We have recently been able to resolve my son’s lack of sleep (and subsequent school absences) due to night puberty peaks. Our new night watch technique has allowed us to largely resolve lack of sleep – for him at least 
As most of you know, my 12-year-old son entered puberty earlier than planned (right after Christmas), and we have been challenged by significant hormone peaks daily (often multiple ones). Many of them occur at night (in fact, at first they only occurred at night). As a result, my son, who is accustomed to testing and dosing on his own, ended up spending most of his nights up until 3-4am, then being too tired to go to school in the morning the next day.
Here is our new regimen:
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we don’t test at night anymore, unless it is for a significant low, or unless it is a very sharp downgoing slope that has reached high to mid range. Testing wakes my son up, while dosing doesn’t. We work on maintaining good calibration and inject based on CGM data.
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my wife and I assume night duties, rather than my son (although my son still has a low “low alarm”).
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we program a high threshold to wake us up – it is now 120 for us. As soon as he goes through his upper threshold, we make a decision and inject. We don’t wait and confirm the trend with a few points (which we used to do). Our new philosophy is “decide and inject” (I’ll discuss it in another post). We assume a medium hormone peak (based on slope mostly) and inject on that basis. He does not wake up when we inject. As a note, hormonal peaks have different correction factors than glucose peaks for us.
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if the peak is deeper and higher than expected then we inject again as soon as we find out - decide and inject. So, if I injected for a 150 peak, and the CGM hits 150, then I inject him again at 150 for a 180 peak etc.The new injection is the difference between what was injected and what should be injected for a 180 peak.
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if, within 25-30 minutes of his insulin activation inception (it is 40-45 mins for us), we don’t see him turn the corner, we inject more (i.e. we stack). I’ll discuss our safe stacking technique in another post.
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after every injection, we set up a wake-up alarm for ourselves to verify how he is doing, readjust the high alarm, and possibly adjust the low alarm as well
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we use a high low alarm when he is on a high peak (maybe 95 or 100) so as to be able to catch early a sharp downdrop due to insulin
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all three of us have a low alarm on at all times at different levels, so that if, for some reason, the person on night watch doesn’t wake up on low alarm, someone else will.
These techniques have allowed us to minimize his time up at night and still deal with his highs. Our results are not great during puberty. He spends about 15-25% of his time high (depending on how bad the week is), and 6-7% of his time low. But his average is still below 110 on average. Not great but not horrible either, given the circumstances.
This technique meets our needs of not requiring him to be up a lot at night, while still preserving some ability to deal with highs (and lows, of course).
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