From Providence, Utah, USA:
Our son is 14 years old and has been a Type 1 diabetic for the last four and a half years. We are struggling with a very strong dawn phenomenon. Blood sugars seem to steadily rise throughout the night after midnight, often reaching the 300. We are presently using lispro and pork NPH. He receives injections before each meal and bedtime snack. We have tried various combinations using NPH at dinner time and bedtime snack time as well as Ultralente. None of these have seemed to made any difference in correcting the problem. We have been giving a 3 A.M. injection of 4 units of lispro, which brings his morning reading to a normal level, but feel that there must be a way without doing so. Our doctor is at a loss as to how to help us.
I agree that it is extremely antisocial to have to give insulin at 4 A.M. You don't say whether your son is experiencing hypos during the day or if this was a problem at night when he was on Ultralente. Without knowing more, I would be inclined to say that, all things being equal, the bedtime dose of NPH or Ultralente has to be increased until you get a response.
Original posting 26 May 97
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