“Once upon a midnight dreary, while I pondered weak and weary ….”

mother and son sleepingSometimes I feel like Edgar Allan Poe knows my soul, as I stumble out of bed to check Hannah’s blood sugar in the middle of the night.

There’s been a progression of the necessity for these midnight checks.  When she was first diagnosed, this whole world of diabetes was brand new to us and our lack of knowledge meant we just did what we were told.  Night after night, I crept into her room, hoping she was still breathing, relieved every single night I could wake her and check her blood sugar.  I’d jump out of bed if the baby monitor picked up the slightest rustle.

Then we started to see patterns in her numbers.  Low at bedtime?  Give her a snack!  Remember the carb counting plan, i.e. 15-30 carbs for a snack?  We got around that with CarbSmart ice cream mixed with peanut butter.  And although our Certified Diabetes Educator gave us permission to forego the midnight checks, we still had that fear of “what if….?”  It only takes one story of a child who had a seizure in the middle of the night to have that nightmare implanted in your brain.

After a while, I felt fortunate that we didn’t have to check Hannah at all in the wee hours…. and then technology reeled us right back in.  New pump?  Gotta check every few hours!  New sensor?  Have to calibrate!  I don’t know about your kiddo, but Hannah  is impossible to wake up once REM sleep sets in.  Our middle of the night checks take at least 30 minutes.  Sometimes more when I end up falling asleep in her bed.

What do you do when you have a sitter, or a grandparent, caring for your child through the night?  Do you every feel like you’re imposing on them?  Or like you’re being thought of as overprotective?  The month before we entered the world of T1D, my motherly instincts were screaming, “Something’s not right with your girl!”  Thankfully, I listened to them, and you should, too.  If your gut is telling you that you – or a caregiver – should wake up your child and check them at 3am, because it’s in the best interests of your child, then do it.  (Now, there IS a time to let loose the reins a little, but that’s another topic…..)  There are some things you can do to make things easier for your babysitter:

  • Have an alarm clock set to the designated time.  I’ve found it helpful to have everything ready ahead of time – meter, treatments, snacks.  No sense in running up and down the stairs at 3am.
  • If the caregiver is going to be drawing the blood – as opposed to waking the child – let them know the best place to poke and make sure they practice ahead of time.  The middle of the night is not the best time to figure this out.
  • Talk with your child about the process.  “When Maggie wakes you up in the middle of the night, please help her check your blood sugar.”  Sometimes just planting that thought makes things go smoother.

I meet parents all the time who check their child’s blood sugar nightly after years of being diagnosed with type 1 diabetes.  My heart goes out to you, because I completely understand why you have to do this.  Here are some ideas that may be new for you, or just different:

Snacks help prevent low blood sugar levels and provide energy between meals. Typical snacks contain 15 to 30 grams of carbohydrate. Below are some low-fat snack ideas to try.

Snacks containing 15 grams of carbohydrate:
1 medium apple or orange
18 small pretzel twists
2 popcorn cakes
1/2 small bagel with fat-free cream cheese
3 cups air popped or low-fat microwave popcorn
8 oz. or 1 carton light yogurt
4 to 5 vanilla wafers
5 to 6 saltine crackers
1 1/2 graham crackers
1/2 cup low-fat ice cream
2 Tbsp raisins
1/2 cup unsweetened applesauce
1/2 cup sugar-free pudding
1 fruit roll-up
1 fruit juice bar

Snacks with 30 grams of carbohydrate:
1 small bagel with fat-free cream cheese
1 oz baked tortilla chips with 1/4 cup salsa
1 low-fat granola bar
1 large banana or 2 pieces of fruit
4 oz individual fruit cup and 1 cup skim milk
1 cup Cheerios with 1/2 cup skim milk
1/4 cup dried fruit
2 caramel corn cakes
1 cereal bar
15 baked potato chips
14 animal crackers and 1/2 cup skim milk
2 fig cookies and 1 cup skim milk

  • Encourage your child to eat fresh fruit rather than juice as a routine snack (unless blood sugar is low).
  • Add sugar-free flavorings (such as sugar-free cocoa or milk flavorings) to milk, if needed.
  • If your child is still hungry after the snack, offer water, popsicles made with diet pop or Kool-Aid, or carrot sticks or celery in a dish with cold water and ice cubes.
  • If low blood sugars happen repeatedly at the same time of day, or if your child exercises for a long time, a snack may help prevent low blood sugar.
  • Bedtime snacks are important for blood sugar control for children with type 1 diabetes. A snack that includes carbohydrate and protein helps to keep up your child’s blood sugar level through the night. A typical bedtime snack should include 15 grams of carbohydrate and 7 to 8 grams of protein. This amount can change based on your child’s age, blood sugar levels, and activity throughout the day.
  • Children who have had an active day should have a bedtime snack no matter what their blood sugar level.

Examples of foods containing 15 grams of carbohydrate and 7 to 8 grams of protein include:
1 slice of bread plus 2 Tbsp peanut butter
1 6-inch tortilla plus 1/4 cup grated cheese
6 saltine crackers plus 1 string cheese
3 cups popcorn plus 1 oz of meat or 1 egg
12 small pretzels plus 2 Tbsp sunflower seeds
3/4 to 1 cup cereal plus 1/4 cup peanuts
5 vanilla wafers plus 1 cup milk*
8 oz of no-sugar-added yogurt*.
*Yogurt and milk provide about 15 grams of carbohydrate as well as protein.

It is good to choose a solid food at bedtime. Solid foods will churn around in the stomach before passing to the intestine where most food is absorbed. Milk or yogurt alone might pass quickly through the stomach, but milk and cereal or yogurt and crackers might pass through more slowly. Adjust carbohydrate amounts based on what the blood sugar is at bedtime. Here are some guidelines to follow:

At bedtime, if your child’s blood sugar is:

  • 150-200 mg/dl (8.3-11.1mmol/L): Give your child 15 to 20 grams of carbohydrate and 7 to 8 grams of protein.
  • 100-150 mg/dl (5.5-8.3 mmol/L): Give your child 25 to 30 grams of carbohydrate and 7 to 8 grams of protein.
  • 100 mg/dl (5.5 mmol/L): Give your child 30 to 45 grams of carbohydrate and 7 to 8 grams of protein.