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July 29, 2001

Daily Care

Question from Raleigh, North Carolina, USA:

I am 28 years old, have had type 1 diabetes for just under 20 years, and I have been on an insulin pump (of one kind or another) for about 15 years. From the time I was diagnosed through high school, college, and into my professional career, I have generally had fairly tight control over my diabetes. My blood sugars were always in pretty tight control, and my hemoglobin A1c's were great, but in the past year or so, I have not been able to stay in control. For the past year, I have had sky-high sugars for a day or more, and then I will drop way low and not be able to recognize it at all. Additionally, my A1c's have not been good at all. Are there any suggestions on what I can do to get back on track? How can I give my doctor enough information to help him help me get there?

Answer:

This is a tough question. Presumably, you are informed about lifestyle habits which will impact your control level. Is your insulin source okay? Are you using Humalog or buffered Regular insulin? You may want to try a switch from one from the other.

You may even want to ask your physician if you might be hospitalized for a 24-hour period and utilize an insulin infusion for 24 hours to see if your requirements are similar to those in the past. In some individuals, insulin requirements change over time and periodic changes need to be contemplated and carried out. If you cannot have 24 -hour intravenous insulin, you may consider a detailed reevaluation of basal rates in which you split day into three time periods and see if your basal rates keep sugars in good control over each of those time points. You may also want to examine your bolus insulin. A 50:50 split in basal and bolus insulin is what is usually expected. Are yours close to this or do you find you giving one form over the other? Please work with your physician to troubleshoot your control.

JTL

[Editor’s comment: Your situation might well be clarified by monitoring sugar levels continuously for several days to try to sort out what’s happening in more detail. See The Continuous Glucose Monitoring System. Ask your physician about using it.

SS]