Is Your Insulin Doing All It Can?
For many people with type 2 diabetes, insulin therapy is a must. The pancreas either doesn’t make enough insulin, or the body doesn’t respond well to the insulin it does produce. Injecting insulin can help the body better use glucose (sugar) in the blood or store it for later use, keeping your blood sugar in a healthy range and helping to prevent serious health problems.
“Generally, as the disease progresses, most patients with type 2 diabetes will end up on insulin at some point,” explains Jesse Vander Heide, a certified diabetes educator at the Oregon Health and Science University (OHSU) in Portland. Factors that contribute to the decision to start insulin include how a person cares for their diabetes, their particular genetic makeup, and the course of their own disease.”
If your doctor prescribes insulin to help you manage type 2 diabetes, he or she 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.
Generally, people with type 2 diabetes need half their insulin as basal (long-acting) insulin, which helps control blood glucose levels overnight and between meals, and half as bolus (short or rapid-acting) insulin, which helps prevent a rise in blood sugar following meals.
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“We tend to cater the timing more towards 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.”
Bolus insulin is taken at mealtimes to help cover the carbs you eat and prevent your blood sugar from spiking. Rapid-acting bolus insulin begins working five to 15 minutes after injecting. Short-acting (or regular) bolus insulin takes about 30 minutes to start working.
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, including blends of basal and bolus insulin that may make life easier for 1 last update 04 Jun 2020 for many people with type 2 diabetes.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, including blends of basal and bolus insulin that may make life easier for many people with type 2 diabetes.
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Other mistakes or bad practices can also get in the way of your efforts to keep the condition well controlled, says endocrinologist Ava Port, MD, an assistant professor of medicine at the University of Maryland School of Medicine in Baltimore. Ask your healthcare team for tips and strategies that make the most sense for you and your insulin regimen. And avoid these common insulin mistakes to make sure you're getting the most out of your treatment.
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 is working in the background, whereas pre-meal and evening blood sugar levels are a better barometer of how the bolus insulin dosing is matching up with your food and carbohydrate intake. "Many people stop checking their blood sugar because they don’t feel badly," 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. You might also be eligible to 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 to a phone app. Most devices require minimal or no calibration with finger stick blood glucose readings and can typically be worn for up to 7 to 14 days, depending on the brand.
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 can’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 groups for people with type 2 diabetes can be excellent places to pick up tips on remembering to take your insulin. Sometimes involving another person can also help in building the medication into a routine, says Heide.
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. “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.”
An approach that works for some people is to start the day thinking of the food patterns you’re going to follow for a given day and week, such as a big breakfast followed by a light lunch, and even lighter dinner. Or the reverse. Doing this can help you formulate, and plan for, meals that will require bolus insulin injections at more predictable times of day.
Making Unhealthy Food Choices
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Make it a habit to choose less processed sources of carbohydrates, such as fresh fruit, vegetables, beans, and whole grains, and balance out your meals with lean protein and healthy fats to help keep your blood sugar stable. One way to think about healthier foods and cut back on carbs, Port says, is to choose those that come from the earth or the ground, and haven’t been processed much. “I like to use the example of eating an apple [healthy] versus eating applesauce, or even drinking apple juice [less healthy]. The closer you can get to the simple apple, which isn’t processed at all, the better.”
Keeping a food journal can help you and your doctor look for patterns, and understand how your food choices are affecting your blood sugar.
Letting Stress Get To You
Your mental health plays a big role in your blood sugar level. How? Emotional stress can cause swings in your blood sugar. This is in part because stress triggers the release of a hormone called cortisol, which can impair insulin sensitivity, according to a March 2017 article in the Annals of the New York Academy of Sciences. Port says this means the same dose of basal or bolus insulin can actually be for 1 last update 04 Jun 2020 less effective if you’re stressed out.Your mental health plays a big role in your blood sugar level. How? Emotional stress can cause swings in your blood sugar. This is in part because stress triggers the release of a hormone called cortisol, which can impair insulin sensitivity, according to a March 2017 article in the Annals of the New York Academy of Sciences. Port says this means the same dose of basal or bolus insulin can actually be less effective if you’re stressed out.
