I lived in Australia for 10 years, and after speaking with an endocrinologist here in the US, I have recently changed my insulin from Actrapid (Regular) with Protaphane (NPH) to a sliding scale of Humalog and Lantus prior to breakfast. I am having troubles though with my control, especially upon waking in the morning. For the last week, my fasting blood sugars have been around 330-400 mg/dl [18.3-22.2 mmol/L], but during the daytime, my sugars range 80-150 mg/dl [4.4-8.3 mmol/L], and my control is really quite good.Can you suggest a solution? Can you please tell me where i can go to find out as much as possible about the amount of insulin I should take for a particular amount of carbohydrate?

The standard of care requires that you find a physician who can follow your sugars with you. There are several good endocrinologists in your area who can help you with this.

Your amount of Humalog per unit of carbohydrate is determined by your activity,diet, underlying insulin resistance, and other factors. To give you a specific dose is not appropriate. As far as your sugars, you may want to try taking the Lantus (insulin glargine) in the evening, although that may not help. An additional issue is to look at the relative balance between long-acting insulin and the short-acting insulin. This is really where a physician should help you.

JTL

[Editor’s comment: You will find Stop the Rollercoaster by John Walsh and Pat Roberts most helpful in helping you adjust this new regimen.

SS]