"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".
Laura Plunkett has a BA in Psychology with Honors
from Brown University. She has been a head teacher in a preschool intervention
program, a research assistant to Dr. Aaron Beck studying anxiety disorders
and depression, and had a thriving therapeutic private practice for 14 years
with families, individuals and couples. She is a workshop leader and public
speaker who is comfortable with large audiences and often speaks together with
her mother on issues of parenting. Her avocation during Danny's illness has
been doing research on the latest developments in diabetes and nutrition and
corresponding with researchers and specialists in many countries. She is a
member of the Juvenile Diabetes Research Foundation.