My 5 year old son was diagnosed with type 1 diabetes only about a month ago. He is now in the honeymoon and only receives 5 units of NPH in the morning. Even though he gets no insulin after 9:00�A.M., he still wakes up often with a blood sugar below 50. As our pediatric endocrinologist recommends, we are trying to give him for his bedtime snack, 1 carb choice, and 2 protein choices to get him through the night. Why is he waking up so low? The doctor says it is his own body doing it, but I don’t know why the remaining beta cells would be overactive!

Your son’s total daily insulin needs at this age would be about 15 units. At the moment he is only getting 5 units so that during this honeymoon phase he is still making approximately two thirds of the insulin that he needs. However the way in which the insulin is released is distorted and the so called ‘first phase release’ which normally occurs within a minute or two of a rise in blood sugar is often delayed so that it takes place several hours later and after the blood sugar level has subsided producing an inappropriate hypoglycemia. This is a problem that will disappear with the end of the honeymoon phase. In the meantime the situation is normally contained during the day; but can be a problem, as in this case, at night: it may be that the amount of carbohydrate at supper needs also to be restricted so as to limit the delayed insulin peak.

DOB