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April 9, 2006

Daily Care, Hyperglycemia and DKA

Question from Subury, Ontario, Canada:

Our daughter's blood sugar levels in the morning are continually high, 12 to 18 mmol/L [216 to 324 mg/dl]. We have tried everything, but are having no success getting those morning numbers lower. We have increased her nighttime NPH and decreased bedtime snacks. We tried giving her insulin at bedtime or supper time We have done frequent nighttime blood sugar testing (every two hours), but we just can't seem to get the mornings to come down. Her hemoglobin A1cs have been in the 8.8 to 9.2 range and the rest of her blood sugar numbers are well within her target range (5 to 12 mmol [90 to 216 mg/dl]). We are concerned with possible long term effects of the highs. We have been told it could be the dawn effect. Do you have any recommendations?

Answer:

You are correct that this could represent the “dawn phenomenon,” which results in higher blood sugars on waking in the mornings. I tend to use NPH at bedtime when the dawn phenomenon is pronounced such as in your daughter. Please check with your diabetes team prior to making any changes, but my suggestion, in a case such as this, would be to increase the bedtime NPH further, especially when mealtime averages at other times of the day are normal. You may wish to write down her carbohydrate intake, insulin dosing and blood sugars for seven days and review that with an informed diabetes educator for more complete advice.

MSB