May 25, 2003
Daily Care
Question from Orland Park, Illinois, USA:
Two months ago, we switched my four year old son (diagnosed a year ago) to Humalog before meals and Lantus, and I am concerned about his nighttime blood glucose levels. At bedtime, his blood glucose readings are about 75-120 mg/dl [4.2-6.7 mmol/L], and we generally give a snack consisting of at bedtime of at least 6 grams of protein, 10 grams of fat, and 30-35 grams of carb. When we check him three to four hours later, his blood glucose levels are consistently 400-500+ mg/dl [22.2-27.8 mmol/L], three hours after that, he is still well over 300 mg/dl [16.8 mmol/L], but he tends to wake up within normal range (120-200 mg/dl [6.7-11.1 mmol/L]). When we lower the amount of carb at bedtime snack, we always need to wake him during the night for a snack.
I obviously know that the very high blood glucose during the night is not good for his little body, but that is what we need to do to have him wake within normal range. Is it normal for 30 grams of carb to raise his blood sugar to almost 500 mg/dl [27.8 mmol/L]? Is there something I could be doing to keep his blood sugar within normal range all night?
Answer:
This is a frequent problem with the little ones. Postprandial blood glucose is often higher than you would imagine. We can’t really balance the carbs and insulin as well as we would like to believe, especially in the little ones.
I suppose you could try to “tweak” the bedtime snack, maybe a bit fewer carbs, but I would likely just live with it. You have traded the unexpected lows from NPH for the expected high of Lantus (insulin glargine). I like the expected better — at least you know the cause.
LD