The only way to ensure that your child is receiving the proper amount of insulin during the day is to TEST, TEST & TEST!
According to the American Diabetes Association (ADA) website:
How often your child checks could change from day to day. Talk to your doctor or diabetes educator about when and how often to check on a normal day. Because different people require different treatment options, the Association does not recommend a specific number of tests per day. Your doctor or educator can work with you and your child to determine the best treatment plan. (People who take insulin generally require a minimum of three or four tests per day, though this can vary widely and it may be necessary to test more often.)
While recommendation or lack thereof from the ADA may be helpful to someone who just wants some basic information regarding Type 1 diabetes, they really do not paint the whole picture for someone who really needs to live with or care for a child with Type 1 diabetes.
A child with Type 1 diabetes can easily test a minimum of 9 times a day, sometimes more. While this may seem excessive to some, especially to people without Type 1 diabetes, but let me break it down for you.
A child with Type 1 gets tested:
(1) when he wakes up
(2) 2 hours after breakfast to make sure the correct ratio is being used for breakfast and that all is working properly
(3) before lunch
(4) 2 hours after lunch to make sure the correct ratio is being used for lunch
(5) before dinner
(6) 2 hours after dinner to make sure the correct ratio is being used for dinner
(7) before bedtime snack
(8) 2 hours after bedtime snack or before the caregiver goes to bed
(9) 3am to ensure numbers are not rising or dropping
These test times do not include days of extra activity (10), days where a low is being treated (11), days where a high is being treated (12), or sick days (13).
Again, understandably, this may seem excessive, but let my provide a real life example of what can happen if you do not test on a regular schedule everyday for the rest of the child’s life.
- If a caregiver tests before breakfast and the number is 99 the caregiver can go ahead and give breakfast. Before breakfast insulin is given to cover the carbs that the child is going to eat. Child finishes eating and goes to school.
- If the 2 hour check is skipped for whatever reason, the next check would not be until lunch time, possibly 4-5 hours after breakfast. Child feels fine all through the morning of school so no one even thinks that anything can be wrong.
- Child goes to lunch and says he feels sick, like he is going to vomit. Go to nurse, check sugar and the number is 525!! Child is tested for ketones and they come back high. Somehow, somewhere something went wrong since this morning. As there was no 2 hour check no one is sure where the problem occurred.
- Go back to the history in the pump and see that the breakfast insulin was given so that should have worked fine. Go to check the child’s pump that looks good. Check the child’s site where the pump connects to his body that looks good. Check the tubing of the pump, THERE IS A CRACK IN IT! Somehow between the first test of the morning and lunch time a crack occurred in the tubing and the child was not receiving any insulin…the very thing he needs to stay healthy and alive.
Now, while this does not happen every day, and in fact, it rarely happens, but you tell me, what caregiver of a child with Type 1 diabetes is going to take that chance with their child’s health and life.