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September 1, 2019

Daily Care

Question from :

My adult son takes 40 units of Lantus insulin each night as basal and one unit of NovoLog for every 15 grams of carbohydrates. However, he has missed a few doses each month and not taken NovoLog regularly for the past two months, I am now finding out. Today, he checked his blood sugar and it was 260 mg/dl [14/3 mmol/L]. He ate and drank and took NovoLog and now has had a constant sugar of in the 50s mg/dl all day. I am coming home to this now. I made him eat and drink to get his blood sugar up but I am concerned to say the least. Do I need to take him to the hospital?


From: George Grunberger, MD, FACP, MACE

There is no need to go to the hospital. Just make sure he eats or drinks 15 grams glucose (4 oz fruit juice, or 1 slice of bread or 3 glucose tablets), rechecks his blood sugar in 15 minutes and if he is still below 70, repeat with 15 grams glucose. It sounds like he needs to see an endocrinologist to set an appropriate insulin regimen (e.g., basal insulin, such as Lantus, to make sure his blood sugar is within the target range in the morning and then appropriate pre-meal coverage with bolus insulin, like NovoLog, to make sure meals are covered but not so much that sugar will go low after meals).