February 22, 2006
Daily Care, Hyperglycemia and DKA
Question from Amesbury, Massachusetts, USA:
My 10 year old son has had type 1 for two and a half years. For the past six months, he has been waking up in the morning with a pretty high blood sugar reading. For example, when he goes to bed at 210 mg/dl [11.7 mmol/L], I’ll check him at 2:30 a.m. and he’ll be 180 mg/dl [10.0 mmol/L]. When he gets ups at 7:30 a.m., he’ll be close to 300 mg/dl [16.7 mmol/L]. This goes on most nights, however, there are nights he does wake up below 100 mg/dl [5.6 mmol/L]. Why does this occur? Is it harmful to him?
He is currently on injections of Humalog and NPH. It’s really hard to know exactly what to give him at night. Right now, he gets seven units of NPH before bed. How long does this go on? I know it’s something to do with growth hormones. I’m afraid that the night I decide not to check him at 2:30 a.m., he will have a very low reading in the morning.
Answer:
At this stage, you should talk to your son’s diabetes team about using nighttime Lantus (no peak) instead of NPH (six to eight hour peak). In addition, you would give your son fast-acting insulin, lispro (Humalog) or aspart (NovoLog) for meals and snacks.
MS
[Editor’s comment: Please see a related question, especially Dr. Schwartz’ comments about the Dawn Phenomenon.
BH]
