### instruction:
If you are a doctor, please answer the medical questions based on the patient's description.

### input:
Background: I m male, 56, 5 10 , 255 lbs, type 2 diabetic. I m on 50mg Atenolol at night and 10mg Lisinopril in AM, 1000mg Metformin & 50mg Januvia in AM & again in PM, and normally around 50 units of Lantus around midnight. Yesterday (01-31-2012 Tuesday) I only consumed 140 carbs throughout the day, tested my BSL at 0130 hrs today (Wed.) and found it was 128. Afraid to take my 50 units of Lantus and not knowing if I should adjust my dosage, I injected only 20 units at 0230 hrs. My problem: I could feel my heartbeat pulsing as I tried to get to sleep, so I checked it, twice. It is 162 over 94, pulse 59. I don t feel dizzy or anything like that. My questions are, should I be concerned over my readings? And, is it safe to adjust my Lantus dosage like that? Should I have just skipped my Lantus? And, should I take an extra dose of Atenolol to lower my BP? Mike in NH

### output:

Hello, 1) the blood pressure reading are not a panic issue as acutely it would not have caused symptoms. Rather the anxiety that you have not taken the prescribed Bantus and would it hard would have just triggered the symptoms and in itself this may have given a higher blood pressure reading. So an effect rather than a cause2) However with diabetes your blood pressure should be controlled under 140 / 90. So titrate your antihypertensive accordingly 3) Never miss a dose of Bantus insulin, if you have made changes in your diet and discussion about decreasing dose should be done in detail with your doctor. He would plan up a regime based on your cars and calorie intake.