Recently, my 11 year old son, who has had diabetes for 10 months and has been under great control (Hemoglobin A1c’s are 5.8 and 6.3%.), is having some elevated morning blood sugars (160 mg/dl [8.9 mmol/L] range), which he never had before. I think he is beginning puberty, he is extremely hungry all the time, and I have checked his sugar during the night a few times which seems to be slowing creeping up in the early morning hours. I know this is probably the dawn phenomenon, but what do you think I should do to correct this? Will this persist for the next few years or will it go away? Should I make him skip a snack at night?

I do not know your son’s insulin regimen, but the best way to try to correct early morning raise of your son’s blood sugar might be either to postpone, if not done already, NPH or Lantus (insulin glargine), until bedtime, increasing the dose if necessary or to use an insulin pump, perhaps only for the nighttime. The pump is probably the best option in the long run if you consider that puberty’s effects on blood sugar may last until 18-20 years of age. Another possibility to try first is skipping the bedtime snack if the 3:00 am blood sugar is above 90 mg/dl [5 mmol/L]. Ask your son’s diabetes team before making any changes.

MS

[Editor’s comment: It appears that impending puberty and the end of your son’s honeymoon are causing the elevated blood glucose levels and hunger and that he needs his treatment plan revamped. Please make an appointment with your son’s diabetes team to discuss all options with regard to insulin regimens and meal planning.

SS]