Titration And Timing Of Basal Insulin
After the recent unexpected finding of increased mortality in the intensive glucose-lowering therapy group of the ACCORD study, which might be partly related to the rate of the reduction in A1C , clinicians may now be more reserved to lower glucose levels promptly. However, we still feel that in addition to timely initiation, rapid titration of the dose is indispensable for successful insulin therapy. The ACCORD study solely included patients at high risk for cardiovascular disease, in whom low A1C levels were reached by using up to four or five different classes of glucose-lowering drugs. In contrast, in less selected patients treated with stable doses of one or two oral agents, simple titration algorithms targeting fasting plasma glucose 100 mg/dl can safely achieve A1C of 7.0% . A patient-driven algorithm, with patients increasing their insulin dose by 2 or 3 units every 3 days, as long as their fasting plasma glucose remains above target, constitutes a practical approach that has been shown to be equally or more effective than physician-led titration .
Ways To Lower Your Odds For Needing Insulin
Before people start on insulin therapy, you may be asked to engage in changing your lifestyle. Intensive lifestyle interventions can prevent those with pre-diabetes from developing full blown type 2 diabetes by 58%, according to a clinical trial of over 5,000 people published in Diabetes Care. Lifestyle interventions include eating healthier, exercising, losing weight, getting emotional support, and sleeping well. But its a very hard thing for many to commit to exercise and diet in a very strict way, Dr. Levy says.
Whether youre taking oral medications or insulin, lifestyle modifications can help manage your blood sugar levels, Dr. Levy says. Heres what works:
Medication changes arent always possible for someone with mental health issues, such as schizophrenia. We have many, many options to treat blood sugars. But it could be that they finally found the right drug for their psychiatric disorder. So, we will work around it, Dr. Levy says.
Even after making serious lifestyle changes, your body can still need insulin to function properly. That doesnt mean youve failed or that youre not trying hard enough.
Diabetes is a progressive disease. We know that insulin-producing beta cells fail over time. Even for people who eat perfectly, take their medicine, and whove lost weight. They may still need insulin injections. It doesnt mean theyve done anything wrong. Its just the nature of diabetes, Hinnen says.
How Can I Keep My Blood Sugar Level From Getting Too High Or Too Low
You need to check your blood sugar level regularly using a blood glucose monitor. Your doctor or his or her office staff can teach you how to use the monitor. Youll need to write down each measurement and show this record to your doctor. He or she will use this information to decide how much insulin is right for you.
Blood sugar measurements can vary depending on your lifestyle. Stress levels, how often you exercise, and how fast your body absorbs food can affect measurements. Hormonal changes related to puberty, menstrual cycles, and pregnancy can, too. Illness, traveling, or a change in your routine may mean that you have to monitor your blood sugar level more often.
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Needing Insulin Does Not Mean Failure On Your Part
If your healthcare provider feels you need to take insulin to help control your diabetes, it does not mean that you’ve failed in some way. Some bodies simply require more help with controlling the condition. And sometimes insulin is the bridge you need to help level out your blood sugar so that you have the energy to make the lifestyle changes you need to make. Once you make those adjustments and your body is responding to them, you may be able to go off the insulin .
As with any major change, you may feel stressed and disappointed. And if you feel ashamedas if you’ve failed with your health or let your family downthe stress can compound. According to the Centers for Disease Control and Prevention , these feelings are common. It’s important to take care of not only your diabetes but also your mental health because people with diabetes are two to three times more likely to have depression compared to people who do not have diabetes, the CDC says.
This may develop if you begin to feel as if your diabetes is controlling your life, creating a state called “diabetes distress.” The CDC says these feelings can cause you to neglect health habits, blood sugar monitoring, and appointments with your healthcare provider. The condition is so common, the CDC says, that “in any 18-month period, 33% to 50% of people with diabetes will experience diabetes distress.”
What Are The Early Signs Of Kidney Disease In Patients With Diabetes
The earliest sign of diabetic kidney disease is increased excretion of albumin in the urine. This is present long before the usual tests done in your doctor’s office show evidence of kidney disease, so it is important for you to have this test on a yearly basis. Weight gain and ankle swelling may occur. You will use the bathroom more at night. Your blood pressure may get too high. As a person with diabetes, you should have your blood, urine, and blood pressure checked at least once a year. This will lead to better control of your disease and early treatment of high blood pressure and kidney disease. Maintaining control of your diabetes can lower your risk of developing severe kidney disease.
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Is Type 2 Diabetes Curable
Here are a few of the best things that you can do to reverse your diabetes once and for all.
1. Get More Sunshine
More and more emerging research is showing that theres a link between diabetes and vitamin D.
