As you progress as a diabetes parent, you'll learn to look not just at the A1c and meter average but also at averages for each time of day. You'll learn what times of day to study and what to do with the information you get to help your child maintain better control.

Rise and Shine

Morning numbers are the foundation of a well-controlled diabetes day. If you can work to get your child waking up in a range you and your team agree is a good one for him, you'll be a step closer to tight control. But mornings can be tricky. There's the entire night that needs to be handled (and no parent wants to check a child two or three times each night), and many people with diabetes experience a spike in blood sugars as the sun rises. This is usually caused by something called the “dawn phenomenon.”

The dawn phenomenon can cause blood sugar to rise, since the body needs an extra boost of insulin at that time. Kids on pumps can up their basal rate for those few hours; kids on shots will need to figure out which insulin should be increased so it peaks to match the glucose surge.

Fret not: This does not mean you'll need to be up all night every night for the rest of your child's life. But it does mean you'll be doing numerous night checks for an entire night from time to time. In an ideal world, you'd do checks every two hours through the night once every six weeks or so to gather the information you and your team need to make changes to help get that morning glucose reading in target range.

You may find, with that checking, that your child's morning high is not from dawn phenomenon, but actually from something called the Somogyi effect, which is a rebound high after a nighttime low. If this is the case, ask your team to help you adjust for less insulin earlier at night instead.

Midday Readings

Throughout the day, you'll want to know how your child reacts to meals. This is why in addition to lunch and snack time readings, postprandial readings are helpful as well. Postprandial readings, taken about an hour and a half to two hours after a meal or snack, show you if the insulin you gave for that food covered it well.

These readings will also help you find out which foods react differently in your child. You may find that pasta or pizza keeps her blood sugar high longer, so you can change the insulin dose based on that information.

Of course, checking a child at every meal and at every postpran-dial may be too much. Instead, focus on one meal time at a time and do postprandial for it for a week, watching for a pattern. Then move on to another meal. If you keep good records, you should be able to gather enough data to last a good long time.

Bedtime

What's the best number for a child who is ready to go to sleep? The answer varies from child to child and depends on what kind of insulin therapy you are using. If your child is pumping, you'll be able to set basals to vary through the night. If your child is still on a peaking insulin, you may want to talk to your team about what number is safe for bedtime.

But even when you've found the right number, you'll need to know your child is safe all night long. While some children wake up when they feel high or low, others do not. Plan on checking your child at your bedtime as well (if you stay up later than she does), and set a goal of a middle-of-the-night check at least once a week. If your spouse can do one as well, that would be two a week with each of you only having to get up once. This should be enough information to keep your child safe. Some parents argue that middle-of-the-night checks are needed each night. That decision is up to you and your team.

If your child gets up more than once to go to the bathroom at night, you may want to do a quick check as well, since increased urination can be a sign of high blood sugar. Of course, there will come the day that your child says, “But Dad! Everyone pees!” and she's right. But checking means better safe than sorry, and one more number gives you more data to work with, leading you to in-target averages.