November 16, 2000
Hypoglycemia
Question from Klamath Falls, Oregon, USA:
I have had type�1 diabetes for 17 years and just got on new insulin (Ultralente instead of NPH). I tried supper Ultralente and bedtime Ultralente. My blood sugar at 3:00 am is low and I have to eat. At 5:30 am, it is low again, and I have to eat. By breakfast it is usually around 70 mg/dl [3.9 mmol/L]. I went from 10 Ultralente to 5 Ultralente and have the same test results. I can’t sleep because of being scared of not waking up. I have been as low as 23 mg/dl [1.3 mmol/L] at 3:00 am. Do you think I could just take the Ultralente in the am and no Ultralente at bed? I cover all food with Humalog except my bedtime snack.
Answer:
It sounds as though you were placed on Ultralente insulin, and I’m not sure you ever had satisfactory control. However, Ultralente is tricky to use for several reasons. It has a longer duration of action than does NPH. That means when the dose is changed, you may experience a delay in any observed change in your blood sugars. In addition, I tend to use two shots a day because one shot infrequently is adequate for all basal needs. Finally, there is a point during the crossover from NPH to Ultralente where there is NPH on board with Ultralente which can cause the blood sugars to fall. I would try and get some help with your physician on this.
JTL
