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Diabetes

Question on urine/blood sugar-please help

03/14/2008

Question:

I have been a diabetic for the past 5 yrs and started on insulin very recently . Currently taking 11 units of Launtus in the evening along with metformin/actos/Glimipride . I have observed that my Fasting sugar levels are pretty normal ( Between 90 and 110 mg/dl) but still by after meals sugar levels are in the range 200 -250 mg/dl . Along with that , i have been passing out sugar in Urine . I tried increasing by 2untis as Doc suggested but i go hpyoglycemic during night time ( 62 mg/dl ) and i am scared to do any changes to the insulin dosage . I need some help before i call my Doc ..Is Lantus insulin not working for me ? Appreciate your advice .

Answer:

The lantus is a long acting insulin which serves your basal needs.  The body's insulin requirements can be separated out into those which deal with basal needs throughout the day and night and those which are short-term or intermittent, as for example in relationship to a meal.  The observation you have made is that the blood sugar in the morning is quite good but then rises in response to a meal.  What your body needs to have to deal with that is raising the insulin level over the short-term to serve the needs to store sugar created by the meal.  That can be accomplished by either stimulating your body's own insulin, as for example could be done by raising the dose of the glimepiride or by administering a shorter-acting insulin by injection prior to the meal.  Another alternative might be to change the composition or size of the meal.  So the answer is that it is not the right insulin to change for this situation - timing insulin around the day is a key part of making it be effective without creating additional risk as you are experiencing with the low sugar reactions. 

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Response by:

Robert M Cohen, MD Robert M Cohen, MD
Professor of Clinical Medicine
College of Medicine
University of Cincinnati