November 28, 2004
Insulin Analogs, Other
Question from Youngstown, Ohio, USA:
Why does my son’s blood sugar seem to rise during the night causing him to wake up high, over 200 mg/dl [11.1 mmol/L], in the morning. He is 10 years old. Diagnosed two and a half years ago, he takes 14 units of Lantus before bed and Humalog to cover meals during the day. Occasionally, he has a bedtime snack which we cover with Humalog (1 unit per 15 grams of carbohydrates). However, a lot of times he does not eat before bed and still wakes up higher than his blood sugar reading the night before, sometimes much higher. An example is last evening when he ate dinner at 6:30 p.m. (covered with Humalog), had no bed time snack and his blood sugar before bed was 180 mg/dl [10.0 mmol/L]. He had 14 units of Lantus before bed. He did not eat again until breakfast at 11:00 a.m. the next morning and his blood sugar was 340 mg/dl [18.9 mmol/L]. Why does it rise like this? This happens quite often.
Answer:
This is probably due to something called the “dawn phenomenon”. Growth hormone and sex hormones, especially during puberty, are particularly “active” around 5 to 6 o’clock in the morning and they have a glucose raising effect. In diabetes, the insulin levels are usually waning around the same time so the rise in glucose occurs before breakfast. Longer acting analogs such as Lantus can generally cope better with this than NPH but you need to discuss dose with your team.
KJR
