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Type1Mum

When to train teenagers to do their own night-time checks?

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right2fight

Hey Anna, It's hard to leave them alone at first, but you gotta trust them, after all it's their body and they know what to do. I expect your son does real well, with all his activities and I guess he keeps you going all the time.

 

Margaret

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DeusXM

And yet nighttime hypoglycaemia hardly ever kills anyone with T1. Let's not forget that whilst your body might not be so good at lowering BG, it's got no problems at all at raising it. Even if your son has a hypo in the night and doesn't wake up during it, he'll almost certainly be absolutely fine and wake up the next morning with a sore head and that's about it.

 

If anything, cutting the strings a bit would help all kids start taking better care of themselves. I was lucky in that I was dxed at 14 and I was in a position to point blank tell my parents to back off and let me get on with it. If you're always fretting about your kid and their diabetes, they're never going to take responsibility because they'll always think a parent is going to sail in and do it for them. Give them the responsibility and they'll rise to the occasion.

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type1tenorlady
wanted to chime in here, this recent study would indicate that people with type 1 do not always wake from their lows - in fact most do not.

 

PLoS Medicine - Awakening from Sleep and Hypoglycemia in Type 1 Diabetes Mellitus

 

I think someone mentioned this study in another thread... and the fact that they only tested 16 people. I also agree with Deus; I would be more interested in a study that investigates the percentage of time that we go low and our bodies respond well enough that we don't need to wake up.

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samsmom

I dont think that testing your kids during the night is "fretting" over them. If there is reason to test them in the night, such as high activity day, being off, heavy correction before bed, or whatever, I think that is called being a parent. I would rather test my kid and treat the problem, then have him wake up feeling like crap and going to school like that. I think that by doing this, you can also show them how to take care of lows in the middle of the night. If they dont wake up, they dont wake up, by me not testing, thats not going to change it. By the way, my son is # 8 in the family with type 1 diabetes and my entire family does things this way. The teenagers with diabetes are perfectly fine and adjusted. Some of them wake up with the lows and some dont.

 

Whatever my son needs, he will know that his parents will be there to help him and as he grows he will do more on his own. Just remember that just because people have different views on this does not make either side right or wrong.....

 

Parenting is a hard job, to say the least, but I can tell you that handing over all control to a teenager re diabetes just might burn them out....I will not risk that and I will not ever tell my kid "sorry, your on your own during the night".....if my kid wants more control on his own, we will give it to him but if his actions warrant intervention from his parents, we will intervene.... I sure hope that if you find that your teenager is not waking from his lows (finding our either by a rebound high in the A.M or seizure or feeling like crap every morning) that a parent would intervene..at least I hope a parent would.

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DeusXM

I'm certainly not going to give out parenting advice since I'm not qualified in the slightest to do that. However I think you've either misinterpreted what I was saying. I never said 'abandon them'. By all means, let them know that you're there for them. But there's a difference between being a good supporting foundation and doing it all for them.

 

If there is reason to test them in the night, such as high activity day, being off, heavy correction before bed, or whatever, I think that is called being a parent.

 

And doing those things for yourself is part of having diabetes. If I was doing any of those things, I'd make sure myself that I got up to do a late night test instead of having my mother have to put herself through all the rigmarole. Again, this is purely my perspective as a teen growing up with diabetes, not being a parent, but I think it's essential when you're coming to terms with growing up that you feel in control. Having someone else manage what is ultimately my problem is the opposite of that. The sad fact is that having diabetes means you need to be a heck of a lot more resilient, organised and solemn that everyone else your age. And the most valuable lesson I ever learnt as a teen was learning how to balance the responsibility of having diabetes always hanging over my shoulder with 'fitting in' with everybody else and enjoying life.

 

I would rather test my kid and treat the problem, then have him wake up feeling like crap and going to school like that. I think that by doing this, you can also show them how to take care of lows in the middle of the night.

