Low at bedtime - high reading in AM

[nissen99]

My 17 year old son was diagnosed with Type I 11/13/07 so we are still fairly new at all of this and really depend a lot on my weekly contact with the diabetes nurse to adjust his dosages of lantus and humalog. He has been at the same rate of lantus at bedtime for a few months now. The humalog gets tweaked to different ratios for breakfast, lunch and dinner almost weekly. A few times now he has gone to bed with a good BG reading (last night was 100). He did drink one juice box b/4 bed because he was experiencing a few hypo symptoms. This is normal for him. He woke up this morning with a blood sugar of 269. This happened one other time last week. He did not have anything else to eat after bed either. He gets a little frustrated with that. Perhaps his lantus dose needs to be increased? Or would more information be needed to determine if that dose is appropriate (for example daytime readings.) Maybe this is just normal to have these fluctuations(?) (Sometimes I feel like we are never going to get this down!)

[palefacegirl03]

It may be dawn phenomenon that he is having problems with,
from children with diabetes website(also applies to adults)

A sudden rise in blood glucose levels in the early morning hours. This condition sometimes occurs in people with insulin-dependent diabetes and (rarely) in people with noninsulin-dependent diabetes. Unlike the Somogyi effect, it is not a result of an insulin reaction. People who have high levels of blood glucose in the mornings before eating may need to monitor their blood glucose during the night. If blood glucose levels are rising, adjustments in evening snacks or insulin dosages may be recommended.

[Scratch]

It could be rebound.

His blood sugar could be dropping low, eventually his liver kicks in and releases glycogen from the body stores raising his blood sugars.

I'd suggest setting the old alarm clocks every hour to hour and a half and seeing what happens.

[Cyborg]

If no insulin was taken for the juice box, that may have contributed...

[Gary_W]

It could be rebound.

His blood sugar could be dropping low, eventually his liver kicks in and releases glycogen from the body stores raising his blood sugars.

I'd suggest setting the old alarm clocks every hour to hour and a half and seeing what happens.

I agree with this. I know it sounds crazy as you're new to this, but I used to inject far too much basal insulin. I would often wake up high, despite reasonable bedtime numbers, feeling hungover. In me, it was caused by dropping too low in the night and my liver stepping in to save me. Unfortunately the liver doesn't always realise its own strenght and waking up as a 14.0 uk (230ish US) was not uncommon.

Obviously hard to say, but the above is a possible explanation.

Gary

[BriOnH]

If no insulin was taken for the juice box, that may have contributed...

Totally. You don't know when this blood sugar raise occured. Did it happen in the am or did it happen an hour after he drank the juice box. If he is getting 8 hours of rest and you don't test in between those 8 hours you are just assuming the raise in BGL is happening when he wakes. What about the other 8 hours?

[Alice]

Also, that juice box is a rapid-acting carb (sugar)...try just eating some whole-wheat bread before bed, an apple, something with fiber to slow the carb down a little. That's why people like peanut butter with crackers and/or bread at bedtime.

[Cyborg]

While on MDI, I always used a cheese and lunch meat snack. No carbs, just protein and fat...

[Tattoo azz]

i would set the alarm clock for an early am check, i know its hard being a teenager with diabetes your body has enough to cope with without all this **** from diabetes, but it has to be done. A quick piece of advice for you as well DON'T PANIC, i know how hard it must be to have a child suddenly have this to deal with (well hardly a child as he's 17 but he's still your son) anyway keep us informed and good luck