An 8-year-old boy with type 1 diabetes has been receiving NPH and regular insulin. His mother calls the nurse and explains that the child's morning blood glucose readings have been above 200 mg/dL. What should the nurse advise the mother to do?
1. Raise his NPH dose by two units to cover the elevation in the early morning.
2. Change the time of the night dose to 1 hour before sleep.
3. Do blood glucose checks during the night.
4. Keep a glass of water near the bed to dilute the sugar levels during the night.
Rationale: (3)
The child is having a rapid decrease in his blood glucose level during the night, causing a hyperglycemic rebound response. The rebound rise in the blood sugar reading is picked up in the morning blood glucose reading, which can lead to misinterpretation. This may be classified as a Somogyi effect. (Hockenberry, Wilson, 9 ed., p. 1603.)