July 22, 2004
Hyperglycemia and DKA, Insulin
Question from Salt Lake City, Utah, USA:
If I have a blood sugar of 140 mg/dl [7.8 mmol/L] before bed, two hours after a meal of pasta and bread, and 3.75 units of insulin remaining on board (checked on the pump), why is my blood sugar 200 mg/dl [11.1 mmol/L] in the morning? I have not had any problems with my basals and I have accounted for a morning rise in those basals. The dosage of insulin to carbohydrates was double checked at dinnertime, especially for pasta meals. Am I having a low blood sugar in the middle of the night and not knowing it? Should I adjust my insulin to carbohydrate ratios?
Answer:
I would suggest you document your sugars over the night. You will probably see a progressive rise after 3:00 a.m. This is the result of the hormones that rise in the early morning (growth hormone and cortisol) that serve to antagonize insulin. The effect is to cause the liver to export glucose out and increase the blood sugar. The appropriate response is to increase the basal rate to help suppress the output of glucose by the liver. Please discuss specific increases in your insulin infusion rate with your diabetes care provider.
JTL
