High BG's before 4am

hi, my son takes Humanlog(L) and NPH(N)  before dinner, we seem to be able to adjust the L to accomendate his dinner.  We give him some snacks before bed for NPH because it peaks around 4am in the morning. We check him at 12:30am and 3:30am in the morning, his BG's is around 14-16, it only comes down from 4am to 6am in the morning. so he is high from 9pm to 4am in the morning. any ideas what to do to deal with this issue?

My son usually goes to bed with his sugars between 10-12 (reading after eating his bedtime snack).  By midnite he is usually below 10 and wakes up with an 8-9.

We take Humalog with each meal and then take Lantus at bedtime and find this allows us to keep his sugars under 10 while not worrying about bedtime lows although sometimes at midnite he may need a swedish berry or two to bring his sugar up a bit if he is 7 or under.

NPH is an old insulin (just to say, my father has been a diabetic since one years old in 1941 and NPH is the insulin he used BACK THEN and even he takes Humalog and Lantus at this point).

However, of course I am not a doctor but taking Humalog and NPH at dinner seems old school and is unpredictable and runs the risk of an overnight low when the NPH peaks.  

I too am a diabetic and took the Humulin R at bedtime years ago which is a slow acting insulin but switched years ago to Lantus.

My whole family (father, older brother, myself and my son) are all on the Humalog and Lantus regime and it works for us.  Lantus is a basal slow release/acting insulin that is said to last 24 hours so it replaces the NPH.

Good luck.


we can use Lantus and humalog because he is in school and we don't have access to him during school hours, morning NPH will peak around lunch time to accomendate his rounte, but it did not work well for night,

i meant 'we can't use'

we did a trail last night, we increase the L before dinner, so he can eat whatever he wants to make sure he is not high before bed time snack, and he got 5.5 before bed, instead of giving him one snack (10g carbs), we split the snack (10g carbs) into two, one gave him before bed, so he had around 8-9 BG from 9pm to 4am, we checked him again at 4am, he was 8, we gave him 4g carbs of milk to last for the rest the hours (NPH peasks around that time), he woke up at 6.9. The downside of the method is we have to wake up at 4am every day, however, preventing him from high for 7 hours at night probably worths the work.

Thank you, Jodi for your suggestions, I agree the Humalog and Lantus regime will work better but considering our limitation at current point, we seem to stuck now. We will have a meeting with the endo tomorrow, see what she is going to say about that. I will let you know,

great thanks again

Hi again,

When my son was first diagnosed, I did not bring him home for lunch so in order to accomodate the lack of shot at lunchtime he would get Humalog to cover his breakfast and Humulin N (two shots given separately at breakfast) would cover his lunch.  So he would get Humalog/Humulin N at breakfast, Humalog at dinner and Lantus at bedtime.  I feel bad that you have such a difficult night routine and that you son has to be woken up several times especially to eat or drink milk.

Speak to his doctor, I am sure they can come up with a better routine for your son that will work and be less invasive to his night routine.  Also, lack of sleep and stress can raise blood sugars too so I hope his doctor can come up with a 'better' plan.

I don't mean to sound like a "know it all" it is just we have issues too with having to keep our son up later than we want at bedtime due to his sugars and I sympathize.

Good luck and keep me posted!!!

I am so appreciated you would share your experience with me!! It is comforting to know we are not alone.

I was told Lantus will last for 24 hours, so your son would still have Lantus in the background during the day on the top of another two shots you gave him? how did that work?

Lantus does "supposed" last 24 hours but I don't believe it is a 'true' 24 hours as well it is a small dose of 7 units.  I believe they gave him the Lantus to carry him through the night therefore eliminating the slow acting at dinner (therefore reducing the risk of nightime lows).  The slow acting at breakfast Humulin N was to cover his lunch and everything is basically trial and error and we checked his sugars and this routine works for us.

However, that being said, I did have to add a lunchtime shot of Humalog 3/4 units and still kept the other shots as is.  His doctor suggested reducing the Humulin N at breakfast and increasing the Humalog at lunch as it is more predictable but I have not done this yet since we now have his sugars in a good place (so if it ain't broke why fix it).

Lastly, since my whole family is diabetic I tend to question the doctor more and sometimes make my own adjustments for my son (the doctor knows this since I am Type 1 and whole family and is okay with this).

All I can say is whenever you make changes you just have to monitor the sugars closer in the beginning.

Take care.  Jodi

hi Jodi

We went to see the endo and she did not like the idea of using Lantus. She is concern that there is some link with potential cancer with this insulin. She did not like our idea of putting my son on a insulin pump neither because he is very active.

I went on the internet to search about the information about Lantus and did find some articles about it but there is no final conclusion about the linkage.

We will going to another hospital for an assessment the end of this month, I will raise the same question to them see what their suggestions are. I will let you know.

Take care


Our son (age 10) is on Humalog for meals and corrections, and Lantus in the evening.  It works very well for us, as we rarely have night-time lows.  Yes, the Lantus does act for about 24 hours, so it is keeping a "baseline" insulin throughout the day as well as the night.  

When the report of a "possible" link between Lantus and increased cancer risk was originally announced, I asked our Ped Endo about it (in addition to doing on-line research).  It was a strictly statistical study using a relatively small number of subjects, and there was no possible or probable "biological" explanation offered for the statistical data.  If my memory serves, the data was collected on older patients with Type II diabetes who were taking larger doses (such as my MIL who takes 75+ units per day), and not on younger Type I diabetics who take smaller doses (my son takes 13).  

When my son was originally diagnosed, he was put on NPH at the hospital with a BG target of 85-200.  In our first appt with our permanent Ped Endo, he put William on Humalog/Lantus, and refined his target to 85-150, which is do-able on this program.  He explained to us that, especially with kids, the insulin needs to be dosed based on meals, rather than trying to force meals that conform to insulin doses.  NPH is definitely "old school", even in adult patients (my Type II MIL uses Humalog/Lantus), and it is more difficult to get tight control of BG with NPH.  

At any rate, I'm interested to find out what the other hospital says.  Please keep us posted.



Hi Monique,

Thank you for your information!

My son is only 41/2 year old. He is taking only .5 NPH at night at dinner time. I guess he is in his honeymoon period. I really like the idea of keeping his BG low at night to reduce the risk of complication without risking being low. Do you know Lantus comes with .5 unit? or maybe .0.1 or 0.2 possible?

The past three months since he was diagnosised, he has few cold and experinced high fever last week. It have been a very stressful and roller coaster experience for our family.  I am trying very hard to keep myself staying postive however, everytime when he got sick, I slipped into depression again. As you see, I am quite depressed lately as he has been sicked non-stop. He is also very tired in the morning when he gets up. I am not sure if this is the norm for a  4 year old or something I should checking out with the doctor.

Take care


Hi Christine,

Unfortunately, Lantus only comes in 1 unit doses.  

I understand how you are feeling and how frustrating it can be especially that your son is getting sick so often when first diagnosed.  My son caught strep throat and the flu within one month of his diagnosis last year.  He had fever for days and his sugars were crazy.  He has been sick the last two weeks and his sugars are completely out of whack.  It is frustrating and despite my best efforts to keep him away from anyone that may be sick there is little I can do when it comes to school (last week while waiting at the office, he was sitting next to a boy with the stomach flu when FINALLY after 5 minutes, the secretary realized this was a BAD idea and moved my son to another room away from sick kids).

My son is more tired int he a.m. since his diagnosis (this ironically works for us as he use to get up at 6am and NEVER slept in).  Sometimes if his sugar is higher than usual he may be tired in the morning or maybe due to the fact that I also wake him at midnite to check his sugar (does your son sleep thru the finger pricks in the night?  Mine does not).

Lastly, you are not alone.  Sometimes I can get down as well as this is a very overwhelming (albeit treatable) disease).  It is a great worry and responsibility for the parents especially the main caregiver.  I hope that you have a least one other person who can give the shots to your son.  My husband started about a month ago and after a year, this is finally giving me a bit of a break in the morning.

It does get easier with time so hang in there.  Too bad no moms live in Montreal, Quebec as I have been trying to organize a group but so far no takers.  

Feel free to chat/write whenever necessary.

Take care,


Hey, Christine,

Sick days can be so challenging!  I'm sorry you're both struggling with that right now.  My son seems to require quite a bit more sleep/rest than my other two boys...at least an additional 2 hours or so.  I don't know if that is related to the diabetes or not.

Are you using syringes for injections or a pen?  If you are using syringes, the available dose of Lantus will depend on your syringe.  We use a syringe with 1/2 unit marks, and I frequently use that additional 1/2 unit.  I would check with your pharmacy to see if there is a 1/4 unit marked syringe available.  I don't know about pens, but again you could check with your pharmacy.  I do know that some pumps can dispense 0.1 unit at a time, so that may be a longer-term option to look into.

What is your son's overnight BG target range?  Our Ped Endo wants our son to have a slightly higher BG overnight....at least over 100, and I generally will not give a correction for anything under around 170, to avoid lows at night (but that's just my personal preference).  



hI Jodi

It makes me feel better everytime I read your posts. Thanks!

I guess it is out of question that I can put my son on Lantus regardless what the endo says about it. But I will still ask them about it.

ya, it is so powerless when it comes to prevent our kids from the sicks when they are in school. I pray every morning before I leave him to work. I just hope God will hear my prayers to protect him as well as all other moms with diabetes kids.

I am luck to have a wonderful husband to help me out with some insulin shots and blood tests. I am grateful for that. My son wakes up sometimes when we do the  blood test on him but he seems fall back to sleep very quickly. I am not sure that would have any effects on him.

I do wish that we live close by unfortunately this is not the case. I am living in Toronto. I think it is great we can still support each other throught this chat room when we are overwhelming with all the stuff.



HI Jodi

just want to get back to you about the lantus. The nurse did tell me about the side effect of taking it but the result is not confirmed and only done on type2 who take a lot of amount. Basically she told me the same thing that you mentioned before. i found out the lantus is not approved by the FDA for use for kids under 6, so we are not going to use it for Tristan since he is only 4.

The new team is great and the things are more organized now.

Happy holidays!