Ask the Diabetes Educator Archive

Q:

I was at 300/1000 this morning. forgot to take my nph last night. I just took my normal nph this morning and took a double 30unit dose of R and ate a regular meal. After breakfast I was still at 300/1000. I then took 10 units of R to bring it down and it worked okay. should I have gone about this a little differently. should I have taken R in the morning without eating and waited for sugar to go down before eating. should I have used a higher than normal nph to bring morning sugars down.

A:

I'll answer you first by saying that you should call whomever is managing your diabetes with you to get the best immediate answer. They have your health history and hopefully factual reasons as to why you are on the insulin regimen that you are. I can address your situation generally. Firstly, doubling up on NPH would not help those immediate high blood sugars, and may put you in a position for hypoglycemia later on in the day. How much regular you should take would depend on what your breakfast consisted of, and historically how much regular it takes to lower your blood sugar. If this is something you don't know nor have ever seen a pattern with yourself, working with a Diabetes Educator who understands nutrition and carbohydrate counseling could help you here. A general rule is that we give 1 unit of insuln for every 15 grams of carbohydrate. This will vary with an individual. You might even consider asking your practitioner about using lispro instead of regular insulin; the lowering effect is generally better. Also, many people with diabetes are more insulin resistant in the morning. So you see, there are many factors to consider here. You may have to do some searching on your own to find a Diabetes Educator in your area if the guidance is not available in your practitioner's office.

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