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September 20, 2000

Hyperglycemia and DKA

Question from Texarkana, Arkansas, USA:

My eight year old daughter was diagnosed when she was six years old. Her blood sugars have been good up until now. Now, she is high every morning, and we've upped her insulin and started giving her N insulin at bedtime, but she is still high in the morning.


As long as she isn’t having lows during the night, you have to keep working with your physician to increase the dose. Insulin requirements go up as you grow. Also, if she has been stable for about two years on the same dose, she has probably been in the remission phase [the honeymoon] where her body has been making some of the insulin on its own. This remission usually wears off by about two years after diagnosis, and insulin requirements go up. Be prepared for more increases over the next several years as she continues to grow and go through puberty which further increases insulin requirements.

Additional comments from Lois Schmidt Finney, diabetes dietitian:

Please do several nights of 3 am blood sugars to be sure she is not going too low overnight. Is she eating more for a snack in the evening or having several usually hard classes that add a lot of stress and might push up her sugar level overnight?


[Editor’s comment: Your daughter’s situation might well be clarified by monitoring sugar levels continuously for several days to try to sort out what’s happening in more detail. See The Continuous Glucose Monitoring System.