Question from Ottawa, Ontario, Canada:

I am 29 years old, I was diagnosed with type�1 diabetes two years ago, I take four shots per day, and, until recently I haven’t really had any problems with high blood sugar in the morning. A few weeks ago, I switched my before dinner insulin from a pre-mix to Regular due to the fact that my blood sugar was peaking right after dinner and then going low before bed, and during the night.

Taking Regular solved the problem of my blood sugar peaking after dinner and the lows before bed, but now I am high (13-16 mmol/L [234-288 mg/dl] )some mornings. I thought at first that I was dipping low in the middle of the night, but I have checked a couple of times and wasn’t low.

I take NPH before bed, and, when I was taking the premix, I took 4 units, but, since I have started on the Humulin, I now take 6 units so I don’t understand why I sometimes have high blood sugar in the morning. I eat the same thing before bed (15 g carb) and have normal blood sugars (4-7mmol/L [72-126 mg/dl] ) before bed as well. What could be causing the high blood sugar in the morning? Should I start to increase the NPH before bed or decrease it?