 

See I'd argue the opposite. If you don't suffer every now and then you don't learn how to prevent it. First time I had a night hypo I didn't wake up from, yeah, I had a splitting headache and felt like crap. Couple of paracetamol later I felt a bit better and got on with my day. Guess how many times since then I've failed to make sure my BG is secure just before going to bed?

 

Of course all this depends on whether your son really is mentally mature enough yet to be able to think like that. If you think he isn't, then fine. But even if he isn't, I think you'd be amazed at how quick he'd grow up if he had to. Knowing what I was like as a teen as well, I wouldn't expect him to 'ask' to be given more control. It's a bit like doing the washing; it's something I needed to learn how to do in order to cope but I'd never ask my parents if I could do it as long as I thought I could palm off all the responsibility on them.

 

Obviously you know your son better than me, but I still think if you give him a chance to shine, he'll amaze you more than you could imagine, and that's got to be a great achievement as a parent.

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Erin

When I was a kid I remember running late night checks every so often after an insulin change... I think before High School Mom and Dad alternated nights checking me, and when I was in High School we did a 3 day rotation, with me getting up one night out of three. This way each of us only had to wake up 4 or so times, and my blood sugar got checked every night.

 

I think that was a great way to ease me into dealing with it all on my own... I was taking partial responsibility, and it really felt like my parents helping me with a bothersome chore, rather than them doing something because I couldn't.

 

If I thought there would be a problem on a given night, I'd just set an alarm, or ask dad to check my level first thing in the morning (he got up ridiculously early back then... close to 4 am).

 

I guess what I am suggesting is start turning your son's diabetes management into a team sport, with your son in the lead position, and you as support. (and you should really be warming the bench most of the time)

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HollyB

That sounds like a really great way to do things Erin. It's always a difficult balance between giving enough independence or loading on too much; I really like the way this solution reinforces a teen's own competence while remaining there as a support.

 

Though that said, I still think Aaron would sleep through most alarms at certain points in his sleep cycle, and I plan to enlist his roommate in his upcoming school trip to Boston to pummel him with pillows till he wakes up if he has to set his alarm for a night check and sleeps through it.

 

Deus, maybe I'm just a softie mom here but I'm not sure that just because you did and could manage things on your own as a teen it's necessarily best to make kids handle everything. Yes, of course they will have to eventually. They'll also have to cook for themselves, drive a car, travel on their own, manage their own sex lives and money, etc. Doesn't mean they have to do all of it by 12 or 16.

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Erin

Though that said, I still think Aaron would sleep through most alarms at certain points in his sleep cycle, and I plan to enlist his roommate in his upcoming school trip to Boston to pummel him with pillows till he wakes up if he has to set his alarm for a night check and sleeps through it.

.

 

 

I don't think you'll have a problem getting a teenage boy to wake Aaron up... as Aaron's alarm will be annoying the %$ out of the roommate at the time.

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blue_eyed_devil

well i was 10 when i was diagnosed and i pretty much did it all. mum and dad were there, and i'm sure they were watching me, but they always maintained my indipendance.

 

i remember i was high once on a camp at like 3am in the morning and the teachers called my parents in a panic. my parents simply said to the teachers, 'what does lauren want to do? she's the one with diabetes, not us'. when they got back to my room i had corrected and gone back to sleep. they woke me up and i was unimpressed.

 

i feel that diabetics need to look after themselves from an age basically when they are able too. if you don't let them look after themselves, who will?

 

that's my little bit, but i'm not a parent, so can't really comment - only talk about my experience... :)

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spring

I was diagnosed when I turned 11, and I don't think my parents ever tested me while I slept, and only ever woke me to test when I was sick. I recall being rather disgruntled by the diabetes camp policy of waking everyone each night. ;)

 

That said, I wake fairly easily to alarms, and if I had been exercising in the evening or something of the sort, Mum would ask if I'd remembered to set my alarm.

