My sugar levels vary. Should I adjust my Insulin?

Question

Hello doctor,

I am a 24-year-old male, diagnosed with type 1 diabetes at 12. My HbA1c is 8.2 % despite Glargine 20 units at night and Lispro with meals. My blood sugars swing between 60 and 220 mg/dL, especially at night. I have a few concerns, such as:

Is this variability expected, or should Insulin timing or doses be adjusted?
Would continuous glucose monitoring help improve control?
Are there lifestyle or dietary strategies that can be used in conjunction with Insulin?
How often should kidney, eye, and nerve checks be done at this stage?
I am also concerned about future complications. What early signs should I watch for to prevent serious issues?

Please help.

Answer 1

Hello,

Welcome to icliniq.com.

I understand your concern.

I would try to brief you on your queries. Your HbA1c (glycated hemoglobin) of 8.2 % is above the target, and you should aim to keep it below seven. The blood sugar swings between 60 and 220 mg/dL suggest both hypoglycemia and post-meal highs are present. The Lispro dosage that you are taking should match the carbohydrate load and be given just before meals.

A CGM (continuous glucose monitor) is highly recommended in your case. It helps detect unrecognized hypoglycemia, especially at night, and helps in real-time trends for meal or insulin adjustments. Lifestyle changes would help you regulate your blood glucose levels better.

To avoid rapid spikes, eat low-glycemic-index foods, high fiber, lean protein, and healthy fats. Exercise improves Insulin sensitivity. Regular annual screening, like KFT (kidney function test), LFT (liver function test), and lipids, is important. You have not mentioned whether you are facing any other medical conditions. It would have helped me to guide you better.

Please be alert for the following symptoms such as:

Excessive thirst.
Vomiting.
Abdominal pain.
Fruity breath.
Rapid breathing.
Sweating.
Shakiness.

If you notice such symptoms, consult your physician immediately.

I hope this answers your query. For further queries, consult me anytime.

Thank you.