Another question....on insulin

This is more for my education about type I’s and their lives, than for personal use.

I have several friends that use insulin to control their diabetes. We are looking into the possibility of adding insulin to my regime. But I have many questions about using insulin that I know my team may not appreciate as important…I am hoping you will.

First, how do you know how much to give yourself. One friend knows to give herself 50 units (which is equal to what?) in the AM and then more when she needs it. She has been doing this for years, so I trust what she is doing to be helping her, she is very emphatic about her care. So how does she know after lunch say, and her taking a BS reading, how much to give herself or if she does need more insulin and how much?

How often do you inject yourself (average) if you are following a healthy eating plan? Is it true (according to another acquaintance) that once you are on insulin, you can eat what you please and inject yourself after eating anything…chocolate cake with frosting an inch thick?

Although I know this is untrue, I will ask anyway, type I’s don’t have to test, they just inject themselves with insulin on a time schedule and they are fine?

Like I said, some are totally bogus I am sure, and others are just a curious need to know. Thanks for taking the time to instruct me…it’s how we learn about each other…the truth anyway.

Absolutely untrue: Once you are on insulin you can eat what you please and inject yourself after.NOT TRUE! It is still important to eat healthy and watch carbs. Some people do subscribe to the eat what you want and bolus for it school however they are in for some unpretty surprises when they gain weight and develop insulin resistance which means they then have two problems, not just one. Also, the more insulin you use to cover heavy carbs, the more the risk to miscalculate and go too high or too low.Many people will bolus extra for special going out meals, unusual treats or parties. I don’t even do this because after one early severe low insulin really scares me and I’d rather keep the dose low. Also I haven’t eaten any sugar at all for many years for other reasons.

Absolutely untrue: Type ones don’t have to test, they just inject on a time schedule and they are fine. Some doctors still use the outdated regimen of set doses for mealtimes, but it doesn’t work very well. If you don’t test before meals you can’t calculate your bolus based on the carbs you are about to eat. If you don’t test after you don’t know if you are high and need to do a correction bolus. You also don’t know if the I:C ratios you are using need to be changed.

For your questions, I’ll answer just for me. We’re all different and the key to using insulin to manage diabetes to me is to learn as much as you can and then find what works for you, then be willing to learn some more and change it in pursuit of that moving target of good control.

I inject myself five times a day up from four I started on. I take a varied number of units of bolus before each of my three meals based on my insulin carb ratios for each meal, which for me are 1:7, 1:9 and 1:18. I started out taking 10 units of insulin at bedtime for my long-acting or basal dose. It wasn’t working the way I want so I split and raised the dose and now take 6 at bedtime and 7 in the morning.If I am high after meals (I’m not usually) I take a correction dose. One unit lowers me about 35-40 points; I also take into account the percentage of insulin on board when I compute this.

I like many people recommend the book Using Insulin by John Walsh.

Hi Cathy,

I’m a type 1 who was on shots for a few years before switching to the pump a couple of years ago. I’ll try to answer your questions to the best of my knowledge and experience–I hope my explanations make sense to you!

First, knowing how much to give yourself: it does take some time, and it is helpful to have a doctor to guide you through it. It’s pretty much boils down to learning how many carbs one unit of insulin will cover for you. Also, this may be different at different times of the day. Personally, I require more insulin in the morning so I know that I will give myself more units for breakfast. My doctor worked with me on my I:C (insulin: carb ratio). Once you know this, you just need to know how many grams of carbs are in the food you are eating, to know how much to give yourself. It’s a bit of trial and error in the beginning as you learn how different foods affect you, and keeping a log of your numbers so you can see where you need to make changes is very helpful.

The number of injections: When I was on shots, I took a lantus shot at night, which was my long-lasting insulin. Then, I basically took a shot at every meal, and then as necessary to control any high blood sugars. However, if I was eating a low-carb meal, I could sometimes get away with no shot if my blood sugar was good before hand. Still, I found myself taking too many shots for my liking, which is why I switched to the pump.

And while you may be able to get away with eating a large piece of chocolate cake, it’s obviously not recommended because 1) it can be hard to know exactly how much insulin you will need to give yourself and 2) odds are you might be fine at first and then end up with a high reading later because of all the fat slowing the absorption down. That being said, sometimes it’s worth it… :slight_smile:

Testing: definitely necessary! You might be a little bit high and not know it, or a little low. That would affect how much insulin you gave yourself. Even if you’re on a highly regimented eating plan, sometimes your glucose will just do something wacky so you always want to check before you give yourself a shot.

Sorry, this was very long! I’m not sure if that was at all helpful, but there you have it!

Zoe & Christina covered your questions beautifully.

Do you know your friend’s A1c? Her 50 units in the morning is probably slow acting basal insulin, either Lantus or Levemir. Basal acts as background insulin to keep BG level between meals & overnight. Basal is taken either once or in split doses.

