I have type 1 diabetes, diagnosed almost a year ago (while I was pregnant), but I am thankfully still in my honeymoon. I was just switched from NPH morning and night (about 12 units total with Humalog to cover meals) to 10 units of Lantus at night, and it doesn’t seem to be working very well. I just can’t seem to get my fasting blood sugars below 130 mg/dl [7.2 mmol/L] whereas on NPH I was usually in the 90s mg/dl [5 mmol/L], which I felt was fine. I have tried adjusting my dose anywhere from 8-2 units, but it doesn’t help. With 8 units I wake up at about 160 mg/dl [8.9 mmol/L], and with 12 units, it’s the same.

I don’t know if a pump would help, but I do know that my doctor already mentioned she is hesitant to start me on one until I am completely insulin dependent (for insurance reasons maybe?), and at this point all my C-peptide tests show that I am making “some” insulin, just not “enough”.

I have an appointment with my CDE in a few days, and we will most likely be going back to NPH or another long acting insulin now. I am fairly disappointed because Lantus seemed so appealing to me — especially the “peakless” action. I was hoping that at last I would be free from being a “slave” to my insulin — not having to carefully time my meals and snacks to avoid lows. Are there some people out there who don’t respond well to Lantus?

Lantus (insulin glargine) has some different peaks in different people. This must be learned individually by a lot of blood glucose monitoring and good detective work. We have some folks who still need small doses of NPH during the day. We have others who seem to need Lantus at other times besides just bedtime. So, more careful analysis may provide some of the answers you are seeking.

With regard to whether or not you are a candidate for insulin pump therapy, this too should be determined by your blood glucose goals, and your difficulties in reaching them. It may be an excellent way for your control to be improved or sustained, but you should keep talking to your diabetes team in more detail to answer these questions for you.

You may want to visit some of our Chat Rooms and the Insulin Pumpers site to learn more about pumps from those who use them. There are also many good books about use you may want to look at. See our section on Insulin Pumps.

Getting an opinion from another diabetes team may also be helpful, if you feel that your team is not listening to you, and you cannot get their attention to answer your questions.

SB

[Editor’s comment: If you C-peptide is in the lower range of normal, and you are having difficulty with control (i.e., fluctuating blood sugars, high hemoglobin A1c values, frequent hypoglycemia, etc., you are eligible for a pump according to the criteria set by most insurance companies. Please also see Is pumping for you?
SS]