What to do when (BG is high) and it is time for a Dose?

If I have a 300+ BG reading and it is time for a AM or PM dose.

I should take the Dose (7R and 13NPH) as scheduled or
because of the high glucose should I add to the regular dose
an additional amount to compensate for the spike in BG?

for exapmle BG is 300+ do I take (13R and 13N) instead of 7R 13N?

what to do?

Someone who is still on those insulins can advise you but basically I recommend getting on an updated basal/bolus regimen which is a lot easier to control. If you were using fast acting insulin you would be able to correct that 300 with a correction dose and get it down.

If you are using a two injection/day insulin mix regime, you should really consider moving to an Multiple Daily Injection (MDI) regime with a basal/bolus and carb counting approach. A good source for an MDI regime are the books "Using Insulin" by Walsh and "Think Like a Pancreas" by Scheiner. If you normally take an injection say in the morning for your breakfast which combines NPH for basal and R for your meal bolus, you can add in an additional bolus as a correction. With a mix regime, you should be able to do the same, additing the correction into your mix. Please think about moving to a basal/bolus regime, it will give you more freedom and better control.

I am on 4 shots a day and counting every carb I put into my body
and generating extensive graphs and curve charts.
but still the spiking comes from time to time.

Currently I am taking
Morning (7R 13N) @ 9am
Afternoon (Sliding scale) usually 4R to 8R @ 4pm
Dinner (7R 13N) @ 9pm
Middle of the Night (Sliding scale) usually 4R to 8R @ 5am
Checking BG every two hours

and this is coming from
Morning 15R 15N
Night 15R 15N
Not checking BG at all.
for over 15 years

I am really impressed that you are checking your blood sugar every 2 hours. I'm not sure why you are counting carbs tho. Either way, you seem really motivated, but I would encourage you to think about moving to the intensive insulin regime I have described. You seem to be following what is sometimes called a "conventional" insulin regime where you take fixed doses, you have to eat to match the insulin you have taken and you are always chasing highs and lows. I promise you, a basal/bolus approach with carb has enabled many of us to get much better control and freed us to choose when and how much we eat.

When I started insulin a bit over two years ago, I started with NPH and R. I took two injections of NPH every day. They were fixed doses (like you). When I ate a meal (breakfast, lunch and dinner) I would calculate my meal bolus based on the number of carbs in my meal. For instance I might have to inject 1 units of insulin for 10 grams of carbs. If my breakfast was 20 grams of carbs, then I would inject 2 units for breakfast. If my blood sugar was high before breakfast, I could add in a correction using a sliding scale. If 1 unit of insulin droped my blood sugar 50 mg/dl and I was 100 mg/dl too high before breakfast, then I would add another 2 units into the meal bolus for correction. I would then repeat that for lunch and dinner. I found that using NPH/R, I could time my 2 NPH injections to coincide with breakfast and dinner and I would just do a mix, just like you. Using that approach, I could usually get by with three injections a day. I hope that helps.

Agreed, Brian bsc
I just went to doc or ex doc now, what a time waster, I have a month long graph, 2hr intervals.
I really don’t need em, it’s clear what I need to do, I had to pull teeth to get a humalog RX. I will use that as a corrective measure to rising BG. I will keep my 7R 12N regiment, I like the insulin curve of R and N Mix. And the reason to count carbs, is to know how much to eat and or to correct a low BG. How else will you know your insulin to carb ratio?

I have not taken R for a very long time and never took NPH instead I was on Lente or Lente and Regular for the vast majority of my 37 year life with D. I switched over to Humalog and Lantus about 7 or 8 years ago. I did the sliding scale method for a long time but have found that it is designed for someone who eats the same thing every single day and someone who never exercises. Kind of like a robot I guess. Since switching from a sliding scale to I:C ratios and correction factors my blood sugars have finally normalized. If I go high now, I know why and have a way to correct for it. Since you are already counting carbs and taking multiple injections anyway it might be a better way to manage your D. JMHO

I totally agree with Brian. You are obviously working very hard but you have very outdated and inefficient tools. If you updated to MDI you would get much better results.

what is an MDI?

