I am a 26 year old male who has had type 1 diabetes since the age of seven, and for several years I have had frequent high blood sugars in the morning. When this started, I do not recall changing insulin doses. The levels, however, are not always high, and so I hesitate increasing my insulin dose at night. I eat a regular snack before bed.

I have read that sometimes the liver excretes sugar during the night. Do you think that my liver could be the variable in my situation? Do you know of anyone in the Toronto area who could put me on a CGMS to help me determine exactly what is happening at night?

You ask a very insightful question. This is a common issue in clinical diabetes which we have been addressing this issue for some time. If you are not checking your blood sugar at 2:00-3:00 am, you should be. This will allow you and your physician to know if you have enough room to increase the insulin dose without causing nocturnal hypoglycemia. Most intensive therapy algorithms suggest that the insulin not be increased if the 3:00 am value is less than 80 mg/dl [4.4 mmol/L]. If your value is much higher, you will have room to increase your NPH dose at night.

I am sure there are some centers using the The Continuous Glucose Monitoring System, including the University of Toronto. However, these systems do not always allow real-time monitoring so that you have to download the data at a later date to determine what happened in the past. In my mind, whether these continuous monitoring systems are ready for prime time is still arguable.

JTL