Known as the sunshine vitamin, vitamin D can play a big role in diabetes by optimizing glucose metabolism and regulating blood glucose. Studies have found that adequate levels of vitamin D can slash the risk of diabetes by a third .
While vitamin D is naturally present in some foods and fortified in others, the best source of vitamin D is sunlight. Most sources recommend 5 to 30 minutes of sun exposure at least twice a week to meet vitamin D needs.
For those with limited sun exposure, supplementation may be necessary to make sure youre meeting your needs. Consult with your doctor to see if a vitamin D supplement is the right choice for you.
2. Drink Apple Cider Vinegar
If youre a regular reader of my blog, you probably know that Im a pretty big fan of apple cider vinegar. From promoting weight loss to easing inflammation, its one of my favorite natural remedies for supporting overall health.
But did you know that apple cider vinegar can also be beneficial when it comes to diabetes?
I recommend dissolving a few teaspoons of apple cider vinegar in some water and drinking before each meal to get the full effect. Also, check out a few of my ACV drink recipes that you can whip up and enjoy between meals.
3. Get Moving
Why You May Need To Take Insulin
What impacts your need for insulin differs from person-to-person, Dr. Levy says. So, its important to understand what places you at-risk for diabetes complications. The higher your risk, the more you may potentially need to include insulin in your treatment plan. These risk factors include:
But if you dont fall into one of these risk groups, there may be ways that you can avoid taking insulin with certain lifestyle modifications.
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When Should I Call My Doctor
Its important to monitor diabetes very closely if youre sick. Even a common cold can be dangerous if it interferes with your insulin and blood sugar levels. Make a sick day plan with your healthcare provider so you know how often to check your blood sugar and what medications to take.
Contact your provider right away if you experience:
- Confusion or memory loss.
Growing Evidence For Insulin Therapy
As noted above, a commonly accepted view is that type 2 diabetes develops when insulin secretion can no longer compensate for the underlying metabolic disturbance. As secretory capacity progressively declines with time , it is understood that most people with type 2 diabetes will eventually require insulin therapy. Increasing use of therapies to protect against cardiovascular disease is extending the life of people with diabetes , and consequently more people will come to need insulin therapy. Diagnosis at a younger age will also extend the time of active treatment of diabetes. The effect of use of insulin in type 2 diabetes from the time of diagnosis has been evaluated in clinical trials, notably the UK Prospective Diabetes Study and Outcome Reduction With Initial Glargine Intervention . UKPDS showed that early and continued glucose control can reduce microvascular complications and, in the long-term, improve cardiovascular prognosis . The beneficial effect of insulin therapy is further supported by studies in type 1 diabetes where it is apparent that if insulin therapy is used effectively to induce early glycemic control, both micro- and macrovascular protection is achieved . Although it is acknowledged that achieving HbA1c< 53 mmol/mol is a difficult task, improvement of glycemic control with insulin is associated with improved patient well-being even if the HbA1c target is not achieved .
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How Do I Take And Adjust My Insulin Doses
It is important to learn the different methods of taking insulin and what kinds of insulin can be delivered through each method. There are several ways to take insulin syringe, pen, pump, or inhalation though injection with a syringe is currently the most common for people with type 2 diabetes. There are many apps that can help you calculate your insulin doses.
Your insulin regimen should be tailored to fit your needs and lifestyle. Adjusting your basal insulin dosage and timing will require conversations and frequent follow-up with your healthcare team. When initiating insulin therapy, you may be advised to start with a low dose and increase the dose in small amounts once or twice a week, based on your fasting glucose levels. People with diabetes should aim to spend as much time as possible with glucose levels between 70-180 mg/dl. Insulin may be used alone or in combination with oral glucose-lowering medications, such as metformin, SGLT-2 inhibitors, or GLP-1 agonists.
One of the most important things to consider is the characteristics of different insulin types. To learn more, read Introducing the Many Types of Insulin Is There a Better Option for You? and discuss with your healthcare team.
In order to dose insulin to cover meals or snacks, you have to take a few factors into consideration. Your healthcare team should help you determine what to consider when calculating an insulin dose. Prandial insulin doses will usually be adjusted based on:
Consideration Of Other Options
The decision to start insulin therapy will not usually be taken in isolation. Indeed rather than should insulin be started?, the most appropriate question is usually which of a series of options is most appropriate for this person already on treatment but needing better blood glucose control? In the above discussion, we consider situations in which insulin might be started, but in only a few will insulin be mandatory, although in many cases , it can also be the simplest approach to manage in the medium-term .
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When You May Need Insulin
When youre first diagnosed with type 2 diabetes, you may not need to use insulin straight away unless your blood sugar levels are very high. