Lesson 6 - Early Morning Hyperglycemia

Insufficient (or Waning) Insulin Levels

Waning insulin doses are the most common cause of early morning hyperglycemia. It can be treated by increasing the evening dose of intermediate acting insulin.

Insulin, which comes from the pancreas of cows, salmon, or pigs, or is man-made, is the hormone that plays a role in getting glucose inside cells. While it is naturally occurring in the pancreas, diabetics either cannot produce insulin (type 1) or cannot fully utilize it (type 2).

There are several types of insulin available, organized by their onset (how long they take to start working), peak time (at what point are they at maximum strength), and duration (how long they are effective for).

The various types of insulin include:

• Rapid- (or Fast-) acting Insulin: This is one of the newest types of insulin, which begins to work usually within 15 minutes. It peaks between 60-90 minutes, and lasts for about four to five hours.
• Short-acting insulin: This type onsets between 30 minutes to one hour, peaks at two to three hours, and lasts for four to six hours. It is mainly used to keep glucose levels low between meals.
• Intermediate-acting insulin: This type, usually comprised of NPH or Lente insulins, usually onsets between two to four hours, peaks between four and 12 hours, and can last for up to 18 hours. This type of insulin can be used to simulate the body's regulation of insulin, and provides a consistently low level of active insulin at all times in the body.
• Long-acting insulin: This type usually onsets between six and 10 hours, and continues in a steady dose for up to 20 hours. It is recommended for diabetics that require only one shot per day.

It is also important to note that, although insulin types will vary, they all have the following things in common:

• All insulin types have expiration dates (remember to check and toss expired insulin immediately)
• Keep all insulin types away from extreme heat or cold
• All insulin types should be kept in the refrigerator, or up to four weeks at room temperature

You and your physician will work together to find therapeutic types and doses of insulin that will work for you. If, for example, a dose of insulin is thought to be effective for up to eight hours, and this eight-hour period ends sometime during the night, without replenishment, your blood sugar might fluctuate back to pre-insulin absorption levels.

Or, if not enough insulin has been taken before bedtime or dinner, gradual blood sugar elevation might result as the night progresses.

To remedy this, check you blood glucose levels at about 3 a.m. for a few nights in a row to detect patterns, and discuss a medication plan with your physician (to insure adequate coverage throughout the night). You and your physician may decide to adjust your insulin dosage before dinner and/or bedtime to compensate for the insulin deficiency that may occur during the night; this may be in the form of a higher dose, or a supplemental dose before bedtime.

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