Uncontrolled BG levels :(

hi i keep having low and high BS reading i take lantus 25 u at night and i use humalog i have a sliding scale and i am also on metformin 850 mg 1 pill in the day and 1 at night yet my BS readings are still either way high 350 or 398 ml/dg or way low like 47 or 49 ml/dg does this happen to some one else and if it does what do you do when this happens?

The sliding scale for mealtime bolus is not a reliable dosing device. You’re better off learning to count carbs and then finding out what your insulin:carb ratios are and figuring your dose that way. I recommend the book Using Insulin by John Walsh. Are your highs and lows mostly 2 hours after meals or are they often on waking, in between meals and at bedtime? If it is after meals, than learning to more accurately bolus for the food you are actually eating is the way to even out your numbers a bit. If it is between than you might want to look to your lantus dose and possibly split the lantus into 2 doses 12 hours apart.

I just looked at your profile and saw you are a type 1. Why are you taking Metformin? If you are just seeing a regular doctor you might want to get a referral to an endo who can get you on a more suitable treatment regimen.

Hi Maddy: I’ll second what Zoe says. In addition to John Walsh’s “Using Insulin,” another good book is “Think Like a Pancreas.” Do you see a CDE or do you go to a diabetes center? A good CDE can really help you make sense of what is going on and look for solutions.

hii usually the lows are at night like at 2am and in the morning the highs happen alot at night llike right b4 i am goin to have dinner which is at 6 or 7 and i reall dont know why i am taking metformin but i have an endo apt tomorrow actully so ill ask alot of questions tomorrow thanks for ur help and i will look up that book thanks :slight_smile:

Hi Maddy! I used to have the same problem with Lantus! It would cause me to go low during the night, but I would be high around dinner time or after dinner. I was taking it in one dose at 11pm.

For some, Lantus does not actually seem to last for 24 hours. It is most active in the first six hours, then becomes much less powerful around hour 20. There is a solution for this:

I never tried this (because I switched to an insulin pump instead), but many people say that Lantus works better when given in TWO doses. This would mean giving one dose in the evening and another in the morning (or at lunch time). Ask you doctor if you can switch to giving the Lantus twice per day OR also you could try Levemir (also twice per day), as this works more evenly than Lantus for some people.

When I took my Lantus at 11pm, I had lows during the night a lot. I think that I should have switched to taking it at 6-7pm (half dose) and the other half in the morning.

Hi Melitta i dont go to a diabetes center i go to a regular hospital and i see an endo does that count as a CDE? i will also check that book out cuz i am trying to do everything i can to get better controll of my BS .

Hii kristin yea i think i will ask my doc if i am able to split it into 2 doses also i take my lantus at 11pm too
i have also asked for an insuline pump but my doc says i have to keep my BS in normal ranges or i cant get the pump

You may be able to do well even without the pump. I switched to the pump because I was having too many lows at night, but I think that I could have changed that by changing the time that I took my Lantus! Hope that it will help you!

Yea i will talk to my endo doc tomorrow an ask alot of questions and yea diz has been alot of help thanks :slight_smile:

What is your total daily dose of insulin? If the balance between your basal and rapid is off you may find yourself in a situation where your basal is forcing you low at night but your mealtime insulin isn’t sufficient to manage the spike from eating.

If you are going low over night, you might also just try moving your Lantus shot to the morning. That way the Lantus would be tailing off over night and not as likely to make you low.

If you want a pump, ask for it again. A pump is a tool to help you manage your blood sugar not a reward for already doing a good job.

Good luck,


i take 25 u at night and only use humalog wen my BS is 150 0r higher i use 15 u if its 150 n for every 50over dat i use 2 more units. am i making sense? and i will ask again

Thanks :wink:

Like Zoe said, the sliding scale is outdated. You should be taking insulin based on what you eat. How many carbs are you eating for that 15 units? That 15 units is like you are insulin resistant (which is possible), but the 25 units of Lantus is not for someone with insulin resistance. I also agree with Kristin about splitting the Lantus.

Like Maurie said, a pump is a tool to help you get better BS and should not be used as a reward for doing good. It used to be that you had to have poor control to get one. If you want one, push for it. Your doctor is using outdated tools with the sliding scale.

Your last sentence is so logical (and true), Maurie. I was lucky enough that my doctor just signed my pump approval no questions asked, but I can’t tell you how many times I’ve heard both (totally opposite) reasons for denial of a pump. “You are doing too good, you don’t need one” and “You are doing too poorly, you aren’t ready for one.” I actually fell victim to that way of thinking for awhile, thinking may A1C was “alright” so I didn’t “need” a pump. Then when I realized 12 out of 15 women in my type 1 group had pumps I just realized it was a state of the art tool to manage blood sugar.

Zoe my doctor tells me i have to have really good control of my BS to be able to get a pump and i try to stay within normal ranges but its so hard my last A1C was 17.5 my readings are everywhere so i will keep pushing for the pump

Yea i will push for the pump and i am going to see the endo tomorrow i have so many ques for her also i will ask abt spliting my lantus dose thanks for ur help

Maddy -

You are going to have a very difficult time getting decent numbers until you start carb counting - as Zoe suggested. Your basal should keep your blood sugar steady if you don’t eat and it should be necessary to bolus with every time you eat not only when you’re over 150 at the start of the meal. Learning to count carbs and calculate a bolus based on a ratio is one of the fundamental skills you need to learn to control your blood sugar and to use a pump. The key idea is that you want to match the carbs you eat with the insulin you inject. If you are eating only a few carbs, you need less insulin. If you are eating a large number of carbs you need a bigger dose. You want to take that dose at the time you eat, not before the next meal.

If you have any choice in the matter, I would suggest trying to find a new endo. Your insulin regime is very unusual (and not in a good way) and you’re not having much success. A new endo might take a fresh look and help you get on track.


yea the endo i am goin to see tomorrow is a new 1 hopefully she’ll be more helpful and can also give me info on a diabetes educational class because i really dont want any complications later on i want to be able to control my diabetes and not let it control me maurie thanks alot u have been alot of help i really appreciate it

Forgive me for saying it, but your endo’s reason for not giving you a pump is NONSENSE. The pump is a godsend for people who have trouble controlling BGs on shots. That’s because you can have different basal rates for different times of day and night – it’s a natural for controlling those middle of the night lows, because you can set a lower basal for the first part of the night, and a higher one for when your dawn phenomenon (if you have one) sets in. Plus it keeps you level during the day, so no lows just before you’re going to eat.

I agree with the people who said you need to learn to count carbs – the sliding scale is ancient history – used to chase BGs after the fact, not be proactive to begin with. When I was in the hospital recovering from a coma, they used the sliding scale, and couldn’t figure out why my BGs were ALWAYS so high after meals and wouldn’t come down – they weren’t giving me any insulin to cover the meal, just correcting with a sliding scale.


Maybe it’s time to look for another endo who has joined the modern world?

Yea actually the endo i am going to go see tomorrow is a new 1 i will ask her for the pump and hopefully she has joined the modern world and be more help lol. Also i went into DKA abt 3 weeks ago and they would give me meals and my sugar was always high and they would just keep correcting it usin the sliding scale but the BS readings were always high too

How did it go with the endo?