March 14, 2005
Hyperglycemia and DKA, Insulin
Question from Victoria, British Columbia, Canada:
I have had type 1 diabetes for over 10 years and recently have been struggling with my fasting sugars. I’m on a sliding scale, with Humalog before meals and NPH before bed. My sugars can go as high at 25.5 mmol/L [459 mg/dl] around 7 a.m. Often, at 3 to 4 a.m., it is anywhere between 2.8 and 7.0 [50.4 to 126 mg/dl] when I test it. I’ve tried a variety of combinations, no snack, with snack, NPH varying times (later, then earlier) and anywhere between 7 to 12 units of NPH with similar results. I exercise regularly, but always in the day time. I’ve also recently ceased taking the birth control pill. What do you suggest for me?
Answer:
Although it is not always necessary, I prefer to use morning and evening NPH insulin with Humalog. The reason for this is that the Humalog goes away between meals and is not as long-lasting as regular insulin is. To that end, you may want to consider a morning NPH insulin dose at a smaller dose than your evening dose and increase your evening bedtime NPH to titrate to a fasting glucose in the target range. Please discuss these changes with your physician before making any changes on your own.
JTL
