Estimating Insulin Dosage


Q: I am diabetic for almost 20 years.
I was taking tablets till Mar 2015 and in Mar 2015, I switched to Insulin.

My dosage are as follows:
Before B/F Actrapid (8) Insulatard (21)
Before Dinner Actrapid (6) Insulatard (12)

I am on a moderate (not very strict) diet. But I avoid sweets.
I go for walking 1 hour daily

Still my sugar level after meal is around 275.

Please advice.


A:   Hello. Welcome to Ask The Doctor. We are here to help you.

To help you better I need to know a few more details:
1. Your Fasting blood sugar level.
2. Glycosylated Hemoglobin (HbA1c) if done.
3. Your blood pressure.
4. Are your this blood sugar reading running constantly high or you are noticing this recently.

Please revert back with the asked details for a better help.

Comments / Follow Ups

Patient: 1. FBS - Average 170-190
2. Not done
3. Normal 130/95
4. Yes. Always running hight. After starting insulin, there is an improvement but not as required .. Before insuling (Before Mar 2015), Post perinial used to go more than 300.
Doctor: Hello in such scenario I give two options to my patients:
1. Add an oral hypoglycemic agent like Sitagliptin or Vildagliptin to the ongoing insulin regimen.

2. Other option is using Actrapid thrice daily before meals and taking Insulatard once in night time. Dose would be adjusted with the self charging for the few days. Mostly in the scenario you have explained I would go with 10 units of Actrapid Before meals and 30 units of Insulatard in night or 15 units in morning and 15 units in night. The dose would be adjusted based on your blood sugar levels.

However my recommendation for you would be the first option. I am hopeful it would show you the improvement.
Share my opinion with your doctor before your act upon it.
Good luck.
Patient: Doctor: Thanks for your reply .. What are the side effects of taking Insulin? Again, with reference to the side effects, which is better - Insulin or Oral tables?
Doctor: See, Insulin has as such no typical side effects. Most common being Lipodystrophy at the injection site, hypoglycemia.
Definitely in practice, we consider Insulin a better modality with lesser side effects as compared to Oral hyopgylcemic agents.
Good Luck.
Patient: Doctor.. Thanks so much ..
Doctor: Thank you. We are always available for your help.
Take care.

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