July 23, 2003
Daily Care
Question from Pickering, Ontario, Canada:
I am concerned that our daughter may be rebounding. She takes Humalog with NPH at 7:00 pm, and, if she is overactive and doesn’t go to sleep we put her to bed at 9:00 pm, it is usually a sign she is going low. We have frequently checked her at various times during the night and have found no signs of rebounding, but frequently she is very high (15-20 mmol/L [270-360 mg/dl] ) at our nightly 11:45 pm finger poke.
On nights when we do not check her before 11:45 pm, is it possible she is rebounding between 9:00 pm and 11:45 pm. How long does it take someone to go from an extreme low to a rebound? If one does rebound, is it more difficult to get the sugar level down the next day? I am looking for information on rebounding because our diabetes team does not appear to have a lot of information in this area, and I cannot find anything of value in any publications.
Answer:
It is unusual for your daughter to have rebound hyperglycemia at that time, especially if she is not known to be low previously. I am assuming that her control at other times of the day is okay, but it can be difficult to get good control in children under five.
It is worth talking to your daughter’s team about this as she may need some monitoring overnight to see what exactly is happening.
JS
[Editor’s comment: Your daughter’s situation might well be clarified by monitoring sugar levels continuously for several days to try to sort out what’s happening in more detail. See The Continuous Glucose Monitoring System
WWQ]
