My five year old son was diagnosed with type 1 diabetes two years ago. Recently, we have noticed that his blood sugar is rising during the night. Even though he will go to bed with a level of 130 to 150 mg/dl (7.2 to 8.3 mmol/L), he will wake up at around 350 mg/dl (19.4 mmol/L). I always thought that the blood sugar was supposed to drop during the night…that’s the way it has always been until recently, What can be causing this?

There are many factors that can contribute to rising blood sugars in the night. This can include insulin dosing, food intake, exercise, illness, and in some cases from having unrecognized insulin reactions at night which can cause the blood sugars to fall and then rebound quite high in the morning. In addition, as children grow (usually around puberty), growth hormone can cause an increased need for insulin at night called the dawn phenomenon. If your son is routinely having blood sugars in the 300’s in the morning, I would start to correct that by adjusting his insulin or adding a medium (such as NPH) or long acting insulin at night. There are many ways to do this and you would be best served by discussing this with your diabetes team. I always encourage my patients to call in a full week’s blood sugars if they are consistently out of their goal range (80-150 for aggressive control). You’ll also notice that as your child grows, diabetes can become even more difficult to control — so keep up the hard work!

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