July 1, 2015
Daily Care, Insulin
Question from Rajkot Gujarat, India:
I have had type 1 for 35 years. I take Actrapid and Insulatard. My fasting blood sugars are between 300 mg/dl [16.7 mmol/L] and 350 mg/dl [19.4 mmol/L]. After dinner, my blood sugar was 220 mg/dl [12.2 mmol/L] or 160 mg/dl [9.9 mmol/L]. Can you advise me about what I should do?
The best way I can explain your results is to remember that the most important number in diabetes management is the HbA1c. All the outcomes for diabetes complications have been associated with this value. The HbA1c indicates your average blood sugar for the last three months. Your individual blood sugars vary a great deal from day to day. However, you use glucose monitoring to get your HbA1c going in the correct direction, eventually. The American Diabetes Association recommends all patients with diabetes keep their HbA1c below 7%. This means targeting your blood sugars to values below 140 mg/dl 7.8 mmol/L]. If you are not there now, then interval steps need to be taken to improve this. Given your question, your blood sugars in the morning are very high and you need to talk to your doctor about increasing the long-acting insulin. How much you do this and when it should be given are questions that should be answered by your doctor. The other blood sugars at dinner are also high, but the adjustment for that also needs to be discussed with your doctor. I am sorry I cannot just give you some easy recommendations, but treatment of your blood sugars is based on your sugars, your activity, and your diet. These all come into play and should be a point of discussion with your doctor when your treatment is discussed.