August 1, 2001
Insulin
Question from Ottawa, Ontario, Canada:
You responded to a recent D-Team question that by giving NPH later in the evening at bedtime, nocturnal hypoglycemia would be eliminated as compared to giving the NPH at dinner time. Could you please elaborate on this? If I give my child NPH at bedtime (around 8:00 pm) instead of at dinner time (around 5:00 pm) then the NPH would peak between 2:00 am and 5am (as opposed to the dinner NPH peaking between 11:00 pm and 2:00 am), and he could still have the hypoglycemia-rebound effect and wake up high. A bedtime snack is less likely to last long enough to cover the bedtime NPH, but may help cover the dinner NPH. Please help to clarify this, as overnight hypos cause considerable confusion and anxiety.
Answer:
I actually was thinking 10:00 or 11:00 pm, not 8:00 pm, which moves things closer to the morning. However, NPH isn’t a perfect insulin by any means. If your son is really having lots of hypoglycemia, ask his doctor to consider Lantus (insulin glargine). It seems to be a pretty flat insulin, but I have had to give it in the morning rather than at bedtime to some kids who really tend to get low during the night.
LD
