HealthCareMagic is now Ask A Doctor - 24x7 | https://www.askadoctor24x7.com

Type I Diabetic Since 20 Years. Allergic To Gluten .

Posted on Tue, 17 Nov 2020

Question: Type I diabetic since 20 years. Allergic to gluten. Taking Actrapid 40-23-28 and Lantus 30. Sugar levels are slightly high after meals. Need to talk to a doctor who can help me make adjustments to the insulin doses

Answered by Dr. Dr. Abhay A Mali (3 hours later)

Brief Answer:
Need more information.

Detailed Answer:
Hi,
For better advise I want to know-
1) Your name & Age.
2) Height & weight.
3) When was last HbA1c done? and what was the level?
4) What are current blood sugar levels by glucometer?
Check all blood sugar levels in a day as follows -
1. Fasting blood sugar level
2. 2 hours after breakfast blood sugar level
3. Before Lunch blood sugar level
4. 2 hours after lunch blood sugar level
5. Before Dinner blood sugar level
6. 2 hours after dinner blood sugar level
Depending upon above information further changes in insulin doses may be suggested.

Rehgards,
Dr. Abhay Mali
Diabetologist.

Above answer was peer-reviewed by : Dr. Yogesh D

Follow up: Dr. Dr. Abhay A Mali (18 minutes later)

1) XXXXXXX Hotchandani, 38 years
2) 5’7”, 71kg
3) 6 months ago, 5.9
4) sugar levels
100
250
180
120
110
220

Answered by Dr. Dr. Abhay A Mali (1 hour later)

Brief Answer:
HbA1c reflects excellent control of Diabetes.

Detailed Answer:
HbA1c Level of 5.9 even after 20 years of Diabetes reflects excellent control of Diabetes provided there should not be recurrent episodes of hypoglycemia (low blood sugar level).

Considering current blood sugar levels I may suggest to Increase dose of Human Actrapid to
44 before Breakfast, 22 Before Lunch & 32 Before Dinner.
Recheck all 6 Blood sugar levels after 1 week.

As it will require a continuous follow up and titration of insulin doses depending upon blood sugar levels, I may suggest to consult near by Diabetologist who can physically examine you & if required easily approachable.

Regards
Dr Abhay Mali.

Above answer was peer-reviewed by : Dr. Raju A.T

Follow up: Dr. Dr. Abhay A Mali (10 minutes later)

Thank you, doc.
Yes there have been a few episodes of hypo hence I reduced my insulin intake by certain units back then.
I will visit a diabetologist in person in a few days. The insulin I am currently on is Actrapid and the syringe allows me to take 40 IU at the most at a time. If I have to increase to 44 units I will probably have to take two shots before breakfast or switch to an insulin with 100 units potency.
Also, I some how feel that Actrapid which ideally should take 20 mins to activate, takes much longer to activate in my body. Do you suggest that I should go for Lispro or shall I continue with Actrapid only?
What about Lantus? Shall I keep taking 30 units as I am consuming right now?

Regards, XXXXXXX

Answered by Dr. Dr. Abhay A Mali (46 minutes later)

Brief Answer:
Short acting insulin are better than Actrapid.

Detailed Answer:
Definitely Insulin Lispro or Aspart (any one) is better in terms of controlling after meal blood sugar levels.
If cost is not an issue any one of them is better option than Actrapid. Dose to dose substitution can be considered.

Continue Lantus 30 units as before.
Keep monitoring Blood sugar levels as advised.
Recheck HbA1c.

Hope you will find this helpful.

Regards
Dr Abhay Mali.

Note: For further follow-up, discuss your blood glucose reports with our diabetologist. Click here.

Above answer was peer-reviewed by : Dr. Arnab Banerjee