Question from Rutland, Massachussetts, USA:

Within the last two weeks, my son’s 2 a.m. numbers have been high. He is on a scale for NovoLog and he takes Lantus at 8:30 p.m. We recently changed the scale for his NovoLog, lowering the scale so that he receives it at a lower blood glucose range. His numbers during the day are within range, but by 2 a.m. they are high. Our diabetes team cannot figure out why this is happening since his bedtime numbers seem fine. We are trying an increase of the Lantus, but they are also considering putting my son on a CGMS to see if this is a possible rebound effect.

I should also mention that this seemed to start happening when my son caught a cold and we had to be more aggressive with his NovoLog to keep ketones at bay. His cold is subsiding, but my husband still believes that the highs at 2 a.m. are a result of his cold. Our endocrinologist doesn’t believe this, because his numbers are not high all day. This is an example of how his numbers have run: Breakfast: 133 mg/dl [7.4 mmol/L] – 1/2 unit NovoLog; Lunch: 149 mg/dl [8.3 mmol/L] – 1 unit NovoLog; Snack at 3 p.m.: 92 mg/dl [5.1 mmol/L]; Dinner: 207 mg/dl [11.5 mmol/L] – 1 unit NovoLog; Bedtime: 84 mg/l [4.7 mmol/L] – 1 unit Lantus (15 gram snack); 2 a.m. 275 mg/dl 15.3 mmol/L]. He is eating about 45 grams of carbohydrates at each meal.

Could the 2 a.m. highs be a result of his cold that he is getting over? Could it be a rebound from a low we are not catching? What would be the best way to catch these lows? Should we check him at 11:30 p.m. as well as 2 a.m.? Any advice you can give would be greatly appreciated.