Several times a year my “Irish” gets up and I have to rant about the way Type-2′s are introduced to insulin therapy. Or rather not introduced. Given very little information or instructions at all!
I’ve been a very active member of the ADA message boards for over eight years and have spoken to probably more than a thousand people over the years. Every day it seems I hear another horror story about people being put on insulin with practically no information about it, and also sometimes no instructions even on how to inject it. This is completely unacceptable in my opinion. Insulin isn’t like taking a pill, and there are also different types of insulin that are for different purposes and act differently in your system.
So this post will mainly be some basic information about insulin. It’s a shame you didn’t get it from your healthcare provider, but at least I’ll try to help you with the “mystery”.
There are basically two varieties of insulin: Basal and Bolus. Basal is a long or intermediate acting insulin. It releases small amounts of insulin into your system during long periods of time. A normal body produces insulin 24/7 in this way to keep its functions working properly and keep the glucose numbers normal. People with diabetes often don’t produce enough insulin naturally to keep this function working properly, so this is often the first type of insulin prescribed for a Type-2. In many cases the person is also taking oral medication(s) and this basal insulin is to help supplement these. It’s especially used to help with high fasting numbers and time when you aren’t eating. The usual brands for this are Lantus and Levemir in this country.
These insulins do not work on food eaten. They release in way too small amounts to cover food. When taking these you still have to be very careful with the amount of carbs you eat or your numbers will remain very high.
In an ideal situation the doctor will start you on a certain amount and then tell you to test and call in your numbers to see how effective the amount is. Then the doctor will adjust the amount until your fasting numbers are within range. I say ideal because often people will write in saying that the insulin isn’t working. I ask if they were given instructions to call the numbers in and they say no. Grrrrrrrrrrr! I then explain this and tell them to call the doctor and report the numbers. Insulin isn’t like an oral pill, it takes time and experimentation to find the right dose for each person because every person’s body is different. There are often many adjustments before the final dose is determined. It almost never happens the first time.
Now we come to Bolus type insulins. These usually end with a “log” such as Humalog. They are meant to be rapid-acting and to cover the food you eat. They are also sometimes used for “corrections” when numbers are high to bring them down.
These insulins usually start acting within 15 minutes of injecting them. You’re supposed to inject them before you start eating and make sure you eat within 15 minutes. The amount of insulin you use depends on the amount of carbs you plan to eat usually, but this also isn’t always explained to folks. Some doctors just prescribe a set dose, not informing people that a set amount means you can only eat the amount of carbs that dose will cover. A set dose is a very poor way to handle this type of insulin. The best way is to experiment and find just how many carbs a unit of insulin will cover in your body. This is called a carb-ratio, and it really does take a bit of work. Once you do discover it, you can base the insulin dose you take on the amount of carbs you plan to eat. This still requires carb counting and knowledge, but it works much better in controlling your numbers. You do have to make certain that the dose you take is covered by carbs eaten, however, or you can go low(hypoglycemia).
I usually refer people to the book “Think Like a Pancreas” by Gary Scheiner. It’s a book that explains all about insulin and how it works. It’s also very easy to read. Anyone using insulin should have this book in my opinion. It also explains in great detail how to develop a carb-ratio, and how to do basal testing, things you really need to know and understand.
Many health plans cover instructions for insulin use. The problem is that doctors don’t always recommend them. Check and see if your plan does cover it. and if so insist on being referred to one. This is your right.
Even with instructions I’m afraid that the main part of knowledge will have to come from what you yourself seek. It’s a sad fact, but currently true for many type-2′s.
I believe insulin to be a great drug, I’ve used it myself for many years. It does take a lot of knowledge and learning though, and as I’ve said, you’re usually on your own to find the information.
One other word. A type-2 who starts on insulin does not become a type-1. Type-1 is a completely different disease. A type-2 never becomes a type-1, but is an insulin-dependent type-2.
End-Rant (for now)
© EMO 4/12
Knowledge is Power