by peggy
(denver, co.)
When I first got diabetes, my blood sugar was at 800, then I went on Lantus insulin and metformin and glipizide.
At first, it took a while for my blood sugar to go down. I was really doing well, and now I am at 300 and above most of the time. I take 26 units of insulin every night and still I am having these issues.
I am so tired of giving up all the food that I enjoy and still I am having problems. Please help!
—Peggy, Denver, Colorado
Peggy, glucose around 300 mg/dL or higher most of the time is not acceptable control, even though it is lower than 800. Contact your diabetes clinician today for prompt review. A basal insulin dose of 26 units cannot be judged as sufficient or excessive without your weight, fasting and after-meal pattern, HbA1c, injection technique, kidney function, medicines, and symptoms.
Do not increase Lantus, metformin, or glipizide by yourself. If glucose remains at 300 mg/dL or above, or you have vomiting, abdominal pain, rapid breathing, fruity breath, severe dehydration, confusion, marked drowsiness, or elevated ketones, seek emergency care.
Answer by Dr. Albana Greca, MD, MMedSc
Hello Peggy,
Your frustration is understandable. The answer is not necessarily more food restriction. Your treatment, insulin delivery, glucose pattern, illness risk, and diabetes type need reassessment.
Glucose of 800 mg/dL may indicate a life-threatening crisis. Falling to 300 is improvement, but 300 remains severe hyperglycemia with risk of dehydration, DKA, hyperosmolar state, and complications.
The old answer incorrectly suggested that 300 after eating might be acceptable. Common adult goals are 80–130 mg/dL before meals and below 180 mg/dL after meals, although goals vary.
Our dangerous blood sugar guide explains when severe hyperglycemia requires urgent care.
CDC guidance advises emergency evaluation when glucose stays at 300 mg/dL or above and there are signs of diabetic ketoacidosis. Seek immediate help for:
Stress can raise glucose, but persistent results above 300 should never be attributed to stress or age without checking for medical and treatment-related causes.
Lantus is basal insulin. It mainly controls glucose overnight and between meals; it does not directly cover each meal.
If fasting glucose is high, basal insulin may need clinician-guided titration. If fasting is near target but post-meal glucose rises sharply, more basal insulin may cause overnight lows without fixing meal spikes. Another medicine or mealtime insulin may be needed.
The number “26 units” alone does not show whether the dose is right. See our insulin guide.
Bring the pen, needles, meter, strips, and medicine list so technique can be reviewed.
Metformin reduces liver glucose output. Glipizide stimulates insulin release and can cause hypoglycemia and weight gain. Its continued use should be reviewed if insulin is intensified.
Do not stop or increase either medicine independently.
Current treatment options are reviewed in our type 2 diabetes treatment guide.
Do not use strenuous exercise as emergency treatment. With ketones, illness, or insufficient insulin, exercise may worsen hyperglycemia or ketosis.
Extreme restriction may not correct a medication problem. A dietitian can help include reasonable portions of favorite foods while matching meals to treatment.
Our carbohydrate and diabetes guide focuses on portions and meal structure rather than banning all preferred foods.
Remember: glucose above 300 most of the time means the current plan is not working safely enough. It is not acceptable after a meal and is not a reason for harsher food restriction. Promptly review ketones, illness, insulin delivery, glucose patterns, and whether basal-only insulin is adequate.
Safety note: Persistent glucose of 300 mg/dL or higher requires prompt medical assessment, especially with illness, ketones, vomiting, dehydration, breathing changes, or confusion.
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