dose for the pre-meal blood sugar and the number of 'carbs' actually consumed. If giving insulin or measuring blood sugar is a problem at kindergarten, you could cover the middle of the day with NPH with the morning Humalog. You could also slowly dispense with the bedtime snack. This way you should get more control over all blood sugars and get her to bed earlier. If the evening Lantus delayed bedtime you could give that in the morning though it still needs a separate injection. Finally, you could use one of the essentially painless blood sugar monitoring devices [ED: See Alternate Site Testing] so that you could do a blood sugar after she has gone to sleep without waking her up.


Original posting 25 Oct 2003
Posted to Daily Care


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