August 28, 2001
Question from Cairo, Egypt:
There is a 63 year old patient with type�1 diabetes for years and a hepatitis C infection, and the doctor advised her to use twice daily premixed insulin. However, with this regimen, she has hypoglycemia (46-52 mg/dl [2.6-2.9 mmol/L]) before breakfast and hyperglycemia (220-320 mg/dl [12.2- 17.8 mmol/L]) afterward. What’s your advice?
First of all, let me repeat once more that premixed insulins are not the best way to treat any insulin requiring patient because blood sugar swings are the rule when using them, and it’s always very difficult to establish good metabolic control. My advice would be to switch that patient to a regimen with Humalog or Novolog before each meal and NPH or Lantus (insulin glargine) as basal insulin. Please discuss this option with her doctor.