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Question:

From Florida, USA:

I am Type 1 diabetic and have been for 38 years. I recently was put on Humalog and Ultralente. My morning blood glucose is always over 230 mg/dl [12.8 mmol/l]. I take 20 units Ultralente at dinner, and sliding scale before each meal of Humalog, and count carbs. Which one would you suggest I increase and when?

Answer:

It is important to work with your physician to try and work out the best balance of food, insulin, and exercise. If the "formulas" you are using aren't obtaining the blood sugars you want, you have to try and come up with new "formulas".

A few suggestions:

  • Until you have established the formulas and how sensitive you are to lispro insulin [Humalog®] and "sliding" scales, you may first want to optimize your control on a more rigid schedule and then see if you can be more flexible. What I mean, is you might first want to try and eat the same amount of carbohydrate at the same time every day for a while and establish how much Humalog you need at each meal. Then you might want to try changing the carbohydrate at one meal at a time and see if the "formula" you have worked out for how much insulin you need per gram of carbohydrate really works. (Some people can come up with formulas that work, others have a harder time coming up with formulas to allow day to day variation.) You might also want discuss with your doctor cutting back on your sliding scale for a while, perhaps covering with smaller amounts of Humalog only for blood sugars over 250 or 300 (and then readjusting your insulin the next day to try and prevent the highs).

  • You want to adjust your "basal" insulin so you wake up with a lower blood sugar. Possibilities to consider include splitting your total Ultralente into 2 equal or nearly equal doses, before breakfast and in the evening (either before supper or at bedtime), and/or adding a small amount of Lente in the evening if the blood sugars are increasing from 3 A.M. to dawn.

  • Some people find that Humalog may improve the blood sugars a few hours after meals, but the blood sugar may then increase later before the next meal. Sometimes splitting the "fast acting" pre-meal insulin into part Humalog and part Regular helps.

It is important to work closely with a physician to help you work out the details. It may take some "trial and error" before you come up with the best routine. It is worth the time and effort if it improves your control.

TGL

Original posting 12 Jul 97

  
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Last Updated: Tuesday April 06, 2010 15:08:54
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