Diabetes nurse educator, Christine Manga, offers valuable advice for parents of children with T1D experiencing interrupted sleep patterns.
A diagnosis of Type 1 diabetes in a child comes with many physical, mental and emotional challenges for both the child and parent. As parents assume most of the responsibility for managing the diabetes, it’s no surprise that parental burnout is real.
Of the plethora of feelings parents experience, fear and guilt appear to be common threads in literature. Chronically disrupted sleep resulting in chronic sleep deprivation is another standout topic. Parents who are sleep deprived have an increased risk for depression, anxiety and potential weight gain. It can have a detrimental impact on relationships, work and day-to-day functioning.
How to deal with 2AM testing
2AM testing of blood glucose is a part of the deal. If the glucose level is in range, that is great. If not, it probably means not much sleep for the rest of the night. How do you deal with this?
Good overall blood glucose management is key to a better night’s sleep. If there are regular night-time hypos, the treatment regimen that the child is on will need reviewing. Reassessing the basal doses, carb ratio as well as correction factor and carb counting skills will aid in achieving good stable glucose levels. A pre-bedtime low-GI snack may be recommended. Even with all of these parameters met there is still a chance of night time hypos. Remember, diabetes does not sleep.
If there is more than one parent at home, working on a rotation basis for testing will allow for better sleep. This could be split up for day to day, week to week or even half evening shifts.
If you are a night owl, staying up until 1am and then your partner being responsible from then until the morning will guarantee a few hours of quality sleep.
If you are a single parent, ask for help. You could teach a relative or friend how to test and what to do depending on the outcome. A solid night of sleep once a week will do wonders.
Minimise the fuss
Be prepared for evening testing and treating, the less fuss involved, the quicker you can get back to sleep. Have the tester and strips out, have a sweet or juice on hand in case of a hypo. Use dim lighting and make sure the passage and room is free of obstacles. Don’t engage in conversation unless necessary.
Good sleep hygiene
Good sleep hygiene will make falling asleep easier for you when initially going to bed or after testing. This includes no use of electronics an hour before bed; a cool, quiet environment if possible, and avoid caffeinated drinks. Try sticking to a routine. Same bedtime every evening, make it early even if it means missing out on some adult time. The extra sleep will help you.
Using continuous glucose monitoring (CGM) technology to track blood glucose levels that give predictive warnings of an impending high or low reading will provide peace of mind and negate the need to physically get up and test your child. Sensor augmented insulin pump therapy plays a huge role in reducing overnight hypos.
Unfortunately, this technology is expensive and not financially feasible for most of the population. If you are fortunate enough to use any of these, do not do sensor changes or infusion site changes before bed. Calibrations may be required or there may be a site failure that goes unnoticed until intervention is required that will take extra time.
Be kind to yourself
When there has been a rough sleepless night, be kind to yourself. If you are unable to complete all the home chores, park some for the next day. Try to get in a 10-minute power nap. Type 1 diabetes stretches the boundaries of what we believe is possible and what we are capable of.
It is important to know that if blood glucose levels are stable then there is no need to test at 2AM every night. Once or twice a week is sufficient.
Seek counselling for you and your child
Children with T1DM can experience feelings of guilt and believe they are a burden. They may also show anger or resentment towards the parent or caregiver who does their testing. An over-tired parent may struggle to show compassion thereby aggravating the child’s ability to accept their condition. Seek counselling for both you and your child if necessary, reach out to your diabetes team, join support groups and learn how other families cope. Sharing your experience and insight may just be what another parent needs to survive.
Remember, this 2AM testing ritual will not be forever.
MEET THE EXPERT
Christine Manga (Post Grad Dip Diabetes and Msc Diabetes) is a professional nurse and a diabetes nurse educator. She has worked with Dr Angela Murphy at CDE Centre, Sunward Park since 2012.
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