Question from East Lansing, Michigan, USA:

I’m 27 and have been a type 1 diabetic since 1999. For the first couple of years, staying in control was relatively simple, but now it seems difficult. I have never had to have assistance from a low. I am still able to get juice/etc. myself even when I’ve been as low as 25, but I seem to hit 300 to 400 mg/dl [16.7 to 22.2 mmol/L] fairly often, at least a few times a week. My A1c is always around 6.5 to 7.5, but my blood sugar averages are generally in the high 100s to mid 200s [about 10.0 to 13.9 mmol/L]. I test about eight times a day.

Part of the problem I face is determining how much insulin I need for any given meal. It seems hopelessly random, so I don’t bother counting carbohydrates anymore. What’s the point if sometimes the same sandwich takes seven units of Humalog and sometimes it takes more than 20? I’m on 30 units of Lantus each day, which I know is the correct dosage because my sugars don’t move at all if I don’t eat anything, and then take Humalog before meals, usually a random guess at, say 12 to 15 units. I then test an hour later to see how much more is needed as a “chaser”. My endocrinologist, who is very highly respected and head of the department, says I’m doing quite well, but it sure doesn’t seem like it when I read up on things on-line. I just can’t imagine that random dice throwing to determine Humalog injections is the right way to go. But again, even when I chart out times of days and food diaries and identical carbohydrate meals, there is no correlation between what I intake and the insulin needed to counter it. How can I get in better control?