A Beginner's Guide to Control of Blood Glucose Levels with Insulin Insulin is a vital hormone produced by the pancreas that allows your body to use gl...

A Beginner's Guide to Control of Blood Glucose Levels with Insulin

Insulin is a vital hormone produced by the pancreas that allows your body to use glucose (sugar) from carbohydrates in the food you eat for energy, or to store glucose for future use. Insulin helps keep your blood glucose levels from getting too high (hyperglycemia) or too low (hypoglycemia). For individuals with diabetes, particularly type 1 diabetes and sometimes type 2 diabetes, the body either doesn't produce enough insulin or cannot effectively use the insulin it produces. This often necessitates the use of external insulin to manage blood glucose levels. This guide will walk you through the basics of controlling your blood glucose levels using insulin, tailored for beginners.

Why is Controlling Blood Glucose Important?

Maintaining optimal blood glucose levels is crucial for preventing both immediate and long-term health complications. Uncontrolled high blood glucose levels can lead to:

Short-term complications: Frequent urination, excessive thirst, blurred vision, and increased risk of infections. In severe cases, diabetic ketoacidosis (DKA), a life-threatening condition, can occur.
Long-term complications: Damage to blood vessels and nerves, leading to heart disease, stroke, kidney disease, nerve damage (neuropathy), vision problems (retinopathy), and slow wound healing.

Conversely, excessively low blood glucose levels (hypoglycemia) can cause:

Shakiness
Sweating
Dizziness
Confusion
Loss of consciousness (severe cases)

Effective insulin management is the cornerstone of keeping blood glucose levels within a target range recommended by your healthcare provider.

Understanding Insulin Types and Their Actions

Insulin comes in various types, each with a different onset, peak, and duration of action. Knowing these characteristics is essential for managing your blood glucose levels effectively. Here’s a breakdown of common insulin types:

| Insulin Type | Onset | Peak | Duration | Example Brand Names | Typical Use | |--------------------------|-------------------|-------------------|-----------------------|-------------------------|------------------------------------------------------| | Rapid-Acting | 15-30 minutes | 1-2 hours | 3-5 hours | Humalog, Novolog, Apidra | Taken before meals to cover carbohydrates | | Short-Acting (Regular) | 30-60 minutes | 2-4 hours | 5-8 hours | Humulin R, Novolin R | Taken before meals; also used in insulin pumps | | Intermediate-Acting | 1-2 hours | 4-12 hours | 12-18 hours | Humulin N, Novolin N | Provides basal insulin coverage between meals | | Long-Acting | 1-2 hours | No pronounced peak | 24 hours (or longer) | Lantus, Levemir, Tresiba | Provides basal insulin coverage over 24 hours | | Ultra-Long Acting | 6 hours | Minimal Peak | 36 hours or longer | Toujeo | Extended basal insulin coverage | | Pre-Mixed | Varies (see labels)| Varies (see labels)| Up to 24 hours | Novolog Mix 70/30 | Fixed combination of rapid/short & intermediateinsulin|

Rapid-acting insulin is designed to cover meals and snacks. It begins working quickly, usually within 15-30 minutes after injection, and lasts for a short period.
- Example: Imagine you're about to eat a meal containing 60 grams of carbohydrates. Your doctor has instructed you to take insulin according to a carb ratio (we'll discuss this later). This type of insulin is your go-to.
Short-acting insulin also covers meals, but it takes longer to start working (about 30-60 minutes) and lasts longer than rapid-acting.
- Example: A patient waiting for lab results may be given this at a hospital to lower blood sugar quicker.
Intermediate-acting insulin provides background insulin coverage for about 12-18 hours.
- Example: Used typically twice daily to provide baseline coverage for the user, like an undercoat for painting, it covers most the board.
Long-acting insulin provides a steady background insulin level for approximately 24 hours or longer.
- Example: A basal insulin regimen might involve injecting long-acting insulin once daily at the same time to provide continuous coverage, ensuring you have a baseline level throughout the day and night.

Determining Your Insulin Dosage

Insulin dosage is highly individualized and depends on several factors, including:

Blood Glucose Levels: Pre-meal and post-meal readings.
Carbohydrate Intake: The amount of carbohydrates you plan to consume at each meal.
Activity Level: Physical activity increases insulin sensitivity, so you may need less insulin on active days.
Body Weight: Higher body weight generally requires higher insulin doses.
Insulin Sensitivity: Some individuals are more sensitive to insulin than others.
Time of Day: Insulin requirements can vary throughout the day.
Overall Health: Sickness and stress can impact blood glucose levels and insulin needs.

Your healthcare provider will determine your initial insulin dosage and teach you how to adjust it based on your blood glucose readings, carbohydrate intake, and activity level. Two important concepts to understand are:

Basal Rate: This refers to the amount of insulin you need to cover your body’s basic insulin requirements between meals and overnight.
Bolus Dose: This is the extra insulin you need to cover the carbohydrates in your meals.

Calculating Bolus Doses:

A common method for calculating bolus doses involves using an insulin-to-carbohydrate ratio (I:C ratio). This ratio tells you how many grams of carbohydrates one unit of insulin will cover. For example, if your I:C ratio is 1:10, one unit of insulin will cover 10 grams of carbohydrates.

