If you have diabetes and take insulin, you have a lot of plates to keep in the air.
It doesn’t have to be overwhelming. It’s not, by any stretch, an impossible task.
It’s doable, but it takes some, well, doing.
“It’s like one giant puzzle, or one giant math problem. You have a lot of variables,” says Pamela Allweiss, an endocrinologist with the Division of Diabetes Translation at the CDC.
“Your meals might be one part of the variable,” she says. “And when you’re going to be eating. You have to know what type of meal -- how many carbohydrates, for instance. It will depend on the time that you eat. It will depend on what your blood sugar [level] is going into the meal. Sometimes, it also depends on the dose of insulin.
“It’s definitely a puzzle. That’s why we like when people get diabetes self-management education. It empowers the person with diabetes to learn all these things.”
Start with the following:
Your Blood Sugar Levels
Everything starts with monitoring your blood sugar levels.
“If a patient is taking insulin, they really do need to be checking their blood sugar much more often than when they weren’t taking insulin,” says Joanne Rinker, director of training and technical assistance at The Center for Healthy North Carolina. “When they’re prescribed insulin, especially if it’s short-acting insulin, they should be checking their blood sugar 2 hours after every meal. Because that is the only way for us to know if that was the correct dose.”
You don’t want your blood sugar going too low (hypoglycemic) or too high (hyperglycemic). You should stay between 80-130 mg/dL before meals and less than 180 after a meal.
Testing is the only way to know, for sure, where your levels are. Once you know your number at different times of the day -- when you get up, before and after meals, or at bedtime, for example -- you can start to figure out what to do about it.
Your Eating Habits
One of the first things you learn with diabetes is that carbohydrates can drastically change your blood sugar levels.
What are carbs? There are three types:
Starches include vegetables like potatoes, peas, and corn. Beans, lentils, and grains like barley, oats, and rice also fall in this category.
Sugars refer to both natural ones, like those in fruits and milk, and those added in processing, like high-fructose corn syrup.
Fiber comes from plants, including parts of fruits and vegetables, as well as grains and nuts.
Carbs are an important part of every diet, but those with diabetes need to keep close track. Start with between 45-60 grams of carbohydrates per meal. You can get 15 of those grams from things like:
- A small piece of fresh fruit
- A slice of bread
- A 1/2 cup of oatmeal
- 1/4 of a large baked potato
- A 1/2 cup of ice cream
It’s not only what you eat, of course. It’s when.
Your blood sugar is expected to go up after a meal, especially one with lots of carbs. If you don’t eat, or eat a meal with few carbs, your levels could go down. The only way to know for sure is to test.
Insulin helps make sure your blood sugar levels don’t go too high or too low.
There are different types. The differences are:
- When the insulin begins to work
- When it works best
- How long it lasts
Rapid-acting starts to work 15 minutes after injection. It does its best work in about an hour, and its effects will last for 2-4 hours.
Regular (you may hear it called “short-acting”) begins its thing in about 30 minutes. It’s most effective in 2-3 hours and continues to work for up to 6 hours.
Intermediate-acting begins its work 2-4 hours after injection. You’ll get peak help in 4-12 hours, and it’ll keep chugging for up to 18 hours.
Long-acting takes several hours to start working, but you’ll get a steady, slow effect for about 24 hours.
So which is right for you? Rinker says it depends on a bunch of things.
“Most fast-acting insulin, you’re supposed to take it maybe 15 minutes, or at the most 30 minutes, prior to eating,” she says.
That’s to account for what you’ll hear called “lag time.” Basically, that’s the brief amount of time between when you inject and when the insulin hits your bloodstream.
The key is once it’s in the bloodstream, you have to have food in your body to go with it. If you don’t, you’ll end up with low blood sugar.
“So it’s all those things. It’s that timing of when you take your insulin, as well as when you eat your food,” Rinker says. “It becomes very challenging in places like restaurants, because you may take your dose, but then they’re behind in the kitchen, so you have to go request some bread or something.”
Allweiss points out that the insulin needs to be delivered correctly, too. Don’t share insulin pens, blood glucose monitors, or syringes.
Lots of things can affect your blood sugar levels. They include:
- A lack of sleep
- Exercise (or lack of it)
- Interactions with other medicines
- Short- or long-term pain
Rinker suggests you log everything, including:
- Your exercise
- What you eat each day (especially how many carbohydrates)
- When you inject your insulin
- What type of insulin you inject
- Anything else that might come to mind
Keep track of your glucose levels in the log, too, to see how all the above things affect the levels.
It can get overwhelming. But, again, it doesn’t have to be.
“I think the best way to do it is to just tackle things one thing at a time,” Rinker says. “Don’t think about all the things that you have to do. Think about maybe mastering one thing. And then, once you feel really comfortable with that one thing, then moving on to the next.”
The Internet has a host of sources to help. Diabetes educators and your doctor are there, too, to answer questions or address specific problems. In the end, though, your best advocate is you.
“It’s a process. You can’t learn everything in a day,” Allweiss says. “But with a little bit at a time, people become very, very good at managing all the different factors.”