10 Ways You May Be Sabotaging Your Insulin Therapy
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For many people with type 2 diabetes, insulin therapy is a must, and there can be serious consequences for those whose insulin isn’t working correctly.
“Generally, as the disease progresses, most patients with type 2 diabetes will end up on insulin at some point,” says Jesse Vander Heide, RN, CDCES, a certified diabetes educator at the Oregon Health and Science University in Portland. Your doctor may consider factors such as your current treatment regimen, blood sugar levels, and target glucose goals when advising if insulin therapy is right for you.
If your doctor prescribes insulin to help you manage type 2 diabetes, they will work with you to determine the type of insulin and insulin delivery method that’s best for you. There are different types of insulin available, and they vary in how fast they start to work, when they peak, and how long they last.
Usually, people take basal insulin once or twice a day at about the same time. Whether that’s in the morning or at night depends largely on what works best for your lifestyle. No matter when you take it, the crucial element is consistency, Heide says.
“We tend to cater the timing more toward what the person has an easier time remembering,” Heide says. “But there are instances in which we have to adjust based on what blood sugar is doing.”
Your healthcare team can help you settle on a combination of insulin types that works best for you. New types and formulations of insulin are constantly being introduced, Heide says. These newer insulins can more closely match the function of a normal pancreas.
Other mistakes or bad practices can also get in the way of your efforts to keep the condition well controlled, says Ava Port, MD, an endocrinologist for MedStar Health in Washington, DC. Ask your healthcare team for tips and strategies that make the most sense for you and your insulin regimen. And if you’re concerned that your insulin is not working correctly, avoid these common insulin mistakes to make sure you’re getting the most out of your treatment.
1. Forgetting Blood Sugar Checks
Checking your blood sugar levels regularly helps you stay tuned in to how your body responds to your medications, food, and lifestyle habits, Dr. Port says. It can help you and your doctor determine the right amount of basal and bolus insulin to take. Fasting blood sugar levels reflect how basal insulin works in the background, whereas pre-meal and evening blood sugar levels are a better barometer of how the bolus insulin dosing matches up with your food and carbohydrate intake. Many people don’t check their blood sugar when they feel fine, Port says. Or, despite having symptoms of high or low blood sugar, they simply ignore the fact that their diabetes may be out of control, she adds.
Smart strategies to stay on top of your blood sugar testing routine include choosing a glucose meter that works for your lifestyle, keeping the meter where it’s easy to get to and use, and finding ways to remind yourself to do the checks. It can be a note on your refrigerator, an alarm on your phone, or some other device that prompts you to use it — whatever works for you. These days, most people taking insulin use a continuous glucose monitor, a special device placed just under the skin that tracks blood sugar readings continuously and sends this information to a reader or phone app. Most devices can typically be worn for up to 7 to 14 days, depending on the brand.
2. Missing Insulin Doses
If you have type 2 diabetes and miss a dose of basal or bolus insulin, your blood sugar will rise. It can be tough to always remember to take your insulin, especially when you’re busy at work or school. But it’s incredibly important. Make it a priority, Port advises. Since basal insulin is generally taken just once a day, pick a time that works for you, such as just upon waking in the morning, and make it part of your routine. Keep your insulin supplies next to the alarm clock, in among your makeup supplies, or next to your shaving cream: wherever you’ll see it and won’t ignore it.
If you take bolus insulin, try keeping an extra set of your insulin supplies at work or in a bag you carry with you, so that medication is always in easy reach when you need it. Set an alarm on your phone, or find some other way to remind yourself to stop and take the insulin the prescribed amount of time before eating, Heide says. Support programs and groups for people with type 2 diabetes can be excellent places to pick up tips on remembering to take your insulin. The American Diabetes Association (ADA) has a directory of endorsed support programs, and the Defeat Diabetes Foundation has a directory of local support groups by state. Sometimes involving another person can also help build the medication into a routine, says Heide.
3. Skipping Meals
There are different types of insulin to treat diabetes. If you take rapid-acting bolus insulin and forget to eat, or eat less than you thought you would, your blood sugar level can get dangerously low, Port says. “Even though rapid insulin should be taken before meals, if someone is unsure of when or how much they will eat, it may be safer to wait until immediately after eating to take the rapid insulin,” she suggests. Talk to your doctor about whether this strategy may be right for you, however.
But also keep the big picture — and weight control — in perspective, Port cautions. “You shouldn’t go out of your way to eat just to take your bolus insulin if you aren’t hungry,” she says. If a meal is skipped, the rapid-acting dose should typically also be skipped. “And on that same note, if you are ravenous and needing to eat frequently just to keep your blood sugars up, you should probably talk to your doctor about whether your insulin doses need to be reduced,” Port adds.
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