How can we manage high blood sugar levels in a patient with diabetes using Insulin therapy?

Question

Hello doctor,

I am a 32 years old diabetic patient weighing 75 kilograms. I am on an Insulin regimen, as given below. I take Human Mixtard 70/30 Suspension for Injection 100 IU/ml, 25 units before breakfast, and 35 units before dinner and Human Actrapid 40 IU/ml, 5 units before lunch, and 5 units in the evening. My sugar levels are as given. I have fasting blood sugar of 90 mg/dL, before lunch, 250 mg/dL, after lunch, 250 mg/dL, before dinner, 250 mg/dL. Kindly advise what I should do. Thank you.

Answer 1

Hello,

Welcome to icliniq.com.

Analyzing your query, I have noticed one thing regarding the type of Insulin you are using. You are using mixed Insulin two times a day and regular Insulin once in the evening. Still, your before lunch and dinner sugars are high. You have not mentioned any usage of oral drugs. So for all practical purposes, I consider you are not using any oral antidiabetic drugs. (Consult your specialist doctor, talk with them and take medications with their consent.) In these kinds of cases, it is advised to use basal-bolus treatment. One-time basal Insulin bedtime is recommended with Insulin Glargine and three-time meal-related rapid-acting analogs such as Insulin Aspart or Glulisuline. Start Insulin Basalog 100 IU/ml, 10 units or 0.2 units per kilogram body weight at bedtime. You can raise two units accordingly until the fasting sugar level reaches 100 to 140 mg per dL. Meal-related Insulin should be taken at six units at the start and gradually titrated accordingly by raising two units. In addition, starting the tablet Voglibose or Repaglinide at meal times is advisable to decrease the Insulin doses if there are no contraindications. I hope I have answered your query. Thank you.