“Lifestyle is an imperative component for people with diabetes,” says Gregory Dodell, MD, an endocrinologist in private practice, and assistant clinical professor in medicine, endocrinology, diabetes, and bone disease at the Mount Sinai Health System in New York City. “Getting a diagnosis of diabetes can be like accepting a new full-time job,” he adds.
An Insulin Routine for Type 2 Diabetes
Your insulin routine may include basal (long-acting) or bolus (short-acting) insulin. Basal insulin, usually taken once or twice a day, helps control blood sugar levels during periods of fasting, such as between meals and while you’re asleep. Bolus insulin Is usually taken at mealtimes to help prevent your blood sugar from rising after you eat. The different types of insulin available vary in how quickly they start to lower blood sugar levels, when they peak, and how long they last. On average, people who are only taking insulin for diabetes need roughly half their insulin in the form of basal insulin and half as bolus insulin, explains David Bradley, MD, assistant professor in the division of endocrinology, diabetes, and metabolism at the Ohio State University Wexner Medical Center in Columbus. “But there is a lot of variability; everyone is different,” he adds. “For patients with type 2 diabetes, we have many other non-insulin agents that can sometimes take the place of bolus insulin. For instance, using just a long acting basal injection in combination with a (medicine called a) GLP1 receptor agonist can often eliminate the need for doing bolus shots. This is actually one of the recommended strategies, along with doing basal-bolus therapy,” he says, and often has the added benefit of helping in losing weight as well.
How to Optimize Your Insulin Therapy
No matter what your insulin routine consists of, be sure to follow these steps in order to optimize your diabetes management plan: Test your blood sugar regularly. Your ideal blood glucose (sugar) level takes various factors into account, such as your age, the time of day, planned activity, and the type of diabetes you have, Dodell says. Testing your blood sugar gives you information on how diet, exercise, stress, illness, and other things in your life may raise or lower your blood sugar. Work with your doctor and diabetes educator to determine a good daily schedule for testing your blood sugar levels, and periodically go over your food logs (trackers/diaries) together to get recommendations on things you might want to update or change. Perhaps most importantly, Bradley says that checking blood sugar regularly can help you determine how much bolus insulin to take at any given moment. After all, bolus insulin is used not only to adjust for the effect of food on blood sugar, but as a means of correcting a high blood sugar reading. The only way to make this work is to check your blood sugar levels at regular intervals. The readings also help your healthcare providers make informed decisions about adjusting bolus and basal insulin doses overall. Know where to inject your insulin. “Insulin is absorbed at different speeds depending on the area of injection, so it’s important to use the same body part for daily injections — but to rotate sites on that body part,” says Bradley. “In general, insulin can be injected in the upper arms, upper thighs, abdomen, and buttocks, with absorption being fastest in the abdomen, then the arms, thighs, and buttocks.” Be sure to choose a place to inject insulin that’s at least a finger’s width away from your last injection site to avoid creating areas of lipohypertrophy — lumps of accumulated fat and scar tissue that affect insulin absorption. Eat a diabetes-friendly diet. In addition to helping you reach and maintain a healthy weight and prevent other conditions that can come with diabetes (comorbidities), such as heart disease, a healthy diabetes diet can help you manage your condition. What you eat, especially when it comes to carbohydrates (carbs), can significantly affect your blood sugar levels, according to the American Diabetes Association (ADA). Carbs break down into sugars, so spread out those you eat through the course of the day. Also balance each meal with lean protein and healthy fat. If you’re prescribed a mealtime insulin dose, work with your doctor to match the dose with the food you eat. It’s critical that the bolus insulin you inject be matched with the amount of food you eat; if a person eats very little and takes too much insulin, they can develop low blood sugar, Bradley says. On the other hand, taking too little insulin for the food you eat can lead to high blood sugar. One way to match insulin to food is through carbohydrate counting, which can help you determine how much bolus insulin you need to cover the amount of carbs you eat. This is typically given as an insulin-to-carb ratio, such as 1:10, meaning you would need 1 unit of bolus insulin for every 10 grams of carbs. Work with your healthcare team to determine the right insulin-to-carb ratio for you. Here are some other helpful tips to maximize your diabetes-friendly diet: Choose whole grains like whole-wheat bread and pasta, brown rice, and quinoa instead of refined grains. Pick sweet potatoes over white potatoes. Read food labels carefully to find sugar hiding in foods, like high fructose corn syrup in processed foods. Finally, be mindful of portion control and serving sizes. A diabetes educator or registered dietitian can help you learn the basics of healthy eating, and even tailor a diabetes diet to fit your needs. Stick to your insulin schedule. Skipping or forgetting a basal or bolus insulin dose is no small thing when you have diabetes. It can lead to a higher than normal blood glucose reading, according to the ADA. It’s also important to eat regular meals, because some insulin and oral medications are specifically timed to work with food. Bradley notes that if you normally take bolus insulin and for some reason haven’t eaten, you’ll likely have been instructed to skip the injection. Talk to your doctor about what to do if this happens and try to stick to a relatively regular eating schedule to keep things on an even keel. Stay hydrated. Getting enough liquids is important to prevent fatigue as well as the confusion that can lead your body to think you’re hungry, and encourage unnecessary eating. Elevated blood sugar can also lead to sugar being excreted in your urine and cause dehydration, Bradley says. Exercise. Think of starting and getting exercise as free medicine, says Joanne Rinker, RD, a certified diabetes educator and director of training and technical assistance with the Center for Healthy North Carolina. “Exercise helps decrease insulin resistance, allowing sugar in the bloodstream to be pulled into the cells where it can be used for fuel rather than excreted through the kidneys,” she says. “A single bout of moderate-intensity exercise can increase glucose uptake by at least 40 percent.” And you don’t need to run a marathon to get the benefits; low-impact aerobic exercises, such as brisk walking and strength training are good places to start. What’s more: Exercise also benefits your heart, helps with losing and keeping off weight, and leads to sounder sleep and a better mood overall. Be prepared. If you’re managing type 2 diabetes with insulin or another glucose-lowering medication, you should know the symptoms of low blood sugar (hypoglycemia). Having blood sugar that’s too low may make you feel sweaty, confused, and hungry. Carry a quick-acting sugar — such as a glucose tablet or a quarter glass of fruit juice — to take right away if your blood sugar drops, advises Dodell. But keep the amount you eat small, so you don’t overdo it and raise your blood sugar for the rest of the day. If you frequently experience low blood sugar, talk to your doctor about whether you need to adjust the type or amount of insulin you take. Keep in touch with your doctor. About one-third of people with diabetes fail to take their insulin as prescribed, which can lead to long-term complications such as heart attack, stroke, and nerve damage, according to the American Association of Diabetes Educators. “Stay in regular contact with your doctor, especially if you’re new to taking insulin, to keep him or her aware of any changes to your health or necessary adjustments to your medication, and to ensure that your insulin delivery method is being done correctly,” Rinker says. If you have any questions about your insulin or how to take it correctly, ask your doctor or diabetes educator for more information. You can also ask your doctor to recommend a diabetes support group — where asking questions is invited and can take place in a non-judgmental way. Additional reporting by Andrea Peirce
