Hi,

As I said in my intro, my son (10) was diagnosed w/type 1 in May of 04.

I worry about him CONSTANTLY. How often are parents checking their t1 children? I check Stuart quite frequently...but my issue is night checks. I realize the diabetes and it's craziness doesn't go to bed at night w/my son. He is on Lantus, and has been much more stable on it, but I still check him at 11/11:30, 2:30, 5:00/5:30, then at around 8 when I wake up.

I worry about him so much when he is asleep; I have heard stories of children going low in thier sleep and not waking up.

Will he wake if he goes low?

Is it true that quite a number of children do not wake up in the night when they go low and die?

Adults living w/type 1- do you wake up and check in the night? Do you awaken when you go low?

It's getting towhere I really have a hard time sleeping since his dx. The fear is overwhelming. Is is justified? HELP!!

Joopy,

I understand your concern. But I really think you are getting worked up for no good reason. In the 28 years I have been T1, I have had my fair share of night-time lows. But I always wake up in time to treat them unassisted. My wife is happy to help. But she normally sleeps through it all.

It is really no big deal. I have never heard of someone going low, not waking up and dying. The body has a safety mechanism that stops this from happening. It works very well. Briefly, this is how :

When you eat carbohydrate, it quickly gets converted in to glucose in the bloodstream. The first thing your body does with it is to replenish glycogen reserves. Glycogen is essentially glucose which is stored in your liver and muscles. Your body makes sure that a topped-up supply is always readily available. And if there is a sudden need for energy, it can be used very quickly.

When your body senses that the blood sugar level is dropping too low, the alpha cells in the pancreas secrete the glucagon hormone. Glucagon causes stored glycogen to be released into the blood stream. And the blood sugar level goes up.

So if a low blood sugar is not treated because your son is asleep, what I have described above will happen. He will most likely wake up in the process. But even if he doesn't, he will be OK. So you don't need to worry.

Having said that, if your son is having lots of night-time hypos, maybe there is something you can do to stop them. Like giving him a snack before going to bed. Or injecting his Lantus in the morning rather than in the evening. Discuss it with the doctor and try a few variations on the theme. You will never get rid of hypos at night altogether. But they should be an exception to the rule.

Hope this helps,

Mark ;)

Hi Mark.

Great reply. :) That's what I've heard also and read on various places I've visited, however if someone hypos a lot, apparantly it takes over 24 hours to replenish that store of glucose, so that's why some deaths occur during the night when you drop low but have no stored glucose. I know of someone (T1) who died this way, though it's extremely uncommon. Her diabetes was extremely out of control, and she experienced so many severe unconcious hypos.

Thank You, that does help. He does not have a lot of night time lows actually. We have what I think is pretty good control, esp since we just had our one yr anniversary of diagnosis. His care is my full time job right now...and funny thing is this morning at 6 something he came in my room and said, "Mama, I checked myself and I'm 110" nevermind the fact he scared the beejeebers out of me, I said 'good, you're fine now GO BACK TO BED!!" LOL

Joopy--

Mark has it just about right, and the "safety mechanism" he describes almost always keeps us T1 diabetics alive and ticking in spite of the occasional sacry low blood sugar episode. That said--there IS a situation in which this safety mechanism, also known as the "Gluconeogenesis counter-regulatory response" will not function. That happens when a preson has habitually low glucose levels. If one stays below 80 (US, not sure of UK equiv...) all the time, then the body never has sufficient glucose reserves to recharge the liver's store, and even severe hypoglycemia will not trigger release of extra glucose--you can't get water from an empty canteen, in other words... However, that's really the only situation under which the life-saving response built into the body would not function.

The issue you mention about dying in bed before awakening due to low blood sugar is called the "Dead-in-Bed" syndrome, and IS something which has some anecdotal and scientific basis. "Quite a number" of deaths would be an exaggeration, but I would admit that it can and does happen. However, I would guess that it would only be likely to occur in children who's parents (or they themselves) drive them to unrealistic and dangerously low glucose levels all the time, in the mistaken idea that the lower the better over the long haul to prevent complications in adulthood.

Let me give a bit of a reality check. My doctor in my teens was Dr. Joslin himself, of the world-famous Joslin Clinic in Boston. I began going to him at the age of 16, so that would have been around 1968. At the time, we had no such things as a1c tests or home glucose monitors. We used to get our sugars checked two to three times A YEAR. Dr. Joslin wanted us to have decent sugars the rest of the time too, and without tests and monitors, here's how he said to achieve that goal. I'd complained to him about having low blood sugars (we used to call it "insulin shock") too much, and he told me, "Boy, you've GOT to FEEL that insulin working, you should feel it every day! How else are you going to know it's working unless you can feel it?!" Yes that's right--one of the most famous and pioneering doctors in the treatment of childhood diabtes told me in 1968 that going low was not a bad thing, but more a GOOD thing!

Of course, today, we have a different feedback mechanism for knowing the insulin is working--we can test and get immediate results many times a day. But my point is this--we never tested. We went low--we never knew how low--all the time, and only knew it by feeling it. We went about our business, and hoped for the best. Many of us grew up and lived healthy happy productive lives. Yes, i've had some pretty scary late-night and early-morning hypos throughout my lifetime. I've spent time with unpredictable control off and on over the years. I'm much better today because of the tools and insulins we have now. I won't say that I've never been in danger in all those 40 years--I've been a bit past the point of safety on dozens of occasions, both as a child and an adult. I've wandered about at night in a stupor and not been aware of anything, only to find unexplained cuts and bruises on my body the following morning. I've woken at 3 am soaked in sweat, shivering on the kitchen floor surrounded by cookie and candy wrappers... I've passed out at work, and once while driving my car... I even, at one point, had several episodes of not waking up until I came to surrounded by EMT medics, after my wife (and once my daughter) called 911. One time, I woke up in the emergency room... BUT (don't get scared...), this was all a long time ago, before testing 8 times a day, and the steady release of Lantus insulin, which I have found prevents almost all of my serious lows now. Sure--sometimes I'll calculate a bit wrong on carbs and go low after a meal. Sometimes I'll bolus a bit too soon, only to find dinner is delayed, and get the sweats and shakes.

Don't over protect your son. Do worry, but don't fret. Care for him, but don't drive him and yourself crazy. Don't attempt to keep his sugar levels unrealistically low--a kid will bounce up and down, nothing wrong with that. Especially as he grows, his body will be throwing you constant curves. This will never be science, but more like black magic. As long as your son's liver stays charged with glucose, his lows will self-regulate. He will always get both lows and highs. Aim for a reasonable middle ground, and be happy if you can approximate that most of the time--that's about as good as it'll ever get--and, after 40 years, I guess I'd be the one to tell you that might just be "Good Enough."

Michael