What's the difference between am and pm?

I am a Type 2 diabetic on insulin. I am on Humalog 50-50 insulin pen.  I take 35 units plus a sliding scale in the morning. My glucose is about 158. At lunch time when I test, I am around 99 or so. I get 8 units of insulin and then eat lunch. At 6:00 p.m, my blood sugar tested 267 and I had not eaten anything between lunch and dinner. This is not unusual, I have been running in the 200's at dinnertime. I am nervous and depressed to have such a high level. I take 45 units of insulin at dinnertime plus a sliding scale. I also test at bedtime 11:00 p.m. and take as many units as the sliding scale calls for. What could be causing this? I have Fibromyalgia and do have a little pain in spite of the Lyrica I am taking. I do not feel very well at dinnertime and I am quite upset about having such a high reading without eating anything. Thank you for any help or advice you may have.

[Anita Ramsetty, MD]

Hi,

You may be able to fix this by increasing your lunchtime dose by a few units(please discuss with your doctor before doing this), but another change that your doctor can try is switching you to a different formulation of insulin, perhaps a 75-25 mix instead of 50-50. It seems as though your problematic blood sugars are happening after about 5-6 hours since your most recent shot, and at that time the Regular portion of your insulin is just about completely gone, and your NPH portion may not be sufficient. So I would suggest trying that formulation first, and if it is not working you may need to break up your shots so that you have more flexibility in dosing. Taking more shots is never something people are excited about, but it does offer more flexibility in terms of dosing and will help in the long run. Keep watching what you eat as you are ding, and try to get in exercise as your body tolerates as this will all help as well.

Take care.