For many people with diabetes the mode of intensive conventional insulin therapy outlined in Example 5 does not work well. They cannot manage with only 1 basal rate injection before going to bed. Besides the booster rate injections before the main meals they have to give basal rate injections in a mode which differs widely from one individual to another. Example 6 is intended to explain this. The patient in Example 6 usually eats 48 grams of carbohydrate at each of her main meals and manages quite well with booster rate injections of regular insulin - 10 units in the morning, 7 units at midday and 8 units in the evening. When she wants to eat more she raises the dose of insulin correspondingly. When she wants to eat less - in order to slim - she cuts down the dose of regular insulin correspondingly. From time to time she checks that the booster rate dose has been correctly chosen, by determining her blood sugar one hour after the main meal (post-prandially).

Immediately after changing over from conventional to intensive conventional therapy she noticed that she had very high blood sugar readings in the late afternoon around 6 p.m. For this reason she added 4 units of NPH insulin as a basal rate dose to the regular insulin given at midday as the booster rate injection. Her midday blood sugar readings are satisfactory so she does not give a basal rate injection in the mornings. But in the case of her diabetic friend things are quite different. Besides the booster rate injection her friend needs a basal rate injection every morning at breakfast time, otherwise his midday blood sugar would be too high. Every person with diabetes has to find out for himself or herself how frequently the basal rate injections are needed throughout the day. Many patients have to give both injections - booster rate and basal rate - at the main meal times. Most of them use two pens for that purpose but some mix regular insulin and NPH insulin in the syringe.

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