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March 6, 2005

Blood Tests and Insulin Injections, Insulin Analogs

Question from Madisonville, Tennessee, USA:

I am on the NovoLog FlexPen for pre-meals, and on Lantus, 21 Units at bedtime. To determine my NovoLog dose for breakfast and lunch, I divide the number of carbohydrates by ten, then add more insulin if my blood sugar is high. At dinnertime, it is divided by 8. My specialist wants me to use the 8 + 1 = 6 per for dinner, plus a scale of 1 unit per 30 mg/dl [1.7 mmol/L] over, instead of 1 unit per 50 mg/dl [2.8 mmol/L] over. My problem is, and I've tried it twice, to satisfy them each time, I make the increase the way I am asked, my sugars steadily increase taking me over the 300+ mg/dl [16.7 mmol/L] mark, and I was hardly ever that high! The increases makes it happen. They disagree and say it isn't possible. I'm testing four times a day and also logging all this, seeing the increase in blood sugar, without changing my meals. I don't know what to do. The increases are not bringing me down, but up. When I lower my insulin dose, my blood sugars eventually come back down. What do you suggest?

Answer:

I’m not sure what is going on. When are you greater than 300 mg/dl [16.7 mmol/L]? If you are testing four times a day, then you probably are not testing two hours after eating. The best way to judge a pre-meal insulin dose is to test before the meal, when you should be less than 120 mg/dl [6.7 mmol/L], and two hours after the meal, to see if you are less than 140 mg/dl [7.8 mmol/L]. Why don’t you try that a few times and see what happens?

JS