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The Question
Fri Apr 25 20:31:21 UTC 2014

which do doctors prefer a person use more of: long lasting insulin or short acting insulin?
Asked By: blg0805  
Category: Insulin

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My blood sugar has been bad..... REALLY bad, my fasting number is usually above 200. I am giving myself 20 units of long lasting and adjusting the short term. It is getting better, i was just wondering if the doctors prefer a diabetic to use more longer or shorter lasting insulin to control numbers. I am a little scared to give myself a lot of insulin at night, long lasting.
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Expert Answers (1)
2014-05-08 11:52:26.0

Dear blg0805, Thank you for your question regarding the ratio of long lasting to short acting insulin. In my practice, we try to divide it about 50/50. We adjust the long lasting by the fasting (am) blood sugars. We try to get that lower than the 200 you cited. Then we adjust the short acting, looking at how the person distributes his/her carbohydrate intake. Usually a person is a little bit more insulin resistant in the morning, so that may mean that the distribution of short acting insulin isn't always in a precise ratio of units/carb intake. Most people are able to get into good control if they work with their diabetes professional over a few weeks or months, giving the professional a lot of blood sugar readings and food/exercise diaries to guide the insulin adjustments.
Answered By: Janice Fisher
Accreditations: RD, LD, PHD, CDE, BC-ADM
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Community Answers (3)
2015-10-30 19:12:29.0

Ideally, long acting insulin should be titrated to that which ensures control while essentially fasting....hence your basal needs. Then, short acting insulin is utilized to cover carbohydrate intake at meals, etc. Each person is an individual with different sensitivity to insulin and different reactions to exercise and food intake. Lifestyle is another important factor. The bottom line is to have a good A1C and as little variance as possible in your daily glucose levels. Personally, I believe CGM is vital to gain an understanding of your needs.
Answered By: crecode

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2014-05-16 23:20:27.0

From a patient standpoint with over 63 years experience, I'd say that with all the evidence pointing to tight control prolonging life, the best answer is neither. For T1D, the best solution is an insulin pump with continuous glucose monitor. I think most insurance now covers these devices, and I'm working on getting legislation passed, titled "the diabetics bill of rights." I've used long lasting, really long lasting(PZI) regular and others, but feel very comfortable with my new closed system pump/CGM.
Answered By: billhammond

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2014-05-16 20:02:04.0

I think it is one of those YMMV. As a person with a small appetite and a job where my weight is an issue (I have to be picked up by another dancer) I have more basal than bolus. It can depend on your appetite throughout the day, level of activity and probably length of time with type 1. Lots of testing will help determine what your basal/bolus balance should be. In my opinion...
Answered By: pugmommy

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*** All information contained on dLife.com is intended for informational and educational purposes only. Our Expert Q&A is not intended to be a replacement or substitute for consultation with a qualified medical professional or for professional medical advice related to diabetes or another medical condition. Please contact your physician or medical professional with any questions and concerns about your medical condition.

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