February 1, 2000
Hyperglycemia and DKA
Question from Lansing, Michigan, USA:
I have type 1, and was diagnosed almost 16 years ago at the age of nine. I currently am taking four shots per day: breakfast H/N, lunch H, dinner H, and bedtime N. I originally went from the standard 2 shots/day to 3 shots/day due to 3�A.M. reactions, and even with splitting the Humalog and NPH I still occasionally have 3�A.M. reactions. Lately I’ve been having normal bedtime testings (100-140), but about 2/3 of the mornings I wake up in the 250-300 range. I’ve tried increasing my bedtime NPH, but it doesn’t seem to be helping much. I’m not sure if I simply haven’t raised my NPH enough to counter a pre-dawn phenomenon or if I’m rebounding. I’ve considered waking up at 3�A.M. and 5�A.M. to test and see where my sugar is. Is this the best way to determine what is happening? Do you have any other ideas?
Answer:
Yes indeed, checking over the nighttime will be of help. I don’t know how much NPH you inject at bedtime, in order to judge whether is enough to assure (on an average basis) a good fasting blood sugar value. If you inject less than 12-14 units of NPH I strongly doubt it. Furthermore, Humalog at dinner quite often doesn’t cover early night hours (when bedtime NPH is still in its injection depot site and therefore hasn’t starting working) and this can lead to hyperglycemia the morning after. This is why I prefer in these cases predinner Regular, Regular mixed with Humalog or NPH in order to cover.
Discuss this with your diabetes team.
MS
