If you have diabetes and are on insulin, there are many things to avoid.
This is not necessarily irresistible. But it’s not an impossible task, by any means.
“It’s like a huge puzzle, or like a huge math problem with a lot of variables,” said Pamela Allweiss, an endocrinologist in the diabetes division of the Centers for Disease Control and Prevention (CDC).
“When a patient is going to eat, the plate meal may be part of the variables,” Pamela said, “for example, it’s important to know what type of food is being eaten – how many carbohydrates it contains, which will depend on the meal time, but also on what blood sugar level will be reached at the time of the meal, and also on the dose of insulin used.”
“It’s definitely a mystery and the reason we like people to be educated about diabetes self-management, it encourages people with diabetes to learn all these things,” Pamela said.
Start taking action in each of the following areas.
Monitoring blood glucose levels
It all starts with monitoring the patient’s blood glucose levels.
“If they are using insulin, they really need to test their blood glucose levels more often than if they are not using insulin,” says Joanne Rinker, director of training and technical assistance at North Carolina Health. “When a doctor prescribes insulin, especially short-acting insulin is prescribed, it’s important to check blood glucose 2 hours after each meal because that’s the only way we know if the insulin dose is correct.”
Patients do not want their blood glucose to be too low (hypoglycemia) or too high (hyperglycemia) and should keep it between 80 and 130 mg/dL before meals and below 180 mg/dL after meals.
Glucose testing is the only way to determine blood glucose levels. Once you know that blood glucose levels vary at different points in the day, such as when you wake up, before and after meals, or at bedtime, then you can start thinking about what to do.
Effect of diet
Carbohydrates can dramatically change your own blood glucose levels.
What is a carbohydrate? It comes in 3 types.
- Starch: This includes vegetables like potatoes, peas, and corn, and grains like barley, oats, and rice.
- Sugars: Both natural, such as those contained in fruits and milk, and those added during processing, such as high fructose corn syrup.
- Fiber: Comes from plants, including parts of fruits and vegetables, as well as grains and nuts.
Carbohydrates are an important part of the daily diet and need to be watched closely by people with diabetes. You should eat 45-60 grams of carbohydrates at each meal, and you can get 15 grams of carbohydrates from each of the following foods:
- a small piece of fresh fruit;
- One slice of bread;
- 1/2 cup (1 cup 250 ml) of oatmeal;
- 1/4 large baked potato;
- 1/2 cups ice cream.
Of course, it’s not just about what you eat, it’s also about when you eat it.
After a meal, blood sugar is expected to rise, especially after eating a lot of carbohydrates. If foods containing only small amounts of carbohydrates are not eaten or are eaten, blood glucose levels may fall. The only way to know exactly what your blood glucose level is is to take a blood glucose test.
The role of medications
Insulin helps ensure that blood sugar levels do not get too high or too low.
There are different types of insulin, which differ in the following ways:
- the time when insulin starts to work;
- The time of optimal action;
- How long the effect lasts.
Rapid-acting insulin:
Action starts 15 minutes after injection and is optimal within about 1 hour, with effects lasting 2 to 4 hours.
Regular insulin:
Regular insulin (also called short-acting insulin) starts to work within about 30 minutes, is most effective within 2 to 3 hours, and works for up to 6 hours.
Medium-acting insulin:
Onset of action is within 2 to 4 hours of injection, with peak effect within 4 to 12 hours and sustained action for up to 18 hours.
Long-acting insulin:
It takes several hours to start working, but the effect is stable and slow, lasting about 24 hours.
So, which type of insulin is right for you? Joanne says it depends on many factors.
“Most fast insulins may need to be injected 15 minutes before you eat, or up to 30 minutes before,”
says Joanne.
This is called lag time. Basically, this is the short period of time between when insulin is injected and when it reaches the bloodstream.
The key is that once the insulin gets into the bloodstream, there has to be food in the body to go with it, or you end up with hypoglycemia.
“It’s all about when you need to inject insulin and when you need to eat,” Joanne said, “but if you’re in a place like a restaurant, it becomes very challenging. Because a dose of insulin may have been administered, but the meal time is delayed because of slow food service. In that case, one must go ahead and ask for a little bread or something else to fill up.”
Pamela pointed out that insulin needs to be delivered properly into the bloodstream, and not to share insulin pens, glucose monitors or syringes with others.
Influence of other factors
Many things can affect blood glucose levels, including:
- Lack of sleep;
- Lack of exercise;
- Interactions with other medications;
- Disease;
- Stress;
- Short-term or long-term pain;
- Dehydration;
- Alcohol.
Joanne recommends that patients document all of the following, including:
- Exercise;
- What they eat each day (especially how many carbohydrates they eat);
- The timing of insulin injections;
- what type of insulin was injected;
- anything else that might come to mind.
And track blood glucose levels in a log to see how all of the above factors affect blood glucose.
These tasks are irresistible. But again, it is also not necessarily a given.
“I think the best way to do it is to work on one thing at a time,” Joanne said, “don’t think you have to do everything at once, think about whether you’ve mastered one thing first, and then, once you’re satisfied with getting that one thing done, then move on to another. ”
There is a lot of information available on the Internet to help, and diabetes educators and doctors are answering questions or addressing specific issues. But in the end, the best advocates for action should be the patients themselves.
“You can’t learn everything in a day,” Pamela said, “but learning a little bit at a time, people become very good at managing all the different things.”