Sleep Safety & Monitoring Checklist

Essential strategies for keeping your infant or toddler safe through the night while managing Type 1 diabetes

Critical Safety Note: Severe hypoglycemia during sleep can be life-threatening for infants and toddlers. Always follow your healthcare team's specific monitoring guidelines and never hesitate to check blood sugar if you have concerns.

Overnight Blood Sugar Monitoring

Recommended Monitoring Schedule

Newly Diagnosed (First 3-6 months)

Check blood sugar at bedtime (8-9 PM)
Middle of night check (2-3 AM)
Wake-up check (6-7 AM)
Additional checks if illness or schedule changes

Established Management (6+ months)

Bedtime check every night
Middle of night check 2-3 times per week (or as directed)
Wake-up check every morning
Increase frequency during illness, growth spurts, or routine changes

When to Check More Frequently

Illness: Fever, vomiting, diarrhea, or any signs of being unwell
Schedule changes: Late bedtime, missed meals, or unusual activity levels
Insulin adjustments: New doses or timing changes
Growth spurts: Increased appetite or rapid growth
Teething: Can affect eating patterns and blood sugar
Travel: Time zone changes or disrupted routines

Continuous Glucose Monitor (CGM) for Infants & Toddlers

Benefits of CGM for Young Children

Reduced finger sticks: Fewer painful blood sugar checks
Trend information: See if blood sugar is rising, falling, or stable
Overnight peace of mind: Alarms for high and low blood sugars
Better A1C outcomes: More frequent data leads to better management
Activity insights: See how play, meals, and sleep affect blood sugar

CGM Placement and Protection

Best Placement Sites

Upper arm: Less accessible to curious hands
Upper buttocks: Protected by diaper area
Back of arm: Harder for child to reach
Avoid: Abdomen (too accessible), areas with pressure

Protection Strategies

Adhesive patches: Extra security and protection
Clothing barriers: Onesies, sleepers with covered arms
Distraction techniques: Keep hands busy with toys
Positive reinforcement: Praise for leaving CGM alone

CGM Alarm Settings for Sleep

Low alarm: Set at 80-90 mg/dL for overnight
High alarm: Set at 200-250 mg/dL (consult your team)
Urgent low: Always set at 55-60 mg/dL
Parent/caregiver phone: Ensure alarms wake you up
Backup alarms: Consider multiple devices for redundancy

Bedtime Routine for T1D Management

Optimal Bedtime Routine

Dinner & Evening Snack (6-7 PM)

Consistent timing helps establish routine and insulin effectiveness

Bath Time & Quiet Play (7-8 PM)

Calm activities help transition to sleep mode

Bedtime Blood Sugar Check (8-8:30 PM)

Target range: 120-180 mg/dL for overnight safety

Bedtime Snack if Needed (8:30 PM)

If blood sugar <120 mg/dL, offer 15g carb snack

Story Time & Sleep (9 PM)

Consistent sleep time supports healthy circadian rhythms

Emergency Preparedness

Severe Hypoglycemia at Night

Signs to Watch For:

Excessive sweating during sleep
Restless sleep or crying out
Difficulty waking up
Seizure activity
Unconsciousness

Immediate Actions:

Call 911 if unconscious or seizing
Give glucagon if trained and available
Do NOT put anything in mouth if unconscious
Turn child on side if vomiting
Stay with child until help arrives

Overnight Supply Kit

Keep These Items Bedside:

Glucose meter and test strips
Glucose tablets or gel
Juice boxes or glucose liquid
Glucagon emergency kit
Ketone testing supplies
Emergency contact numbers
Flashlight or phone light
Backup CGM supplies

Daily Sleep Safety Checklist

Questions About Sleep Safety?

Connect with other parents and get expert guidance on overnight T1D management