December 11, 2000
Daily Care
Question from Charlotte, North Carolina, USA:
I have four year old identical twin daughters, one was diagnosed at 18 months and the other at two and half years old with type 1 diabetes. We are having trouble with the dawn phenomenon. Their blood sugars will be between 80 and 120 mg/dl [4.4 and 6.7 mmol/L] at 3 am, and then by 7 am, they are in the 300s [mg/dl;16.7 mmol/L]. We have been giving them a little Humalog at 3 am, if they are over 150 mg/dl [8.3 mmol/L], to help them from climbing in the morning. Is there anything else we can do to prevent their blood sugars from climbing so much?
Answer:
I can’t offer specific advice, but I wonder if they require a longer acting insulin in the evening which would work overnight without making them hypo around 3 am. You should discuss this with your daughters’ team.
KJR
[Editor’s comment: When you talk with the diabetes team, inquire about switching the longer-acting insulin to bedtime and also perhaps about the use of insulin pumps in you daughters’ situation.
Your duaghters’ situation might well be clarified by monitoring sugar levels continuously for several days to try to sort out what’s happening in more detail. See The Continuous Glucose Monitoring System
SS]
