I am 17 and have had diabetes for 13 years now. I have recently switched from R to Humalog. I have found that when I have a meal with protein my sugars go high and stay high for most of the day. When I skip the protein my sugars are in the 5-7 mmol range, which is perfect!

My usual insulin dose is: 7�A.M. 1H per 6 carbs – 11�A.M. 8N – 12�P.M. 1H per 7carbs – 5�P.M. 1H per 8 carbs – 10�P.M. 1H per 8 carbs and 11�P.M. 5N. I have tried to increase the H but then go low in about an hour then high the rest of the day.

I benefit from the Humalog because I also have Esophageal Reflux Disease and there isn’t really a way to guess how much I’ll be able to eat till I’ve eaten it. Should I just skip the protein and have it in between meals or should I consider having the Humalog and a little R after each meal? What would be the best way to keep my sugars down?

It is clear that you are trying very hard indeed to be in immaculate control of your blood sugars and I am sure that this is reflected in your Hemoglobin A1c levels. At the same time I think that you have set yourself an unnecessarily complex regimen of insulin administration with six shots a day when three or perhaps four could give you similar results. You also write as though protein and carbohydrate were interchangeable alternatives whereas you certainly need both. I assumed that when you referred to ‘carbs’ you were referring to grams of carbohydrate and not to 15 gram units of carbohydrate which some people do. If this is so then you will be getting quite a big dose of insulin on the non-protein/high carb diet and with it good control of blood sugar. When you take protein however I assume you try to keep total calories the same which will mean that you give yourself less carb and therefore less insulin, which may be why the blood sugars are higher.

I think you need some help from the endocrinologist in your care group with whom you could develop an insulin regimen that for example depended on morning Humalog+/- Regular and Ultralente, midday Humalog+/-Regular and before supper Humalog+/-Regular and again Ultralente.

In view of the problems you also have with oesophageal reflux and a consequently variable food intake you might find that you get better control with Humalog immediately after the meal so that the dose can be adjusted for the pre-meal blood sugar as well as for what you actually consume. You might consider the purchase of a GlucoWatch after the FDA gives final approval, hopefully later this year, a device that would give you close and no-invasive control over blood sugars.

Finally I think you need some sessions with an experienced nutritionist who could explain the necessary components of the Recommended Dietary Allowance and the relationships of insulin to ‘Carbs’ and on the basis of a three day diet record work out a diet that will provide both good nutrition and good control.

DOB