 

I did have three fun episodes of not waking up when low overnight. It was actually pretty incapacitating and meant no school for the following day. I suppose everyone's brain reacts differently to a deprivation of glucose. Lucky me experiences temporary aphasia, and not only can't speak properly but also can't write, interpret what I read or remember how to use my glucometer. XP It never needed treating by that point when that happend; all three times it was 5-7mmol/l thanks to good 'ol liver, and after all mental functioning returned two or three hours later, the puking would begin. :vollkomme: though I guess I can't complain since they didn't involve seizure or the like.

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right2fight

Hi Spring, Thanks so much for your response to this thread. I am sorry to hear of the aphasia episodes but very curious as to how many children with diabetes may experience this sort of thing.

 

My son is 13 and was diagnosed at 7. We never woke him to test unless we had reason to, ie... illness, blood sugars being consistently off, ketones, etc. Since he was about 11, he too, wakes if he has a low.

 

Like you he too has been using NPH since dx., and it works pretty good for him. We will be looking into Levemir at the next appointment. Have your experiences been better or worse with it and how hard was the insulin change.

 

Sounds to me like you are on top of things and I can't help but think it's probably because you have always been a smart kid or you took on your own diabetic care early on or perhaps, both.

 

Cheers,

Margaret

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spring

Margaret - in regards to the NPH to Levemir switch, I found it wasn't all that difficult. The difference between the two actually wasn't as dramatic as I'd anticipated, especially with all of the NPH-hate out there, but the Levemir is more stable in that the number I go to sleep with is the number I wake up with (be it 4.5 or 12.5 XP), and unless I over-bolus my breakfast, don't need to worry about going low an hour and a half later.

 

I had only been taking one shot of NPH/day upon waking, and actually had fairly good fasting sugars (though they would vary and occaisionally got into the 8-12 range). Upon switching, I started with one shot of levemir in the morning just to see, and found it ran out almost exactly at the 20 hour mark. I then swapped to taking 2/3rd in the morning and 1/3rd at night, and aside from adjustments in the total dose, found that to work well for me. I'm now taking 16 units in the morning and 8 units at night, so 26 total. (I had been taking 28 units of NPH)

 

In terms of my own approach to things as a pre-teen and later teenager, I was always a pretty positive/optimistic kid anyway and never really given to being rebellious, and of course that isn't the case with every teenager.

 

That said, while I was never depressed about it/didn't consider myself to be in denial, I did go through a couple of years at the end of highschool where I adjusted my personal notion of what a good and bad number was (under 5 was low, under 10 was great, 10-15 was middling and 15+ was a legitimate high). The doctors always seemed to be wrong so I stopped bothering to consult them, save for an annual trip to the endocrinologist, and figured I knew all there was to know. I would feel guilty about the highs and lie to my parents if they asked what the number was, as the truth only resulted in more nagging for something that had already happened. I knew another diabetic teen who was skipping her shots to 'lose weight' and experimenting with various drugs, so I felt like I was doing okay in comparison.

 

I still tested 6+ times a day but stopped keeping a record book, over treated lows and put off treating highs for a couple hours, ending up with numbers boardering 20 every other day. It wasn't until the end of first year university that I realized I'd 'let things slide', and that merely testing often, always injecting and never drinking/getting high does not make one a model diabetic.

 

Boy am I long winded tonight. More than you ever wanted to know. :T At any rate, I appreciated my parents giving me responsibility when I was younger as it helped me feel like it wasn't a big deal and at the same time, was something that 'belonged' to me and needed my attention. Likewise, even when I found it annoying if they would confirm that I'd not forgotten an alarm or asked what my sugars were, it was nice to know they took an interest/cared. I think the balance of responsibility and support, as Deus noted, is good.

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right2fight

Spring, please don't get me wrong, I have treated the whole deal as if it were my own, and only wish it were me and not my child. However, after growing up with brother that has severe asthma, I saw the ramifications of my mother over compensating and babying him. Not a pretty picture. And exactly what you said. We have pretty much dealt with the dx as managable and not "death sentence." I for one think attitude has all to do with how well you manage it.

