A 15-year-old patient with DMI reports increased blood glucose in the morning. What adjustment should be made to their treatment?

In the scenario presented, the patient experiences increased blood glucose levels in the morning, a condition often referred to as the "dawn phenomenon." This occurs as counter-regulatory hormones (like cortisol and glucagon) rise in the early morning hours, leading to increased hepatic glucose production and subsequent elevations in blood glucose levels.

To manage this situation effectively, increasing the bedtime insulin dosage is a common and appropriate strategy. By increasing the insulin administered at bedtime, it helps the patient to better control blood glucose levels during the night and into the morning, addressing the elevated fasting blood glucose.

While decreasing the morning insulin dosage would not resolve the underlying issue and may lead to further increases in blood glucose levels, switching to oral hypoglycemics is not typically used in Type 1 diabetes management, particularly for a young patient like this. Changing to a low-carb diet may help with blood glucose control, but it may not be sufficient on its own to address the hormonal changes that happen overnight. Therefore, adjusting the bedtime insulin dosage is the most direct and effective way to manage the increased blood glucose in the morning.