March 4, 2000
Question from Kulin, Western Australia, Australia:
I am a 25 year old type 1 diabetic. I have had diabetes for over 16 years. Until recently, I have not been testing my blood sugar levels. I have now stuck with my resolution to test on a regular basis, and have found some results which I don’t know how to manage. My main problem lies in early morning hypos which are causing me some distress. My results in the early morning are generally fairly low (around 2.0 – 4.0), my lunch time results are mixed, depending on activity and food intake, but are not low, my dinner time and before bed results are generally good (around the 5 – 10 mark). I am currently injecting 3x Humalog rapid acting insulin before meals, and injecting Humulin Ultralente at bedtime.
I don’t know how to get around the late night /early morning hypos. I thought injecting Ultralente in the morning, rather than last thing at night, might help? My other thought was to decrease my dinner time injection of Humalog, but then this would probably increase my before bed blood sugars which isn’t ideal.
Your suggestion of taking the long acting insulin in the morning is a good one. However, it is worth trying to reduce your night time Ultralente first. If you take your Ultralente at teatime, it may also be worth taking it a bit later, say before bed.
It’s worth discussing this with your diabetes team. Of the above suggestions, cutting your dose of Ultralente back a bit would seem the most reasonable.
Additional comments from Dr. Bill Quick:
Another option to discuss with your team would be to split the dose of Ultralente into a smaller morning dose and a larger evening dose, the sum of the two doses being the same as the amount you’re presently using.
Additional comments from Lois Schmidt Finney, diabetes dietitian:
Another idea is to add a small snack before bed. Try this for 2-3 days and monitor the blood glucose levels. A second idea is to try to split the Ultralente dose, but give the larger amount in the A.M. and a smaller amount at night. (I do not know what amounts we are looking at.) Best to check this out with the diabetes team.