Answer 1 is incorrect. 17.81% chose this answer.” Add basal insulin glargine to prevent Somogyi effect.” If a person is using insulin pump therapy, glargine injections would not be added in addition to the pump therapy. In addition, no basal insulins (like glargine) are used in pump therapy, only bolus insulins. Lastly, Somogyi effect is defined as a hypoglycemic event that triggers a burst of counterregulatory hormones that causes a substantial increase in blood glucose. There is no evidence that the person is experiencing hypoglycemia in this scenario.

Answer 2 is correct. 60.30% of you chose this answer. “Increase the basal rate to prevent glucose elevations.”   YES, this is the best answer. LS is most likely experiencing Dawn Phenomena, which if the natural rise in blood sugars starting around 3-4 am due to the early morning release of cortisol and growth hormones.  By increasing the pump’s basal rate to match this insulin resistant phase, we can help LS get blood glucose closer to target.

Answer 3 is incorrect. About 15.77% of respondents chose this. “Make sure LS isn’t consuming carbohydrates after 10pm.” This juicy answer does not explain why LS’s blood glucose always rises at 4am.  Also, people with diabetes have the freedom to eat carbohydrates throughout the day and evening, they would just need to provide adequate bolus insulin coverage for late night carbs.

Finally, Answer 4 is incorrect. 6.12% chose this answer. “Ask LS to double check their CGM insertion site.” Since we can see a pattern of blood glucose levels rising each day at 4am, we assume that the CGM working correctly (we can always double check using a glucose meter to confirm)

We hope you appreciate this week’s rationale! Thank you so much for taking the time to answer our Question of the Week and participate in this fun learning activity!