October 12, 2000
Daily Care
Question from Laconia, New Hampshire, USA:
I am now 26 and have had type 1 since I was eight. I try hard to keep my diabetes under control. My HbA1c levels are under 7% but I can’t seem to get my fasting sugars down. They are inconsistent, sometimes high, sometimes normal (80-120 mg/dl [4.4-6.7 mmol/L], and are currently around 200-275 mg/dl [11.1-15.3 mmol/L]. I am taking Ultralente at night and in the morning (15 at night, 18 in the am). I have tried increasing my morning dosage, but doesn’t seem to affect my sugars. Can you please help?
Answer:
The problem of persistent hyperglycemia before breakfast on Ultralente insulin is not an unusual problem. In roughly a third of patients on Ultralente, there is a need to give some additional insulin which peaks in the am, corresponding to the increased insulin resistance which comes with the early morning. There are several options. These include adding a dose of NPH at night before bed or switching away from Ultralente entirely. In short, there are solutions to your problem. I would recommend speaking with your physician caring for your diabetes for the best choice.
JTL
Additional comments from Stephanie Schwartz, diabetes nurse specialist:
You might also explore the possibility of an insulin pump. You can explore a lot about it by looking at Is pumping for you?.
SS