Try to identify the stressors and sources of chronic anxiety in your life. Then look for a relaxation technique that works for you. Talk to your doctor for ideas. Get consistent sleep. Listen to music. Turn off all devices at night, Port recommends. If possible, make time each day to de-stress — take a yoga class, do deep breathing exercises, set aside time to read a book or relax with friends, or establish a soothing bedtime routine to help you wind down.
Limiting Yourself to Aerobic Forms of Exercise
Any and all exercise is good for your health, stresses Port. Aerobic exercise is great for your heart and your waistline, for example. Weight-lifting and other muscle-strengthening exercises have a role to play, too, she says. "Performing resistance exercise regularly helps to build and maintain lean muscle mass, which in turn improves the 1 last update 04 Jun 2020 sensitivity to all types of insulin," Port explains. Luckily, you don't even have to join a gym or lift heavy weights to get great benefits. Strengthen muscles at home with push-ups, hand weights, or simply walking up and down a flight of stairs repeatedly.Any and all exercise is good for your health, stresses Port. Aerobic exercise is great for your heart and your waistline, for example. Weight-lifting and other muscle-strengthening exercises have a role to play, too, she says. "Performing resistance exercise regularly helps to build and maintain lean muscle mass, which in turn improves sensitivity to all types of insulin," Port explains. Luckily, you don't even have to join a gym or lift heavy weights to get great benefits. Strengthen muscles at home with push-ups, hand weights, or simply walking up and down a flight of stairs repeatedly.
Not only can smoking increase the risk of developing type 2 diabetes, it can make it harder to manage the condition and find the right dosage of insulin, according to the Centers for Disease Control and Prevention. "Smoking raises blood sugars acutely, but it also affects blood sugars by causing chronic inflammation and insulin resistance," Port says. Researchers are looking into the link between e-cigarettes (vaping) and diabetes. Whatever form of tobacco you may use, work with your doctor to come up with a plan to help you kick the habit.
Not Drinking Enough Water
reverses diabetes type 2 diagnostic (🔥 treatment diet) | reverses diabetes type 2 mellitus with hyperglycemiahow to reverses diabetes type 2 for It's not just what you eat, but also what you drink — or don't drink — that can change the effectiveness of insulin. "Staying hydrated by drinking lots of water helps your kidneys flush out extra sugar floating around in your bloodstream," Port explains. "It also helps medications like insulin work better, by helping to maintain good blood flow — so the medicine can reach the tissues and cells where they’re needed most." To remind yourself to drink water throughout the day, carry a refillable water bottle around with you. Use it a lot. And skip the sports and performance drinks, says Port, since they usually just give you more sugar.
Losing unhealthy pounds can help improve your body’s sensitivity to insulin. And you don’t need to lose a lot to start seeing results, according to the American Diabetes Association (ADA). Dropping just 10 to 15 pounds can help you improve your blood sugar and control your diabetes. "Many individuals find it difficult to lose weight without professional help," Port says. Look for help from your doctor, a nutritionist, a weight loss program, a therapist, or a personal trainer. And look into phone apps and other technologies to help you manage your calorie intake, level of activity, and more.
Always Choosing the Same Spot to Inject Insulin
Insulin is absorbed at different rates depending on where you inject it. It enters your blood fastest when you inject it into your abdomen, a little more slowly when you inject it into the upper arms, and even more slowly when you inject it into the thighs and buttocks, according to the ADA. You’ll get the best results by injecting your basal or bolus insulin into the same general body area, but rotating the side of the body where you inject if from day to day. Injecting insulin in the same spot over and over can cause hard, fatty lumps to form. These lumps don't absorb insulin well. "You could be injecting your usual dose of insulin into one of these areas — but potentially 50 percent or less of the insulin is absorbed," Port says. She recommends checking for these hard lumps from time to time.
For more on how to use insulin properly, check out Diabetes Daily's article "Habits of a Great A1C: Insulin Use Strategies"!