June 28, 2003
Daily Care
Question from Memphis, Tennessee, USA:
For the past two weeks, we have pretty consistently seen our five and a half year old daughter (diagnosed 16 months ago) wake up with fasting blood sugars of 43 to 80 mg/dl [2.4-4.4 mmol/L]. Her control over the past 16 months has been good with her latest A1c being 6.4%. She is currently on a sliding scale of NovoLog in the morning with Lente, and we were also giving her a sliding scale of NovoLog after dinner with a small amount of Lente, but since the low morning readings have started we’ve cut out her nighttime Lente, although we still give her after-dinner NovoLog and have bumped up her pre-bed snack to approximately 50 grams of carb.
We’ve seen an increase in her activity as the weather has gotten warmer which would seem to explain the increased insulin efficiency from a delayed response to the exercise, but it is strange to us to see her morning numbers so low, especially with no long acting insulin at night.
I recognize that the easy answer would be to be sure to give a bedtime snack of 50 grams or so of carb, but we have a hard time suggesting a nighttime snack with no insulin in her system (none taken since 8:30 am) and a bedtime blood sugar of 158 mg/dl [8.8 mmol/L]. If you have any thoughts or insight it would be greatly appreciated.
Answer:
Your daughter might still be in the so-called honeymoon phase, but I doubt that the recent drop in her fasting blood sugars is due only to that. Increased physical exercise may surely be responsible for her lows.
I would advise that you have her checked for celiac disease which is sometimes associated with type 1 diabetes and might be leading to fasting lows.
I think that, from the clinical point of view, your daughter would greatly benefit in terms of blood sugar stability from using Lantus at bedtime eventually with NovoLog at mealtimes. It’s a very good insulin and might be better in your daughter’s case. Ask her diabetes team for further help.
MS