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February 7, 2001

Daily Care

Question from Madison, Wisconsin, USA:

I am 14 years old and I was diagnosed about two months ago. I usually have one to three low blood sugars a day. One was at 9 am, which my doctor says is probably a result of my being in a honeymoon, and my pancreas putting out insulin a little late after breakfast. Reducing my morning insulin doesn't help. I also have problems with the NPH, 17 units causes me to go low before lunch, but just barely keeps my blood sugar under 200 mg/dl [11.1 mmol/L] after lunch. Reducing to 16 units caused my blood sugar to go up to 250 mg/dl [13.9 mmol/L]. Basically though, the low blood sugars don't affect me very much and go away in a few minutes, so I would rather deal with that than long term complications of high blood sugars. Does having that many lows and having an occasional extreme low such as 23 mg/dl [1.3 mmol/L] affect your brain in any way, or have any complications? Also, I read that your blood sugar rises naturally between 4 am and 8 am or something, so if I wake up with a blood sugar of 75 mg/dl [4.2 mmol/L], does this mean that there is a good chance that I was low during the night? My doctor said that prolonged lows during the night are the ones I really have to worry about. Is this true? Can they do more damage?

Answer:

It sounds like your doctor is quite right about your making small amounts of insulin. However, during the honeymoon, it is still erratic and not so predictable. So, I would guess you might be having your morning NPH work quite nicely after breakfast and before lunch, but not lasting after lunch. We usually cut back the morning insulin and use some lunchtime Humalog and/or NPH. This gets rid of the mid-morning and late morning lows and also provides insulin coverage for when it is needed in the early afternoon. Almost all of our teens are doing this with excellent results. Talk this over with your doctor and diabetes team.

I would guess that you are not going low overnight, but it is easy to set your alarm clock and check once or twice. This won’t get you too tired since you do not need to do this every single night, just some detective work to be sure. We usually use high fat ice cream as a bedtime snack to get rid of or minimize the overnight lows and couple this with bedtime and not suppertime NPH.

SB