Here’s how to calculate your bolus dose:

Determine the carbohydrate content of your meal: Check nutrition labels or use a carbohydrate counting app.
Apply your I:C ratio: Divide the total grams of carbohydrates in your meal by the carbohydrate grams your one unit of insulin will cover. This gives the dose of insulin needed.
- Formula: Insulin Dose = Total Carbohydrates / I:C Ratio
- Example: If you’re eating a meal with 60 grams of carbohydrates and your I:C ratio is 1:10, you would calculate your bolus dose as:
  Insulin Dose = 60 grams / 10 = 6 units

Correction Factor (Insulin Sensitivity Factor)

In addition to covering carbohydrates, you might need to adjust your insulin dose to correct high blood glucose levels before a meal. The insulin sensitivity factor (ISF), also known as the correction factor, tells you how much one unit of insulin will lower your blood glucose.

Determine your ISF: Your healthcare provider will provide this number, which is usually written as “1 unit of insulin will lower blood glucose by X mg/dL.”
Calculate the correction dose: If your blood glucose is above your target range, calculate how much you need to lower it by subtracting your target blood glucose from your current blood glucose.
- Formula: Correction Dose = (Current Blood Glucose - Target Blood Glucose) / ISF
- Example:
  - Your current blood glucose is 200 mg/dL
  - Your target blood glucose is 100 mg/dL
  - Your ISF is 50 mg/dL
  Correction Dose = (200 mg/dL - 100 mg/dL) / 50 mg/dL = 2 units

Techniques for Injecting Insulin

There are several methods for administering insulin, including:

Syringes: Traditional method using a needle to inject insulin from a vial.
Insulin Pens: Convenient and discreet devices that contain a cartridge of insulin.
Insulin Pumps: Small, computerized devices that deliver a continuous basal rate of insulin and allow you to administer bolus doses.

Basic Injection Tips:

Choose an injection site: Common sites include the abdomen, thigh, upper arm, and buttocks. Rotate injection sites to prevent lipohypertrophy (thickening of fatty tissue).
Clean the injection site: Use an alcohol swab and let it dry.
Pinch the skin: Gently pinch a fold of skin to create a subcutaneous pocket.
Insert the needle: Insert the needle at a 45 to 90-degree angle, depending on the needle length and thickness of your skin.
Inject the insulin: Push the plunger all the way down and hold for a few seconds.
Withdraw the needle: Gently remove the needle and release the skin.
Dispose of needles safely: Use a sharps container to discard used needles and syringes.

Using Insulin Pens:

Attach a new needle: Remove the pen cap and screw on a new pen needle.
Prime the pen: Dial 2 units and inject the insulin into the air to ensure the pen is working correctly.
Dial the dose: Dial the correct dose according to your doctor’s instructions.
Inject the insulin: Pinch the skin, insert the needle, and push the dose knob all the way down. Hold for a few seconds before withdrawing the needle.

Monitoring Blood Glucose Levels

Regular blood glucose monitoring is crucial for managing insulin therapy. Use a blood glucose meter to check your levels:

Before meals
Two hours after meals
Before bedtime
Before, during, and after exercise
When you suspect low blood glucose

Target Blood Glucose Ranges

Your healthcare provider will give you specific target ranges, but general guidelines are:

Fasting Blood Glucose: 80-130 mg/dL
Post-Meal Blood Glucose (2 hours after starting the meal): Less than 180 mg/dL

Keep a log of your blood glucose readings, insulin doses, carbohydrate intake, and activity levels. This information will help you and your healthcare provider fine-tune your insulin regimen.

Utilizing Continuous Glucose Monitors (CGMs):

CGMs can be a powerful tool to provide real-time blood glucose data and trends. Here are some additional considerations when using a CGM with insulin therapy:

Trend Arrows: Pay attention to the direction and speed of the blood glucose changes indicated by the trend arrows.
Alerts: Set up alerts for high and low blood glucose levels.
Pattern Recognition: Use CGM data to identify patterns and adjust your insulin regimen accordingly.

Hypoglycemia Management

Hypoglycemia is a common side effect of insulin therapy. Be prepared to treat low blood glucose quickly.

Symptoms of Hypoglycemia: Shakiness, sweating, dizziness, confusion, hunger, irritability, rapid heartbeat.
Treatment for Mild Hypoglycemia: Consume 15-20 grams of fast-acting carbohydrates, such as glucose tablets, fruit juice, or regular soda. Wait 15 minutes and check your blood glucose again. Repeat if necessary.
Treatment for Severe Hypoglycemia: If you are unable to swallow or unconscious, administer glucagon. If you are able to swallow, it can be administered to them by a healthcare professional to bring them back to conscienceness.

Hyperglycemia Management

If your blood glucose levels are consistently above your target range, take steps to correct them with extra insulin as directed by your healthcare provider. Ensure you're drinking enough fluids and consider adjusting future insulin doses.

Lifestyle Modifications

In addition to insulin, lifestyle modifications play a critical role in controlling blood glucose levels.

