April 24, 2001
Insulin Analogs
Question from Savannah, Georgia, USA:
I am a 27 year old female with type�1 diabetes for six years, and for the past six months, my fasting blood sugars have been hovering around 200+ mg/dl [11.1 mmol/L]. I am currently taking NPH in the morning and at bedtime and have just recently switched from Ultralente to NPH. Neither long acting insulin has been able to control the fasting blood sugars. On occasion. I awaken during the night to check my blood sugar, and it is usually 65-110 mg/dl [3.6-6.1 mmol/L]. So, an increase of my usual dosage is not possible without the fear of hypoglycemia.
My doctor has mentioned Lantus (insulin glargine) as a possibility. I am quite concerned about my higher blood sugar numbers. My A1c results usually range between a 5.8 and 6.4%, but a recent one was 6.9%. I do know that the latest result is still okay, but for me it is quite a change.
In my type of situation, high fasting numbers, would Lantus be a good thing to try?
Answer:
Lantus (insulin glargine) could be a good option for you. However, I think that your overnight blood sugar profiles are mainly due to too much Regular before supper, the concomitant morning NPH, and an insufficient dosage of NPH/Ultralente at bedtime. Consequently, your elevated fasting values result from subclinical lows before 3 am. That is also mirrored by your hemoglobin A1c levels of around 6%. In fact, the A1c is an average of blood sugar levels over about 90 days, and, in cases like yours, it is can be misleading.
Good luck with your glargine choice, remembering that knowledge and self management ability are indeed most valuable with every insulin regimen in achieving good metabolic control and the best quality of life.
MS