 

You are an inspiration, Spring.

 

Margaret

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type1tenorlady

I was diagnosed at 11 as well, and like others have said it was pretty much my responsibility once I was out of the hospital. I was a very bright child so I guess my family figured I knew better than they did, which in some ways was true. When I started I was only on 2 shots a day (R and NPH), and my mother would always ask if had taken them (which I really annoying, even if I had forgotten) and I was also taught only to test before meals and if I felt low. I never woke up to test unless I woke up low, and that was only to see how low. It occurs to me now that there were probably a lot of times that I woke in the middle of the night with highs (extreme thirst, had to pee a lot, etc) but as I didn't really view highs as immediately life threatening I never thought to test during those times.

 

My biggest issue was the fact that my brother (6 years older, diagnosed a year or two before me), despite having completely abandoned all that the drs told him to do after a few months (including testing, which he still doesn't do), was able to maintain excellent A1C numbers while I stayed in the 9s and 10s for years. I was basically up and down all the time; once I went on humalog/novolog and had a pen with me I was able to correct highs, but I would often put off testing if I felt that I might be because 1.) I just didn't want to have to deal with seeing the numbers or having to hear what someone else would say about it, 2.) I didn't carry around enough pen needles to allow for more than 3 shots when I was away from home so I would wait until the next meal or snack, 3.) I got so used to feeling bad all the time that I eventually took that to be the norm. There were spans of times (2 or 3 months) when I would be in really good control and I would be able to feel a difference, but inevitably something would trigger the rollercoaster and the vicious cycle of highs and lows would begin anew.

 

I have to admit now that if busy or preoccupied I still have a tendency to ignore the signs that something has gone awry until I can't anymore (with lows) or until I remember that there's no need for me to have a raging headache or be completely parched and all I have to do is press a few buttons to make it go away.

 

I never really rebelled so always tested before meals and took my medication, but I really only did the minimum of what was required to keep me on the borderline of good health, and definitely stopped recording everything after a few months. My main motivation for not doing anything really bad was a combination of knowing how crappy it would make me feel if I did (eating junk food, although now I remember almost daily snickers bars/pop tarts during my bio class in 9th grade...) or the fear of not knowing what it would do to me (drinking/drugs). Outside of those things though, I still ended up ignoring a lot of the highs because ignorance is bliss, and if I wasn't constantly seeing 200+ flash on my meter screen then I wouldn't have to think about how I was going to be lectured the next time I went to the dr.

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Type1Mum

Thanks again everyone for all your comments.

 

Jack manages pretty well everything himself and is really on top of his diabetes. I'm not at all concerned about "babying" him. In fact all his teachers can't believe how amazingly well he manages everything. It is just the quantum of sport he does, combined with the fact that he is has really hit puberty and has grown 13.5cm in height since diagnosis last May (5.3inches), that means he does sometimes need night-time testing.

 

I'll be starting the alarm thing with him and hope that the "Pavlov's Dog" principle will eventually be enough to wake him up. At the moment I think the alarm, plus a bit of vigorous shaking will be required.

 

Thanks again - it is nice to hear of all your experiences. My fear when Jack was first diagnosed is that he'd go into a coma if having an overnight low - but your experience has taught me that that would be a very rare occurrence. More likely he'd wake up with a headache after having the liver dump glucose into the bloodstream. Anna (mum of Jack - 12 yo)

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right2fight

Hi Anna, This Forum is awesome. I have learned so much from the members here, who have lived for many years with diabetes. It's a great place to be!

 

Margaret

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ClaireZk
Do you expect your child to test twice a night every night?

 

I was thinking the same thing. And ditto that it seems a bit excessive...

 

Does he have trouble sensing lows? Does he always crash after activity?

 

I was diagnosed as at age 9. I had a very active, normal childhood. I've never done routine night checks. And, in 16+ years I've had some severe lows, but NEVER one that required assistance from anyone.

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