June 24, 2002
Question from New York, USA:
My daughter, who is advancing into puberty quickly, has had two seizures in the morning. The first seizure I attributed to letting her sleep late. Since then, we take her blood sugar about 6:00-6:30 am and treat for lows.
Last night, it was hot, and she had a ball game so she got an ice cream cone with the team, and at 8:30 was only 114 mg/dl [mmol/L]. I gave her a bowl of strawberries and gave the same amount of NPH she always gets. At 6:15 am, her father got her up and she drank a sip of juice and went into the seizure which we treated the seizure with glucagon. She is fine, and her father is going to check her blood sugar at 5:00 am now just to be sure she is okay.
I have been told that the growth hormone is released at night and can trigger lows. Is this true? She is going to be a tall child, and I expect she has a lot more growing to do. I am working with my practitioner to work out insulin (NPH with Humalog) doses, but it is so scary to go through this ordeal. Any thoughts you have for me would be welcome.
Her last hemoglobin A1c was 7.9%, and our family works together to keep tight control, but the seizures are terrifying to go through. I am willing to take any steps to try to avert them.
Hypoglycemia first thing in the morning always suggests some nocturnal hypoglycemia is also likely occurring. Sleeping late is dangerous in this case, and especially so when there has been a lot of late afternoon or evening activity.
Growth hormone does not cause hypoglycemia, but rather the commonly seen dawn phenomenon with insulin resistance and morning hyperglycemia. So you are mixing up several different concepts.
You should work closely with your daughter’s diabetes team, do some overnight monitoring and figure out the best way to adjust food and insulin to avoid the next morning lows. One of the best ways to avoid severe hypoglycemia and hypoglycemia unawareness is to be strict about avoiding hypoglycemic episodes altogether so the body can “reset” its sensors.