Welcome to HealthcareMagic, Yes, you are indeed one of the more complex cases and without the information your dietitians have, it will be difficult for me to sort this out. If you were my patient, however, I would be looking at those blood sugars, your food diary and the insulin peaks and trying to match your food intake to the insulin peaks which means you would have to eat on a scheduled basis or consider going on an insulin pump for optimal control. Has anyone discussed an insulin pump with you? Also, if you are a type I, I agree with the fact your insulin should not be decreased, but the type or mode of delivery needs to be changed. There are several types of insulin out, regular, intermediate, long acting and mixtures of all of these. I try to match the insulin type with the person s meal schedule or vice versa. If erratic, like yours, test and cover with regular. This isn t working for you, so I say either you are on the wrong medication regime, or you need to consider another delivery system such as the pump that is compatible with your inconsistent lifestyle. Letting your blood sugar run 200-300 is too high as you will experience what we call endothelial damage to the lining of your blood vessels which will allow for more plaque formation and the eventual complications you say you haven t seen yet. Some doctors do allow their high patients to run above the normals, but not this high and not without trying the things I just suggested. I cannot give you an idea of the type of insulin switch you should go to without looking at the data your other clinicians have. However, in summary, you still need to work on stabilizing your sugar to avoid the lows but also the highs as they are too high and too low. I suggest that of all the dietitians you have seen, if none of them are certified diabetic educators that you seek this particular specialization of dietitian out as they are familiar with the medications more so than the general Dietitians. The endocrinologists are not trained to put together insulin peaks, food intake, blood sugar values and other variables together to calculate a meal plan so they do rely on the expertise of the Dietitian. Also, I have another question and don t like to assume that this was covered by your doctors yet. You say you were tested for a peptide, were you tested for an insulin auto-antibody? If these are present it will throw the insulin curve off, take the insulin longer to decrease the blood sugar which would account for the low blood sugars. In this case, the insulin is usually increased, but the timing of the normal curve is shifted to the right again meaning you need to eat on a schedule to keep control of your blood sugars. Everytime you treat a low you risk a high. The dietitians have counseled you on eating water soluble fiber throughout the day to help stabilize sugars? This is another thing you can try if you haven t already. Now, I have given you several suggestions to take back to your other healthcare providers to discuss. I sincerely hope this has been of some clarification, some help. Regards, Kathryn J. Shattler, MS, RDN