Diet: Follow a balanced diet with consistent carbohydrate intake. Work with a registered dietitian to develop a meal plan that meets your needs.
Exercise: Regular physical activity helps lower blood glucose and improves insulin sensitivity.
Stress Management: Chronic stress can raise blood glucose. Find healthy ways to manage stress, such as meditation, yoga, or spending time in nature.
Sleep: Poor sleep can affect insulin sensitivity and blood glucose control. Aim for 7-8 hours of quality sleep each night.

Important Considerations

Alcohol Consumption: Drinking alcohol can affect blood glucose levels and may increase the risk of hypoglycemia, especially when taken with insulin. Consume alcohol in moderation and with food.
Sick Day Management: When you're sick, your blood glucose levels can be unpredictable. Continue taking insulin, monitor your blood glucose more frequently, and drink plenty of fluids. Contact your healthcare provider if you have difficulty managing your blood glucose.
Travel: Planning and preparation are vital. Carry sufficient insulin, syringes, and other supplies. If you have a pump, pack extra batteries, infusion sets and be aware of time zone changes and adjust your doses.

Potential Challenges and How to Handle Them

Managing insulin therapy isn’t always straightforward. You might encounter various challenges that require careful management and problem-solving. Here are some common challenges and tips on how to handle them:

Challenge: Dawn Phenomenon

Description: Dawn phenomenon refers to a natural rise in blood glucose levels in the early morning, typically between 3 AM and 8 AM. It is caused by hormonal changes that occur during sleep, such as the release of growth hormone, cortisol, and adrenaline, which can increase insulin resistance.
Management:
- Monitor Blood Glucose: Check your blood glucose levels around 3 AM for several days to confirm the pattern.
- Adjust Basal Insulin: Consult your healthcare provider to discuss adjusting your basal insulin dose or timing of your insulin injections to counteract this effect.
- Consider Evening Snacks: Avoid high-carbohydrate snacks before bed.
- Exercise Regularly: Exercise can improve insulin sensitivity, which can help manage dawn phenomenon.

Challenge: The Somogyi Effect

Description: The Somogyi effect, also known as rebound hyperglycemia, occurs when low blood glucose levels during the night (usually caused by excessive insulin or missed meals) trigger the release of counter-regulatory hormones, leading to a high blood glucose reading in the morning.
Management:
Related reading: Why Is Your Morning Blood Glucose So High The Dawn Phenomenon Explained
- Monitor Blood Glucose: Check your blood glucose levels at various times during the night (around 3 AM) for several days to identify nighttime hypoglycemia.
- Adjust Insulin Dose: Work with your healthcare provider to reduce your insulin dose, especially the evening or bedtime dose.
- Ensure Consistent Bedtime Snack: Consume a consistent bedtime snack that contains both carbohydrates and protein to prevent nighttime hypoglycemia.

Challenge: Gastroparesis

Description: Gastroparesis is a condition in which the stomach takes too long to empty its contents, causing delayed and erratic blood glucose levels.
Management:
- Small, Frequent Meals: Eat smaller, more frequent meals throughout the day to help regulate digestion.
- Limit Fats and Fiber: Reduce the amount of fat and fiber in your diet, as these can slow down gastric emptying.
- Medications: Consult your healthcare provider about medications that can help improve gastric emptying, such as metoclopramide or erythromycin.
- Insulin Timing: Adjust your insulin dose timing to better match the delayed absorption of nutrients from the stomach.

Challenge: Exercising with Insulin

Description: Physical activity can significantly affect blood glucose levels, sometimes leading to hypoglycemia if not managed properly.
Management:
- Monitor Blood Glucose: Check your blood glucose levels before, during, and after exercise to understand how your body responds to activity.
- Adjust Insulin Dose: Reduce your insulin dose before exercising, especially if you're doing prolonged or intense activities.
- Carry Fast-Acting Carbs: Always have a source of fast-acting carbohydrates with you during exercise to treat hypoglycemia if it occurs.
- Timing: Schedule exercise at the same time each day and time to your meals or snacks.
- Snacking: Have a snack before the exercise.

Staying Educated and Supported

Managing insulin and blood glucose levels is an ongoing learning process. Here are some tips for staying educated and supported:

Work closely with your healthcare team: Your doctor, diabetes educator, and registered dietitian are your best resources for personalized advice and support.
Attend diabetes education programs: These programs provide comprehensive information on all aspects of diabetes management.
Join a support group: Connecting with others who have diabetes can provide valuable emotional support and practical tips.
Utilize online resources: There are many reputable websites and apps that offer information, tools, and support for managing diabetes. Some useful resources include the American Diabetes Association (ADA), the Juvenile Diabetes Research Foundation (JDRF), and Diabetes UK.

Controlling blood glucose levels with insulin requires education, dedication, and teamwork with your healthcare provider. By understanding the basics of insulin types, dosage, injection techniques, monitoring, and lifestyle modifications, you can effectively manage your blood glucose and live a healthy, fulfilling life with diabetes. Remember to always consult with your healthcare team for personalized advice and guidance.