Thanks Clare

yes, I would consider a more efficient insulin, but I am uninsured and
the R and NPH are the cheaper than most other insulins.

I do use the I:C ratio to plan my meals and sliding scale to correct.
I am planning to use Humalog for quicker correction.

I appreciate your input, I get so much help from this site..
more than my doc or ex doc as I put it, as of today!

Don't give up on the frequent testing. The power of MDI with frequent testing is that YOU (not your doc) can use all of that data to really get a handle on your blood sugars. You're doing all the work of intensive insulin management; get the tools and you'll start getting a real payoff.


Multiple Daily Injection - it's the standard basal/bolus regime with rapid insulin and carb counting

I just got an RX for Humalog... $145 a vial.
But I am excited to carefully use it for correction.

You don't really need an insulin to carb ratio if you are taking a set dose. The reason for an I:C is when you are using fast acting insulin and bolus for your meal, you determine that dose based on what you are eating.
"One unit will cover 15 carbs" for example,means that for every 15 carbs you eat you need one unit of fast acting insulin (we all have different I:C factors). You don't use it to decide what to eat, it's the other way around. You also don't use the I:C to correct. For that you use an ISF which is a factor of how much 1 unit of insulin lowers your blood sugar. For a low blood sugar you would use something like glucose tablets.You determine how many you need to raise your blood sugar by trial and error. I really do recommend the book Using Insulin by John Walsh. It will help you understand these things better than any doctor will! Hopefully one day you will be able to switch to MDI and will be ahead of the game!

Only problem with getting a vial of humalog is once it is opened, it is recommended to use within 28 days. If you are just using it for corrections then I am afraid it will "expire" and not be as active if you try to use it too carefully. There are 1000 units in a vial, so 28 days worth is 36 units a day.
I too have gotten so much help here, and I asked a question not long ago how long people actually keep their vials of lantus or humalog and with the cost at $145 a vial, I can understand using the less expensive options for insulin. Check the discussions https://forum.tudiabetes.org/topics/do-you-really-throw-out-lantus-or-humalog-after-28-days I got a lot of good responses and learned a lot from it. Just copy and paste the link and the discussion should come up.
I switched endos after 20 years and am thrilled with my new one. The clinic I go to also has a refrigerator filled with "salesman samples" for lack of a better term. I took advantage of some freebies and tried Apidra which is another fast acting insulin. I like it better than the humalog I had been taking but both are equally good for bringing down a high blood sugar.

Zoe -

You still have to match insulin to carbs if you take a set dose and want decent numbers. Having an insulin to carb ratio enables you to know whether you can eat half that apple along with the bean burrito or whether you should wait for a better time.


If you are going to use humalog slowly it makes sense to get the humalog pens. For a while they were giving them away for free with coupons in ADA Forecast and other places. Even if you can't get the samples, a box of pens will be better because each pen only has 300 units so that there is less waste.


In my experience, the R/NPH regimen poses way to many challenge to effectively manage type 1D. NPH is one of the most un predictable insulin in use. It cannot provide the necessary basal insulin during the 24 hour day; therefore, your I:C ration will vary throughout the day. Any factor that can impact BGs will be exemplified and unpredictable. It can be done. But when you weigh the cost of insulins used in currently recommended regimes using long and rapid insulins against the money saved by using R/NPH, it’s not worth the risk and stress of not controlling BGs and life limits (freedom).

Personally, with tens of years using each; the pump, NPH, R/NPH, R/ultralente, and other variations, my choice is a pump or MDI using a rapid (apidra, novolog) and long acting insulin (lantus/levemir split into two am/pm shots).

And, if this was the docs recommendation for treatment, drop the MD w/o looking back and find another Endo MD.

It’s all a challenge and in the end, what works fo you is the best!