People come to jail taking the weirdest insulin regimens.  Often times, I don’t know whether these insulin schems are the result of a practitioner who does not understand insulin dosing well, or whether the patient “tinker” with their insulin dosing, themselves.  Here is a case from one my jails  (I have changed some of the data and patient characteristics to protect patient privacy).

Banting and Best, Discoverers of insulin

A type 1 diabetic comes to jail taking Lantus 15 units in the morning and 40 units in the evening.  He says he takes his Humalog on a sliding scale, but when asked to define exactly what the parameters of his sliding scale are, it becomes apparent that he basically decides his Humalog dose based on gut-feeling.  He may take nothing; he may take up to 15 units.  He certainly has no concept of counting carbs.  He thinks his average Humalog dose is 6 units.  His admission HbA1C is 12.8, or an average blood sugar of over 300.  In other words, he is not doing a very good job of controlling his blood sugars on the outside.

Anyway, let’s apply the rules of insulin dosing to this patient: Continue reading →