Our 16 year old son, diagnosed at age two and a half, is on a combination of Humalog and Ultralente. His basal insulin is 25 units of Ultralente taken at breakfast and supper, and he takes any where from 6-11 units of Humalog at breakfast, lunch and supper depending on carbohydrate intake at each of those meal times. His factor of carbohydrates to units Humalog is 8.

He is experiencing serious nocturnal low blood sugars (specifically between 3 and 6 am). We have adjusted for his hockey games, but they have also occurred when there has been no activity the evening before. His blood sugars have been normal at bedtime and he’s had a healthy snack. Why is this happening and what can we do?

Talk to your medical team about helping you make adjustments to your son’s basal insulin dosages, particularly the evening Ultralente dose. Based on the information you have provided, it appears that your son’s basal insulin requirements have changed, specifically in those dawn hours. It is difficult to say exactly what has caused this change. There are many variables which may play a role, including levels of growth hormone and cortisol (hormones typically involved in the dawn phenomenon ). Wide swings in these hormone levels can be common during the growth stages of childhood and adolescence. Your son’s daytime activity levels may also be playing a role in reducing his insulin needs overnight.

Regardless of the cause, frequent nighttime lows require a decrease in overnight basal insulin. Greater adjustments may be needed on the nights he plays hockey. He may also find helpful as a bedtime snack one of the uncooked cornstarch medical foods designed to help prevent hypoglycemia:

Gluc-o-bar
NiteBite
Extend bar

DMW