This boy has had diabetes for more than 5 years. He requires 25 units of insulin daily, i.e., almost 1 unit of insulin per kilogram of body weight. Immediately before giving each injection he mixes regular (short-acting) insulin with long-acting insulin (e.g. with a basal insulin preparation).

On Tuesday he had a "hypo" at 11 a.m. while at school. Back at home at 1 p.m. the blood glucose reading was still 40 mg/dl (2.2 mmol/l), although he had eaten an extra 12 grams of carbohydrate before leaving the school. On Wednesday morning, therefore, he gave an injection of only 4 units of insulin instead of the previous 6 units. On Tuesday and Wednesday the test results at midday (1 p.m.) and in the evening (6 p.m.) were poor: 1%, 3% and as much as 5% urine sugar, blood sugar 240 mg/dl (13.3 mmol/l) and 400 mg/dl (22.2 mmol/l).

On Friday, therefore, the long-acting insulin of the morning injection was increased by 2 units from 10 units to 12 units. On Friday and Saturday the boy was not pleased with the test results at 10 p.m. before going to bed: urine sugar was 3% & 5%, and blood sugar was 240 mg/dl (13.3 mmol/l) & 400 mg/dl (22.2 mmol/l). He therefore increased the regular insulin of the evening dose by two units from 3 units to 5 units. On Sunday his diabetes is well controlled. He is happy. In this way the boy skillfully balances his metabolic state by using an individually adjusted mixture of regular and long-acting insulin.

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