Question from Rosamond, California, USA:

My son has been having low blood sugars recently around midnight. He normally does not have problems with nocturnal hypoglycemia. He receives Humalog and NPH at breakfast, Humalog at dinner, and Lantus at bedtime. Would the cause of these lows be too much NPH or Humalog? He is playing football now, but has lows on days when he doesn’t play football.

He weighs about 100 pounds. His doses when this started were:

8:00 AM – Humalog – 12 units, NPH 23 Units

7:00 P.M. Dinner – Humalog – 12 units

10:00 P.M. Bedtime – Lantus – 10 units

His doses jumped to these high levels following a deep laceration on his arm that has since healed.

His doctor suggested that the NPH was too high and may cause the low sugar and that the Lantus should be raised to 22 units with about 8 units of Humalog at dinner. He recommended that his morning shot consist of 10 units of NPH and 5 units of Humalog.

We have tried days without NPH and he still gets low at midnight. It seems that the Humalog is acting longer than three to four hours. Could there also be a connection to football causing a low several hours after practice? Could it be that the imbalance of too much Humalog or NPH and not enough Lantus could be the problem? Should we feed him longer acting carbohydrates at night? Is it possible that eating late (7:30) dinner could lead to a low around midnight, especially with a high dose of Humalog?