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I am a male 37-year-old Type 1, diagnosed 22 years ago. For the past several years I've been battling the "dawn phenomenon," and was wondering if, given my current regimen, you might have any suggestions for things I might try to help avoid high morning blood glucose levels.

I weigh approximately 150 lbs, 5'11" tall, and count carbs. I am currently on a 4-dose regimen of Humulin Regular/NPH, as follows: 6:30am-R and N; 11:30am-R; 6:30pm-R and N; 9:30pm-N. Carbohydrate intake throughout the day is as follows: 7:00am-60g; 9:30am-48g; noon-60g; 3:00pm-24g; 7:00pm-60g; 10:00pm-48g.

Blood glucose levels are reasonable throughout the day from 9:30am until bedtime, but from a few nighttime samples I've taken, it appears that it climbs up to around 220 or so at 2:00am, then starts to drop, and then shoots up into the high 200's by 6:30am when I get up. I then take some supplemental Humalog with my morning injection to bring the blood glucose back down (1 unit per 50 mg/dL above 200).

Do you have any suggestions that I might try (using an multidose insulin regimen)? I've heard that an insulin pump is an option that will likely alleviate the problem, and I plan on discussing this with my endocrinologist, but I'd prefer not to go that route if I can figure out a way around it using an MDI regimen.


The trick to improving your night time -- early morning blood sugars is to try and figure out which insulin is working at the time your blood sugar is starting to rise. There is a wide variation when insulin starts to work and how long it lasts as compared to the averages you read in books.

I would suggest slowly increasing the insulin you "think" is working at 2 AM when the blood sugars start to rise. You might try increasing your insulin by 1/2 to 1 unit every 3 days so you avoid low blood sugars, and consequent rebound hyperglycemia. The most likely insulins to consider increasing first are the evening insulins, either the pre-supper or bedtime NPH or possibly the evening regular. When you increase an insulin, first predict when you think the blood sugar will be lower, then go back and see if the blood sugar is truly lower when you predict or earlier or later than you predicted. You may have to increase a different insulin to lower the blood sugar at 2 AM than at 6:30 AM. If slowly increasing the evening insulins doesn't work, you will have to consider other alternatives based on the information you get from these "experiments."


Original posting 15 Oct 96


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