November 24, 1999
Hyperglycemia and DKA
Question from Michigan, USA:
My 5 year old has had Type 1 for a year, and has always struggled with very high blood sugars in the afternoon. Is it possible that her body is releasing counterregulatory hormones in a response to too much insulin causing a rapid drop in blood sugar, even though she has no hypoglycemic symptoms? Our diabetes team has both increased and decreased the morning NPH in an attempt to solve the high afternoon numbers, neither of which has helped.
Answer:
In my experience with hundreds of children and adolescents, late afternoon abrupt increases in blood sugar levels are quite commonly observed. It is explained as secondary to either the weaning of previous Regular insulins of the day as well as the late weaning of NPH of the past night. Two are the possible solutions: NPH added to lunch Regular (with NPH in the morning, it is quite difficult to control late afternoon upsurge) or a small shot of Regular at midafternoon. With our kids, the last has helped so much.
MS
