Why the midnight glucose check must happen

Bobby and I trade off the late night blood sugar check. And by “late night,” I mean typically between midnight and 2 a.m., after any insulin from dinner and dessert has been absorbed. From the time he first boluses (gives himself an insulin dose to offset the carbs), about two hours need to pass to insure the dose is no longer active; he is also on a maintenance level at all times to keep his overall blood sugar under control. Or rather, I should say maintenance levels. How much insulin his pump provides varies during the day based on the ebb and flow of his body’s response to it. The doctors examine his recent blood sugar history and adjust accordingly. He might need less in the morning and more in the evening, and always a little less at night because the risk of hypoglycemia (low blood sugar) while sleeping threatens more immediately than the hyper (high) version.

Hypoglycemia can quickly lead to seizure, coma, death.

Hyperglycemia can, if untreated, lead into diabetic ketoacidosis. This takes a week or so and is typically what happens when you don’t know why your kid is so lethargic and losing weight and having to pee all the time and it’s troubling, but doesn’t seem that serious until suddenly it’s life-threatening and you find yourself on a Cal-Ore ambulance plane on your way to UCSF Medical Center so they can save your kid’s life. Recurring high blood sugars can lead to long-term complications including kidney damage, blindness, cardiovascular disease, nerve damage and skin problems.

In any case, the middle-of-the-night check helps ensure Nick doesn’t slip into a seizure or sleep through a severe high blood sugar without correction. Sometimes I stay up to check, sometimes Bobby does, sometimes I set an alarm. Very rarely, we both fall asleep and I wake up later, panicked, leaping out of bed to check. That’s what happened last night. Fell asleep reading a book, woke up at 4:15 a.m., bolted upstairs to discover his blood sugar running at 390 – quite high. I pressed the button on his pump that figures out how much insulin. Pressed it again to deliver the insulin. Now waiting to make sure his blood sugar has come down.

Complicating matters: The Dawn Phenomenon. (Good name for a band.) It’s a wee-hours abnormal spike in blood sugar caused by the body’s natural overnight release of hormones. “Abnormal”/”natural” – sounds like an oxymoron, doesn’t it? I’m worried the dawn factor will wear off as the insulin’s kicking in, causing him to go low.

Most all the time, we’re able to truck about life normally, unimpeded by the diabetes as long as checks are being done, attention is being paid and, if necessary, corrections are taking place. As long as you manage it, the adage goes, you can do anything. Which is true. But the comfort of constant management, the security provided by being “on it,” evaporates with every unexplained high or low, reminds us how we’re at the mercy of an incurable disease, with only imperfect technology and our own flawed selves to keep it in check.

And that’s us. What Nick goes through in his mind, I can only guess. He doesn’t complain.

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One thought on “Why the midnight glucose check must happen”

  1. Jennifer,
    Every time I read one of these posts, I am reminded of how little I knew about having diabetes. When I was a kid, I knew two people with diabetes, and they were like Nick: so stoic and matter-of fact. As a result, I don’t think many of us know what it means to carry this. Your writing on this subject is beautiful. Thank you for sharing it.

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