A Good Night’s Sleep With Diabetes

Parents of newly-diagnosed children with diabetes have something in common – they don’t sleep soundly through the night. Anxiety soars in the darkness. When our son Danny was diagnosed at age seven, my husband Brian and I barely closed our eyes, and we set our alarm to check on him at least once every night.

And no wonder! There were nights when we found Danny sound asleep with blood sugar numbers as low as 40 or as high as 500.

No matter how carefully we monitored Danny’s food and calculated his doses, we couldn’t seem to control the outcome. Frequently Danny awoke achy, tearful, and exhausted from his nighttime highs and lows. Our doctor and diabetes nurse educator tried many insulin adjustments, but nothing kept him consistently in range.

After eighteen months of this, Danny’s A1c (three-month blood sugar average) was 7.8%. Our medical team was pleased, but we had lived through his huge swings and were the worse for wear. We all needed a good night’s sleep.

Searching for a solution, I looked at the bread, pasta, and potatoes that Danny sometimes ate for dinner and the crackers and cheese or big bowls of fruit that made up his bedtime snack. I realized that if we could limit his evening carbohydrates, he would need almost no short-acting insulin at bedtime. His dose of long-acting insulin-and later his pump’s basal rate of Novolog-would carry him steadily through the night.

One evening at dinner, I explained my idea to Danny. “The goal is to have good blood sugars while you sleep so that your body can rest and regenerate. We want to see whether your nighttime blood sugars become more stable if you cut down on carbohydrates at dinner and before bed.” I saw alarm on Danny’s face. “Don’t worry. You’ll still have carbs at breakfast, lunch, and three snacks. And Dad and I will still eat the same food that you do for dinner.”

Braced for a heated protest, I was taken aback by Danny’s calm reply. “Okay, I’ll go as low carb as I can.” His only request was that he still be allowed ketchup and salad dressing. To my surprise, his sister Jessica said that she’d participate too. Suddenly I was feeling hopeful again. As with any chronic disease, you have to keep generating renewed enthusiasm; otherwise, you settle into ruts without noticing how lax you’ve become. Now at least we had a plan and, remarkably, no one was complaining.

I began by cooking lower-carbohydrate dinners such as chicken, vegetables, and salad, or vegetable soup, steak tips, and broccoli. For bedtime snack, if Danny’s number was in range, he ate string cheese, almonds, or peanut butter and celery. If he were running on the low side, we would add strawberries or blueberries with whipped cream.

The results were stunning. Danny was going to bed most nights at a steady 120 mg/dl and waking up at a slightly lower number. Although we still couldn’t stop all his swings during the day, he was stable for eight or nine hours at night. His two-week blood sugar average dropped from 180 to 140. And after three months of the lower carb evenings, his A1c dropped from 7.8 to 6.8%.

Our new plan required more forethought and creative cooking; some of our favorite meals, like homemade pizza and lasagna, were sorely missed. And we still set the alarm to check on Danny while he slept. But the new diet changed the quality of our nights. We had found a way to ensure that for one-third of every twenty-four hours, the whole family could rest.

Laura Plunkett is the author of “The Challenge of Childhood Diabetes: Family Strategies for Raising a Healthy Child”, and can be reached at www.challengeofdiabetes.com.

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