Insulin shots

My mother is 69,  5' 5, and 201lbs. She takes meds for various conditions. Her doctor has prescribed 2 types of insulin for her to take.

Novlin R U-100 - prescribed to take 17 - 19 units with meals - if her BS is >150 the shot is to be increased by 1unit per 10 of the BS reading over 150

Lantus U-100 10ml - prescribed to take 48 units subcontaneously at bedtime

Mom can only read numbers. She checks her BS. Therefore, she is very dependent on me to make her shots dosage. I have been tracking my mother's BS for the past week. I have averaged her shots out to 18 units after meals and 48 at bedtime. Here are apx. times and readings:

8:00 AM BS fasting avg. is 69 - has breakfast and takes 18 units insulin apx. 30 minutes later
Noon BS avg. is 148 - has small lunch and takes 18 units insulin apx. 30 minutes later
5:00 PM BS avg.is 126 - has dinner and takes 18 units insulin apx. 30 minutes later
10:00 PM BS avg. is 138 - she may have a snack before taking 48 units at bedtime

I understand a good fasting BS level is between 100 and 140. Mom's 7 day overall BS range has been from as low as 51 in the AM to 227 during the day. Questions:

Do the numbers I've recorded look OK?
Does mom need to take all of these shots?
Would a pump control her BS level without her being dependent on someone to make her shot?
Would Medicare cover the pump?
Could I make up some 18 unit shots for her to take?

I need to go back to work and am concerned about her not getting the proper shot dosage.

Thanks for any and all the information anyone can provide.  

[Anita Ramsetty, MD]

Hi,
Thank you for all of the information.
Overall your mother's glucose control is fairly good based on those averages, except for the mornings being too low. This may be due to the Lantus dose being too high--please speak to her doctor about this soon. Otherwise the numbers are good.

Most people take insulin before their meals so I am not sure why your mom is taking it afterwards.

I unfortunately cannot comment on the "need" to take this number of shots. Many people with diabetes do need a basal insulin(like lantus) and pre-meal insulin, which is a close imitation of what our body does for us normally.

An insulin pump is wonderful but it is also possibly alot of work. Your Mom will still have to check her glucose levels several times a day, especially in the beginning, and calculate the pre-meal dose of insulin. Some newer pumps will do this for you, but a pump is still no small undertaking. Speak to some people who are on insulin pumps to get a first hand idea of what is involved.

Medicare may cover the pump, or some of the cost, if your doctor can show that your mom has failed other therapies.

You can assemble some of the shots for her and leave them in the fridge, but if she has an insulin scale that may call for further adjustment in her pre-meal insulin she will not be able to do this. Some pre-meal insulin come in pens, which she can possibly dial up on her own.

Hope this helps,
Take care.