How to control high blood sugar in adults with type 1 diabetes

by AJAY
(INDIA)






Question


Hi,


I have type 1 diabetes from last 6 months and I am 42 years old.


Presently, my reading are before breakfast 165 and after luch it is 265. I am taking insulin 16 units before breakfast and 12 units before dinner.


I follow the diet chart which has been given by my doctor. I have been advised to increase my weight to 72. My current weight is 59 kg, my height is 5'9".


Please suggest if my treatment is correct.


—Ajay, India





Quick Answer


Ajay, your before-breakfast glucose of 165 mg/dL and after-lunch glucose of 265 mg/dL are above common targets for many adults with diabetes. These readings suggest that your insulin plan, injection timing, meal coverage, or carbohydrate matching needs prompt review.


I cannot tell whether 16 units before breakfast and 12 units before dinner are correct without knowing the insulin names, whether they are basal, rapid-acting, or premixed, when the after-lunch test was taken, your HbA1c, meal carbohydrate, glucose pattern, activity, and low-glucose history. Do not increase insulin by yourself.




Answer by Dr. Albana Greca, MD, MMedSc



Hello Ajay,


Type 1 diabetes can begin at any age, including in the 40s. It is not only a childhood disease. Some adults develop slower autoimmune diabetes, often called LADA.



Should the Diagnosis Be Rechecked?


Because you were diagnosed at 42, it is reasonable to confirm how the diagnosis was made, but age alone does not exclude type 1 diabetes. Diagnosis is not based on insulin in the urine. When the diabetes type is uncertain, clinicians may use:



  • Islet autoantibodies such as GAD, IA-2, and ZnT8

  • C-peptide with a simultaneous glucose result to estimate your own insulin production

  • Your history of weight loss, ketosis or ketoacidosis, symptoms, and time from diagnosis to insulin treatment


Do not stop insulin while waiting for classification tests. In a person with severe insulin deficiency, stopping insulin can cause diabetic ketoacidosis.



How High Are Your Readings?


For many nonpregnant adults with diabetes, common general targets are 80–130 mg/dL before meals and below 180 mg/dL one to two hours after the beginning of a meal. Personal targets may differ.



  • Before breakfast 165 mg/dL: this may suggest insufficient overnight basal insulin, dawn phenomenon, a late meal or snack, illness, stress, injection-site problems, or another cause.

  • After lunch 265 mg/dL: if measured one to two hours after lunch begins, this is high and may reflect inadequate or mistimed mealtime insulin, too little coverage for the meal, underestimated carbohydrate, or insulin absorption problems.


See our guides to fasting glucose from 127–200 mg/dL and blood sugar after eating.



Is Your Insulin Schedule Correct?


The total number of units cannot answer this. The first question is which insulin you use. Two injections daily may represent premixed insulin, basal insulin with another product, or a different plan. Each has different timing and adjustment rules.


Most adults with type 1 diabetes need insulin that covers:



  • Basal needs between meals and overnight

  • Meals according to carbohydrate and other meal factors

  • Corrections when glucose is above the individualized target


This may be delivered by multiple injections, a pump, or an automated insulin-delivery system. People using mealtime insulin should be taught an individualized insulin-to-carbohydrate ratio, correction factor, injection timing, sick-day rules, and how activity changes insulin needs.




What to Discuss With Your Diabetes Team



  1. Write down the exact insulin names, concentrations, doses, and injection times.

  2. Record fasting, before-meal, two-hour after-meal, bedtime, and overnight readings for several days, or review continuous-glucose-monitor data.

  3. Record carbohydrate portions, injection sites, exercise, illness, missed doses, and any glucose below 70 mg/dL.

  4. Check HbA1c and review whether basal, meal, or correction insulin needs adjustment.

  5. Ask about carbohydrate-counting education, continuous glucose monitoring, glucagon, ketone testing, and an insulin pump or automated system if appropriate.




What About Gaining Weight?


Weight loss can occur before type 1 diabetes is diagnosed because the body cannot use glucose properly without enough insulin. Some weight regain after starting effective insulin is expected.


Whether 72 kg is appropriate depends on your previous weight, muscle mass, nutrition, activity, and health. Do not try to gain weight mainly through sweets, sugary drinks, or large refined-carbohydrate portions. A diabetes dietitian can help increase calories with adequate protein, healthy fats, whole grains, dairy or alternatives, legumes, and planned carbohydrate matched with insulin.


Persistently high glucose can prevent healthy weight gain. Improve insulin matching and nutrition together rather than simply eating more.




When High Glucose Is Urgent


Follow your sick-day and ketone plan. Check ketones when advised—often during illness or when glucose remains around 240–250 mg/dL or higher. Contact your diabetes team for persistent high readings or positive ketones.


Seek urgent care for moderate or large ketones, vomiting, abdominal pain, deep or rapid breathing, fruity-smelling breath, severe dehydration, confusion, marked drowsiness, or inability to keep fluids down.




What I want you to remember: adult-onset type 1 diabetes is possible. Your readings are above common targets, but the correct adjustment cannot be chosen from the total insulin units alone. Arrange a review of the exact insulin type, basal and meal coverage, injection timing, carbohydrate matching, HbA1c, and glucose pattern.




Written by: Dr. Albana Greca, MD, MMedSc, Family Physician

Medically reviewed by: Dr. Ruden Cakoni, MD, Endocrinologist

Last medically reviewed: August 4, 2026


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Educational safety note: Never change or stop insulin without an individualized clinical plan.



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