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From Gouverner, New York, USA:

I have had diabetes since I was nine. I am now twenty years old. I am having a hard time understanding how to adjust my insulin if my sugars are too high in the evening and morning. My doctor told me that I adjust them with a ratio of 2:1. I am having a hard time understanding how to do this. Could you please explain how to do this? I am currently taking NPH and Regular insulin.


Every clinic has a slightly different approach to adjusting insulin and I hesitate, therefore, to give specific advice. Furthermore, the detail of adjustments will vary according to your own insulin regimen. You need to understand the principles first then the practicalities become easier.

If we consider the role of pre meal blood sugar results then the following is a useful guide: Consistently high sugars before breakfast suggest that you have run out of insulin overnight and need more in the evening -- usually NPH. Highs before lunch are best managed by more Regular at breakfast and highs before tea by more NPH at breakfast. Obviously the opposite is true for consistently low results.

The ratio of NPH to Regular will also vary according to many factors. You should discuss the details of your own regimen with your doctor and don't be embarrassed to tell him that you didn't understand what he said before.

You can get a bit more detail at


Original posting 9 Mar 1999
Posted to Insulin


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Last Updated: Tuesday April 06, 2010 15:09:02
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