What should a patient with type 1 diabetes do if their morning glucose levels remain high despite insulin adjustments?

When a patient with type 1 diabetes experiences persistently high morning glucose levels, checking glucose levels between 2 am and 4 am is essential. This time frame is crucial because it can provide insight into nighttime glucose trends and the potential for nocturnal hypoglycemia or insufficient insulin action while the patient is asleep.

If the blood glucose levels are found to be high during this period, it may indicate inadequate basal insulin coverage during the night, leading to elevated morning readings. Conversely, if levels are low or dropping during these hours, it suggests that the evening insulin dosage may be too high, causing hypoglycemia followed by a rebound effect resulting in higher glucose levels in the morning.

Understanding nocturnal patterns is key to managing fasting hyperglycemia effectively. It allows for small, targeted adjustments to the basal insulin, whether that involves increasing the evening dosage or altering the timing, rather than making premature changes to the morning insulin regimen or relying solely on fasting blood tests. Thus, monitoring glucose in the early morning hours provides critical data that can directly inform further treatment decisions to achieve better overall glucose control.