Question from Fishers, Indiana, USA:

My 12 year old son, who has had type 1 diabetes for a year, takes Lantus at dinnertime with Novolog before meals. Things were fine until a week after school started when he consistently was having high readings (300-400 mg/dl [16.7-22.2 mmol/L]) two hours after breakfast and lunch. His physician increased his Lantus and insulin to carb ratios, but then he went too low. We have since lowered the Lantus and are now adjusting the NovoLog to no avail.

The mornings are the worst. He wakes up in range (90-150 mg/dl [5-8.3 mmol/L]), but his blood sugar will actually go from 90 mg/dl [5 mmol/L] to 300 mg/dl [16.7 mmol/L] in an hour and a half, even when he eats just protein — no carb! On weekends, when he sleeps in an hour, we don’t have this problem, and he is missing much school.

I believe he is having a growth hormone, stress hormone, dawn phenomenon, a getting-up-early problem, or something other than food to cause the rise. How do we deal with it? He will be starting on the pump in about five weeks, and our pump trainer says maybe the shots just don’t work well for him.