My father is taking oral medication and insulin. He takes 27 units in the morning and seven to 10 units of NPH at night. His doctors said we should not be using a sliding scale and that I should not give my father more than his normal one pill per day because his kidneys are bad. Sometimes, I also give my father Regular insulin.

What do you think I should do? I will be taking my father to his internal medicine doctor in less than 30 days.

It is not a good idea to vary the NPH dose at night. Since the NPH peaks in 8 to 12 hours, the sugar at bedtime may or may not reflect what it will be when the NPH begins to peak. Giving intermittent Regular insulin for high sugars for the purpose of getting the sugars down is okay. However, if you have to give supplemental all the time, it raises the questions as to whether the baseline insulin should be increased. It is true that some medications cannot be used if kidney function is impaired. I would suggest you request the level of his most recent hemoglobin A1c as this allows the determination of his average blood sugar over time. This will help to determine whether therapy needs to be intensified.

JTL