Evening Rise as opposed to Dawn Rise

Does anyone else have a child that seems to require more insulin later in the day? My 2 year old son trends higher later in the afternoon and into the night. This seems like the reverse of what most growing children experience. His highest basal rate runs from 12 noon to midnight. His carb. ratios right now are the same throughout the day but for dinner and snack it still seems like it needs to be higher than what he gets at breakfast. It might be that he is eating more protein later and this might be having some delayed effects on his BG. Does anyone else find this to be the case and if so how do you manage this issue?

hmmmm I’ll watch for this in my 2 year old. Seems to be true for her as well. She does get less insulin at breakfast than lunch or dinner right now. I don’t have a clear pattern as we are fighting an ear infection right now. Good luck

Thanks. I hope she starts to feel better soon. Let me know if you really are seeing that trend also.

Hi Natalie, for my son, it’s the same thing. He gets a lot in the afternoon (around 1 or 2) for 2 hours, then around 7 it’s way up until midnight. I asked his endo because I only heard about the dawn phenomenon and she told me that some younger kids tend to need more at nighttime as opposed to older (teenage years and on) when it’s going to be around 3 or 4 AM that he will need more insulin. His basal rates seem to be working good, but of course protein and fatty foods for dinner don’t help when he eats them…

Dawn Rise is true mostly for adult diabetics, probably teens. Children have a different pattern. Most children rise evenings 9pm to 12, after they fall asleep. There has been a drop noted in children from 2am to 3am into the early morning hours. I would try to get my information from a book written for Type 1 children, “Type 1 Diabetes,” by Ragnar Hanas rather than taking it from the John Walsh book “Pumping Insulin,” though both are must haves. Regardless of the pattern most children exhibit, your child will exhibit their own pattern. For instance, Erin starts climbing around 6pm, sharper rise still at 7pm, with time of greatest need 9pm to 12pm. 12 to 2am matches her need from 2pm during the day, and there is usually a drop anywhere from 1:30 a.m. to 3 a.m. until 7 a.m., whereupon she is insulin resistant in the breakfast and early morning hours. I can see her pattern changing now, at 12 years, vacillating between pattern mentioned and a rise from 3am to 7am. She is going back and forth between the adult and child pattern. Many nights, there is no pattern at all. Interesting, but extremely exhausting. I would watch and document your own child’s patterns and needs. A rise from noon to midnight is normal, I think, with the sharper rise in the evenings. It is so great that your child has a consistent pattern. And great that you are noticing it and comparing it but in the end you have to go with what you observe and document. If you can basal test evenings one day and probably you can get overnights many days so you get his basals as stable as possible first, then you can go over the insulin to carb ratio and give him more when he needs it. Insulin to carb ratios do not remain the same at every time of day. Ours are currently (they are tweaked, as needed) 1 to 8 break; 1 to 14 lunch and 1 to 13 dinner. They have never changed at breakfast (1 to 8 for quite some time), but lunch and dinner changes all the time. It was 1 to 10 for years; now it vacillates. P.S. No to the protein having delayed effects on BG, at least for us, but watch out for the fat content. Fat will delay digestion of carbs causing a possible spike later on which can last for hours.

Thank you for your insight. I will look up that book.I am so happy that I have this site to use as a resource. I communicate well with his Diabetic Nurse but she never really mentioned a child his age having an evening rise as opposed to a dawn rise like most teens or adults. It was driving me crazy. He seems to need the highest basal rate later in the day, but maybe not as high of a carb. factor. His basal runs low after midnight. Then in the mornings his basal is a little higher (but not as high as evening) but seems to need more carb coverage. We have had a good stretch here for a while. His average BG has been better and he seems good with about a 45-50% basal to 50-55% bolus setting. I think I do need to up his carb. factor at breakfast though. He still spikes pretty high sometimes after breakfast even with us giving him his breakfast bolus ahead of time and I sometimes have to give him a high correction mid morning so he comes back down to a normal range before lunch. My usual clue that he is “flying high” is he becomes a complete maniac and is tearing up the house and then asks for a “drink and a tic tac.” I am anxious to see what his next A1C is at his upcoming appointment in April. I am hoping it has come down a bit from 8.5%, or at the very least hasn’t gone up, which I would be surprised at that. I know what you mean about the fat content also. We see that happen with pizza. We try to just make pizza at home with a store bought crust and put our own toppings on. It is easier to count the carbs, but he still has problems with a spike later. I have been meaning to try the dual wave bolus for that to see of it helps. Do you use that much? Does it work well for your daughter?

I am continually shocked that CDEs and some endos do not know the child versus adult pattern. Most important, though, is that you, who are checking his BGs so many times a day, document in a log of some kind what is happening. It could be manual (we keep our logs open near the kitchen counter), as well as download through Carelink. Endos who try to force a 50/50 basal/bolus pattern upon a child (when a lot of young children use 38 to 40 percent basal) or advise to watch for “Dawn Phenom” in such a young child… I don’t get it. It doesn’t really matter if every other child in the whole world has high BGs from 3am to 7am. It only matters what your child’s pattern is, what his body does. And since endos and CDEs only analyze the numbers every three months or so, it is your judgment and intuition (based on daily observation and careful records) that you need to listen to. Most likely you will see a daily pattern, and I can tell you from your first post, that I think your observations are correct. Unfortunately, so unfortunately, although the pattern tends to stay the same (with minor variations, there are also sub-patterns), the insulin keeps needing adjustments. Things never stay the same. Pasta used to spike her but now I get Quinoa pasta (in the turquoise box) from the health food store. Tastes very similar to regular but I actually have to give her ten free grams and then feed the insuln later; no spiking. Pizza, she will still only eat one slice, I give it with fruit to avoid the low, then high. I use a 60/40 bolus (remember, there is fruit or fruit juice so it is higher up front than some). I use a two hour dual wave bolus on our Minimed pump. If she is high after three or four hours, I just use an increased temp basal. She does not stay high from pizza more than six hours. Doesn’t always work perfectly, but it works better than a straight bolus where she goes low, then high, then high again. Main point is listen to your gut, educate yourself as much as possible, keep good records. There are times when there is no pattern as far as high and low blood sugars go. If you see a trend (high or low) on one day by the third high or low number, I will increase or decrease temp basal and check BS more often to keep her in range. Every time we have asked the endo for help, her judgment is good, but it was an incorrect guess. Breakfast, they generally will always need more insulin for what they eat. And, call me Scrooge, but cereals are out in our house at breakfast. She will spike into the 300, 400s, not worth it. She often will eat cereal for desert, with her after-school snack or after dinner. I never give cereal alone, to avoid spikes, but after a protein, veggie, etc. meal. She is my neice, not daughter, but I do most of the D care due to her Mom’s work schedule. Her Mom now has off all weekend and does three days in a row but that is recent. I got into the habit of doing all the basals, testing. If her Mom thinks she needs adjustment, she does a temp and tells me to check for a permanent change. We change so often, though, almost daily, either one of us could do it.