Question from Montgomery, Alabama, USA:

We have a seven year old daughter, diagnosed at four-and-one half years of age. We’ve recently moved from Arkansas to Alabama. Lots of changes have occurred in our lives (e.g., new baby, move-related stuff, terrible support at new school, etc.). Recently, our new endocrinologist made a significant change in her regimen, NPH to be given at bedtime. He felt that undetected lows might be occurring. Her HbA1c was 5.9% for the second time in a row. Since a HbA1c value of 9.6% at diagnosis, it has continued to steadily go down. We have had only two low reactions where it was pretty scary. She has often gone low and, once we could not get a blood sugar reading because it was so low. After leaving the endocrinologist’s office, I felt we were prepared to do this. Since then, school has gotten out, her regimen is not as tight, she is not getting as much exercise, and her blood sugars are running high. I felt I had no control, so we went back to one shot in the morning and one shot in the evening. She usually has ice cream for her snack. If I get a reading at 1:30 am of 132 mg/dl [7.3 mmol/L] and gave 3 units of R and 1.5 units of NPH at 6 pm, and she wakes up at 8:15 am with a reading of 334 mg/dl [18.6 mmol/], is it the Somogyi Effect effect or not enough N? If her level is in range and insulin has petered out, could that cause it? For instance, if I check her at 4:30 am and her blood sugar is 121mg/dl [6.7 mmol/L] and three hours later its 289 mg/dl [16.1 mmol/L], what is that? Did she go low and rebound?