Insulin taken before meals, usually about 15 minutes before eating, is rapid acting (bolus) insulin. There are different brands. Rapid acting tends to last about 4 hours, give or take. Doctors advice eating meals 4 hours apart so insulin from the previous meal is gone before another injection. Insulin on top of insulin is called stacking & can cause lows.

People using insulin need to test very frequently: first thing in the morning, before every meal, 2 hours after every meal & before bed. Testing is also important before driving, exercise & when you feel high or low. I test more than 10 times a day.

Lows are corrected with fast acting glucose. Highs are corrected with an additional injection to bring BG down to a target number.

Dosing insulin to food is as much an art as a science. Your doctor will probably start you on low doses & adjust from there. Doses are constantly being fine tuned. We learn to do our own tweaking. To give you an idea, most people start out taking 1 unit of rapid acting insulin for every 15 carbs, a 1:15 ratio. If you ate a 30 carb meal, you’d take 2 units of insulin using that ratio. There is no set formula. Everyone is unique.

You’ll be taught your ISF (insulin sensitivity factor). This means how many rapid acting insulin units will bring BG down how many points. Like everything else, it’s highly individualized.

It’s important to keep logs so your doctor will know how to help you adjust doses. This involves logging your readings, meals & doses.

Usually, I take 5 shots. Basal first thing in the morning, for meals (3) & another basal injection before bed. If BG is high, I’ll take additional correction injections.

Injections don’t hurt. The needles are very thin & short.

Below is the same reply I sent on your other question in case you didn’t see it. I am T2 on insulin. For this question:

I inject for everything I eat over 5 grams of carbohydrates - of I don’t, I go high. I inject on a healthy eating plan - even with “good carbs”, I would go high without the insulin. I don’t eat whatever I want and inject. While I don’t deprive myself of everything I like, I do not abuse the insulin and eat whatever I would like because I have the insulin. Chocalate cake - I have done it once since diagnosis. A half of portion of no sugar added ice cream - ocasionally (with insulin coverage).

I test anywheres from 7-10 times per day on insulin. I dose insulin based on the amount of carbs I eat - the dose varies with each injection. If I am high before the meal, I correct or take insulin to lower the value along with the dose I would take with my meal. Dosing insulin is very dynamic and rarely stays stable for anyone. Even T2"s on insulin (and not on insulin) should not stop testing.

I am T2 on insulin (meal time only currently). A1C - last 5.8% I also use Byetta and metformin.

Adding insulin was a no brainer for me. I was diagnosed with D after a long course of steroids (3-4 months) for asthma and pneumonia, and despite coming off the steroids, I remained with D. I was high post-prandially despite very low carb diet, and felt like crap when I was high - although not overly high - 200-.300 for a very short period of time - 1-2 days. When I called my doc, he wanted me to add meal time insulin (Apidra). I wasn’t hesitant at all. I wanted to feel well.

I learned to carb count and we found what my insulin to carb ratios were and adjusted from there. Initially I dosed on the low side to try to avoid lows and I was very afraid of killing myself. I have had very few lows on insulin. Insulin worked wonderful for me and is working wonderful for me. As I mentioned, I 99% of the time,my highs are post-prandial, and it has helped me to greatly control these numbers. I also figured out my insulin sensitiviry factor, or the how much 1 unit insulin corrected my BG, and correct according to that so I can have numbers in the low 100’s as a goal.

It has given me great flexibility as to what and when I can eat. I work a 13 hour shift at work and flexibility is very inportant in food, because I have no set meal time - it varies greatly every day. I am not suggesting you indulge in foods, I have not done that (in fact I have lost 35 lbs since this all started). But I am not a person who can not do withy ANY carbs in my meal plan and even 15g-30g carbs were causing huge spikes in my BG despite exercise, etc. Using Insulin has allowed me to have this flexibility.

I have been recently put back on steroids for a short course and my sugars have been pretty labile. I would not have any control of this without the insulin. I feel that insulin should not be used as the LAST option in treating T2, and it is NOT a failure, rather an approach to managing a disease in which high BG numbers unchecked can have life long implications.

Dear Cathy,
I love your questions.
How do you know how much to give yourself? The doctor, based on your weight, starts you with a basal dose - long acting. After you work with that to find that that keeps you in the target range of 80-120 when not eating, the doc adds a short acting insulin before meals.
You work with these numbers using all the resources you can: get books. Think Like a Pancreas is good. Dr. Bernstein’s tells a lot about keeping to small numbers of grams of carb to figure out what carbs do to your blood sugar and what a unit of insulin does in bringing down your BS.
For example I can depend on my body’s use of glucose. 1.5 grams of carb raises me 10 mm/dl. This means a 15 gram snack would raise me 100 mm/dl. So I need insulin to reduce that. Presently, 1 unit insulin lowers me 60 mm/dl. I’ve come to this by some trial and error.
No one can inject with insulin on a time schedule and be just fine without testing. I test up to 7 times a day. I take two shots of long acting insulin for my cellular functions over the 24 hours. I keep a small 4x6" notebook, a page a day listing what I eat eat time, my guesstimate of the number grams of carbs and what I gave in units of insulin. Later I put it all into an Excel spreadsheet and it gives me my sensitivity numbers so I am checking that I am doing my math ok. Calorieking is a way to go for grams. So is the Eat Smart scale.

