My two and a half year old son was diagnosed with type 1 when he was 15 months old and now uses an insulin pump. We have been having great control during the day and his past three A1c’s have been in the 6s without a lot of lows, but we are having a lot of issues with nighttime blood sugars. One night, I might have to decrease his basal by 30% for the entire night and the next night, without adjusting his basal, he might be in the 300s mg/dl [16.7 to 21.2 mmol/L]. What could cause this extreme variation in numbers? Is it what he eats for dinner? We usually give him milk at night time and only partially cover. Please help, I am still getting up two to three times a night to check because of this.

Your best resource is probably your own pediatric endocrinology team who knows your child’s diabetes scenario best.

Having said that, I need to disclaim that I have no vested interests pro or against pumps. But, I do not believe pumping is yet FDA-approved for children in this age group.

Your child is not very old, obviously and thus it really has not been a long time since diagnosis. I would imagine that some, if not a good bit, of the excellent control reflects impact of the diabetes “honeymoon.” Maybe the honeymoon is sputtering to explain some higher readings.

Similarly, it does not take much change in carbohydrate intake to affect the relative amounts of insulin-to-carbohydrates, so alterations in food intake (and food digestion and absorption) could influence matters also. You might want to talk about backing off a bit of nighttime insulin rates, with adjustments to kick things back up during the morning and daylight hours when everyone is up and around.

Don’t lose sight of the forest from the trees: the A1c in the 6% range is (more than) excellent, but the hypoglycemia can be devastating and your loss of sleep potentially unhealthy to YOU.

Try not to lose track that while many things can (and do) influence glucose levels, the major impact stems from insulin relative to meals relative to activity. It does not take a lot of extra activity to influence the glucose readings. Sometimes activity has a more delayed effect. Has something changed in terms of evening activities, playtime/horsing around, timing of meals?

DS