July 2, 1999
Question from New Jersey, USA:
My 29 month old daughter was diagnosed with Type 1 diabetes 6 months ago. We have been under the supervision of the Diabetes Center at the nearby Children’s Hospital the entire time. We have been successful at getting her blood sugar levels in control during the day but are struggling with the night time. She is waking up with numbers in the 190-240 range. This has been going on for at least three weeks. Prior to that, she would wake up with numbers in control.
About three weeks ago, she was waking up in the morning with numbers around 200 and with a trace of ketones. Thinking that she did not have enough insulin, we were instructed to increase her N dose at dinner (6:30 at night). We started to check her at 2:00 and found that she was dipping into hypoglycemic levels roughly every third day. We have now started giving her more carbs prior to going to sleep. This has stopped the hypoglycemic events but she is again waking up with higher than acceptable sugar levels.
How have other parents succeeded in balancing the night doses and carbs intake for children of this age (she sleeps straight from 9:00 at night to 7:30 the next morning)?
What sugar levels are “acceptable” for children of this age to be waking up with?
You should not make any changes on the basis of this advice without discussing it with your diabetes team. The sort of problem that you describe is quite common with young children. One approach that I sometimes employ is to give the 6.30�P.M. dose of NPH at 10�P.M. instead. This reduces the likelihood of hypos in the early hours of the morning but gives you more chance of control before breakfast.
You should be aiming to hit sugars of around 4-7 mmol/l (70-130 mg/dl) before breakfast.