I take Lantus in the morning and Humalog before all meals. My current ratio is 20:1, which I learned by testing testing testing and reporting back to my CDE. I correct for every 60 above 100. As for eating chocolate cake, a small portion with your meal plan might work but if you do it all the time you would gain weight and/or be running high all the time. I test 6-10 times a day, depending on how I feel. Always in the morning, before meals, and bedtime.

my son was diagnosed last year and he takes only 8 units of lantus (long acting background insulin) at night. The rest of the time he takes NovoRapid (aspart) for the carbs he eats on insulin to carb ratios. usually he ends up with 4-6 needles in a day. in essence he can eat whatever he wants (though he has to wait til meal or snack time), but it is still important to eat a healthy diet. Yes, he can have a big slab of chocolate cake thick with icing, but he isn’t going to do that everyday. if we are at a birthday party, however, he will have cake with his friends. He tests his sugar a minimum of 4 times a day, more if his numbers are off, if he is unwell or feels low.
my husband has been type 1 for 23 yrs. he takes NPH and novolin toronto in the AM and PM. He does not carb count (though he did sort of in his teen years by giving himself more insulin to eat more, but he was taught that this is insulin abuse- needless to say he has had a hard time wrapping his head around the carb counting thing). I am not sure how much he takes but i think his NPH is 30 something units. I also know that he will adjust if he has been higher than he should be. He does test, but not as often as our son (or maybe as he should), but he says after this long he can tell if he is high or low without checking all the time.
Our DER team set our son’s doses and ratios and we make changes as we go along. Generally, if he is high at a certain time of day for 4 days then we will change the ratio a bit from the meal before or increase the lantus by a unit at night (if his high number is showing up in the am). He is ony 5 so the changes will be small for him and his ratios are still pretty big (like 1 unit for every 40 carbs). I don’t know how much my husband will change his by at a time.
One other thing, insulin pens are much easier to use then syringes (I have found and my son thinks they hurt a lot less- though my husband still uses syringes as he is used to it after so long).

Hi Cathy-First of all, there are different types of insulin. Insulin for long term coverage and insulin for covering meals. As far as testing. I as a T-1, test at least 4 times a day. Before all meals at at bedtime. Many times, also I test when I feel low.

Kathyann, just wondering…do you take your morning Lantus the same time as your Humalog before breakfast (I know you cannot mix the two - I have a separate pen for each), or do you wait and take it a little later?

Hi Cathy

Just another Type 1 answering your question. Everything said here has already provided the necessary information, I think. So, I"m just going to add my personal experience. I have the CGM (Continuous Glucose Monitor) but I test my BG 10 or MORE times per day in addition to seeing my BG reading on my CGM.

I take 10 or more shots per day of Apidra, Humalog, and Levemir. I was on the pump a few years back but it didnt work out for me.

My carb ratio is 1 unit per every 5 carbs. I cannot eat ANY carbs after 3:00 in the afternoon, or else I’ll spike during my sleep. Even if I cover the carbs with insulin. It’s weird. So, I’m on a VERY low carb diet. If I’m going to do any “treats” it’s during the day time- preferably morning. But, chocolate cake, syrup, honey, and anything that has NO nutrituional good in it whatsoever is a big fat “no-no” for me.

Every single insulin dependent is different in their ratios, their dosages, and their sensitivity to insulin. For example, I cannot be on Lantus, Regular, Novolog or NPH. I cannot be on Humalog without the background of Levemir as well (which helped in my need to come off the pump)

My absorption of insulin takes a while with Humalog (up to 6 hours for it to work) and my absorption of Apidra is relatively quick (under one hour to work). I split my Levemir dosage to 28 units before bed and 28 units before lunch. (I’m still working on this)

So, taking insulin will give you a little more freedom in your dietary choices, but it is not going to solve all of your issues. It is a trial and error situation until you’ve figured out your insulin sensitivity, your carb ratio, and your target BG number range.

Good luck!

Hi dargirl here. I like Kathyann take my Lantus in the morning. You have to take two seperate injections. One for the Lantus and one for your fast acting insulin. You cannot mix them. I usually take the lantus 6:00 a.m… Sometimes I do not eat my first meal until 8-9 a.m. Before my meal I test, then calculate based on my I:C ratio. When I wake up and get ready to take my Lantus and my BS are not in range, l do a correction bolus.

I do have a tip for you. Get a log that reflects hourly 6, 7, 8, 9 and so on, for the whole day. I could not wrap my head around the Breakfast, Lunch, Dinner only Log. You write down your BS, how many carbs you eat, what you took for your meal bolus, any corrections bolus you did. This will help you and help your CDE make changes. Also it will teach you how to make your own adjustments.

I live on a constant changing schedule at work. I never have lunch, breakfast, dinner at the same time from day to day.