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September 23, 2001

Insulin Analogs

Question from Jefferson City, Tennessee, USA:

I will turn 30 next month, and I was diagnosed with diabetes (possibly type�1) last week after experiencing blurry vision and other common symptoms. I am taking a fast acting insulin before meals according to my readings and I'm taking 10 units of Lantus at bedtime. My reading is great in the morning (under 110 mg/dl [6.1 mmol/L]), but goes up before lunch and before bedtime (usually around 250 mg/dl [13.9 mmol/L]). What I eat does not seem to affect my readings at all, and I am very confused about this. Will taking more Lantus at bedtime help regulate me? Is this a sign that the Lantus is not working? Is it common to have jumps in levels without eating anything to cause it? Will it eventually be regulated?

Answer:

When you indicate that the sugars are not affected by what you eat, I assume you are taking postprandial blood sugars. This is the best way to match your food with the appropriate insulin dose. Unless you have done this, there still remains the possibility that the Humalog (rapid-acting) insulin is not dosed high enough. If postprandial blood sugars are greater than 140 mg/dl [7.8 mmol/L], than the next step would be to increase the Lantus (insulin glargine) dose, while making sure you have no hypoglycemia at other times. It is recommended you discuss these issues with your physician.

JTL

[Editor’s comment: I agree with Dr. Lane. You seem to be “chasing your blood sugars” rather than basing your rapid-acting insulin on food intake. You need to meet with a dietitian who understands diabetes to learn the principles of carbohydrate counting and insulin to carb ratios.

SS]