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May 16, 2007

Hyperglycemia and DKA, Insulin

Question from Kitchener, Ontario, Canada:

Why does my daughter's blood sugar level seem to go up at night? She is usually going to bed at least two hours after her last meal at 9 mmol/L [162 mg/dl] (target is 8 to 10 mmol/L [144 to 180 mg/dl]). I check her before I go to bed, usually at least three hours later and her blood sugar can be up around 15 mmol/L [270 mg/dl]. She isn't a child to sneak snacks and it happens almost every night. I will then give her another injection of NovoRapid at that point to correct her blood sugar back down to 10 mmol/L [180 mg/dl] and I will then get up at 3:00 a.m. to check her again and it is still around the same, 15 mmol/L [270 mg/dl]. This doesn't make any sense to me.

Answer:

I cannot possibly answer such a question without a lot more information. But, it sounds like you may need more bolus insulin and a higher insulin to carbohydrate ratio. You may also need an increase in the morning long acting insulin as well. You should discuss this specifically with your diabetes team so that they can do some detective work with you and your child, review food options and insulin options as well.

SB