My 15 year old brother, who has had type 1 diabetes since age nine, has had a very hard time controlling his blood sugar for the past year or so. Around 11:00 pm he drops to around 40 mg/dl [2.2 mmol/L] and is up testing and drinking juice or pop until 1:00-3:00 am trying to bring it up. Then in the morning he is in the 400-500 mg/dl [22.1-27.8 mmol/L] range. He has talked to doctors and nurses, but no one can seem to give him an answer on how to fix this problem. He is having to miss a lot of school and I’m afraid this will severely hurt his health. Any suggestions?

First you live in a city with a spectacular pediatric diabetes service. Is your brother you using them? Is he using a multiple shot regimen — at least four? Or a pump?

Tell your brother to ask his diabetes team about trying Lantus (insulin glargine). I have had great success with it. It doesn’t seem to have a peak and is just a baseline insulin. He can then add Humalog in appropriate doses to match the food and the blood sugar at the time. I think it will work better.

Finally, your brother is someone for whom insulin pumps were made. It might be time to move to it. The ability to fine tune the basal which should avoid lows at 11 pm.

LD