My 75 year father-in-law old has had type�2 diabetes for 25 years and takes two pills each day in addition to 70/30 insulin each morning, but his blood sugars have been ranging from 250-275 mg/dl [13.9-16.1 mmol/L] at 5:00 pm and 9:00 pm. His daughter was told to give him 70/30 instead of Regular insulin to bring it down. Could you clear up this question, or tell us where we might can find help?

You have to realize that in answering this question, I am biased against using commercially mixed insulin combinations such as 70/30 insulin. My feeling is that it is fairly easy to mix insulins into the same syringe. This care issue can be easily taught and reenforced. Only patients with visual problems and mechanical problems using their hands should have difficulty mixing.

In addition, the use of pre-mixes brings up the issue about what insulin to take in the face of a high sugar. The correct response should be to use a rapid-acting insulin only and not the mixture with NPH in it — using a pre-mix will cause a peak in insulin action 8-12 hours later, which may or may not be appropriate in the management of his sugars. My suggestion is to get your father-in-law on a regimen in which the insulins are mixed at home, and have a plan to use supplemental rapid-acting insulin with high sugars.

JTL