From Yuan-Lin, Taiwan, R.O.C.:
I'm a 26 year old male who has been diagnosed with Type 1 diabetes for 13 years. I've been living in Asia for the past several years and have had limited contact with my physician in the U.S.
Recently I've been to a hospital to have the 'usual' yearly check up, blood work, etc. The results were within the normal parameter, including a glycohemoglobin result of 7%.
My insulin doses for a number of years have been 15 units of Ultralente and 10 units (plus or minus) of Regular at breakfast and dinner, and a dose of 10 R (plus or minus) at lunch. These have worked adequately for me.
The doctor I spoke with found it odd that I would take that much Ultralente per day, stating that the lasting effect of Ultralente is up to 48 hours and the overlapping periods did not make much sense. In addition, he stated that when mixed in the same syringe with Ultralente, R response is sometimes delayed.
His suggestion for 'physiological benefit' was to take a single Ultralente dose prior to bed and adjust the 3 daily doses of R according to blood sugar levels. This would mean an additional injection per day, but if the benefits are worth it, I'm willing to try.
I'd warmly welcome any opinions or suggestions that your staff may have concerning the doctor's remarks.
If your hemoglobin A1C is good and the schedule you use seems to be working well, I see no reason to change it. Although it is true that human Ultralente can last more than 24 hours, giving it in 2 divided daily doses is actually more "physiological" in many people than giving one dose at bedtime. The purpose of the 2 daily doses of Ultralente is to provide "basal" insulin requirements, the relatively constant amount of insulin needed by the body during entire 24 hours day even when no food is eaten. The purpose of the regular before meals is to provide insulin to match the food you eat. On an average, the total daily dose of Ultralente is usually between 40% to 60% of the total daily dose of insulin (your total daily dose of Ultralente is 50% of your total daily dose of insulin.)
Although it is true that there can be some slowing of the action of Regular when given in the same syringe as Ultralente, this is usually minimal and not clinically significant if the insulin is given within 10 minutes after drawing it up. (Even if not given in the same syringe as Ultralente, regular may take too long to work to adequately take care of insulin needs before meals which is why lispro insulin [Humalog®] was developed.)
[Editor's comment: The doctor also suggested that you "adjust the 3 daily doses of R according to blood sugar levels." I strongly urge all patients and physicians to reconsider this approach, and consider adjusting the dose of R (or lispro) based primarily upon the amount of food (carbohydrate) you're about to eat. WWQ]
Original posting 27 Sep 97
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