Adjusting Insulin
The process of assessing your insulin needs can be a long-drawn one, and you might have to experiment, with the advice of your doctor, to find out what kind of Diabetes control plan suits you best.
What makes up the ideal blood sugar control varies for different people, for different times of the day. It is important that you know your blood sugar goals so you can achieve them.
Select Your Target Blood Sugars
The following tables give you some figures that might make it easier for you to identify your goals. Table 1 gives three typical target goals: the first represents the goals used for tight control in the Diabetes Control and Complications Trial, the second is typical for pregnancy, and the third for people who have Hypoglycemia Unawareness.
Your target blood sugars may be the same or different from these. With your physician's help, be sure to clearly determine your personal pre-meal and post-meal target blood sugars - the ones that you need to work towards.
| Table 1: Target Blood Sugars |
| Time |
DCCT |
Preg. |
HU |
| Before meals |
70-120 |
60-90 |
80-150 |
| 2 hr. after meals |
< 150 |
< 120 |
< 200 |
| 2-3 a.m. |
> 65 |
> 55 |
> 80 |
Tips For Using Insulin
- Frequent or severe insulin reactions rarely occur if blood sugars are tested often, and if the insulin doses have been matched correctly to the eating habits and the lifestyle of the patient.
- A varied lifestyle with set doses of insulin spells disaster. Control is better when you use small doses of insulin frequently and match them to your lifestyle.
- "Brittle" diabetes is simply insulin given in the wrong amounts or at the wrong time.
- Humalog or NovoLog controls the blood sugar over the first 4 hours, and Regular controls the blood sugar for the first 6 hours after an injection. Lente or NPH controls the blood sugar largely between 4 to 12 hrs after the injection. Ultralente's timing gives your its greatest effect between 8 to 18 hours. While the new Lantus has much less peaking action, its activity is evenly spread over 4 to 24 hours.
- Understand insulin timing so you will be equipped to correct your patterns of highs and lows.
- Everyone needs to adjust insulin doses occasionally. Know when to contact your physician for these changes.
Injection Sites
The abdomen is a preferred site for insulin injections because of its consistent insulin uptake. If you feel the need to rotate the location for injections, use one site consistently for each time of day, that is, the abdomen for breakfast, arm for lunch, etc.
Types And Action Times
Table 2 gives the start, peak, and end times for various insulins, so you can choose the kind you need to help you achieve your blood sugar goals.
Humalog and NovoLog insulins start working in about 10 minutes. They can be taken immediately before meals. They keep the blood sugar lower after meals, and are gone from the body in about 4 hours. These faster insulins balance food better and improve control, usually with fewer lows, than Regular insulin.
| Table 2: Action Times for Insulins |
| Insulin |
Starts |
Peaks |
Ends |
Low most likely at: |
| Hum/Nov |
10 |
1.5 h |
3.5 h |
2-4 h |
| Regular |
20 |
3 h |
6-8 h |
3-7 h |
| NPH |
1.5 h |
4-12 h |
22 h |
5-12 h |
| UL |
4 h |
10-20 h |
30 h |
8-18 h |
| Lentus |
2 h |
Negligable |
24 h |
4-24 h |
Regular Insulin starts in 20 minutes and keeps working for about 5 to 8 hours after an injection. Most meals raise the blood sugar for only 2 hours, so Regular insulin tends to let the blood sugar rise, with blood sugar drops seen long after a meal ends. It may work better for slow carbs and in people who have digestive gastroparesis.
Meal Timing
If your blood sugar is high before a meal, post-meal readings can be improved by injecting insulin for the meal and for the high blood sugar, then delaying eating until the blood sugar is below 150 mg/dl. However, missing or delaying meals is the most common cause of insulin reactions. Don't delay eating if it could cause you to miss a meal for which you've already taken your insulin.
Insulin Doses CAN Be Reduced
Many people on pumps or injections tailor their insulin doses to their carbs and activity every day. Other people use set doses of insulin each day. When using insulin, it is wise to remember that insulin doses can always be adjusted to the situation. Always remember that your doctor, nurse educator and dietician can be very helpful when you desire to be more proactive in your own care.
Insulin doses need to be lowered -
-if insulin reactions are frequent or severe.
-if the reactions occur within 1 to 2.5 hours after an injection of Humalog or NovoLog, or within 2 to 4 hours after an injection of Regular. (ie carb coverage)
-if insulin reactions often require more than 20 grams of glucose to bring the blood sugar back to normal.
-before exercise, especially when it is moderate, or strenuous, and last longer than 40 minutes.
-after long or strenuous exercise. Reduced doses could be needed for up to 24 or 36 hours following the activity.
-if you decide to eat light and lose weight
-before meals that are smaller than usual.
-if the stress in your life is reduced, as during a vacation.
Call your physician to discuss an immediate lowering of your insulin doses.
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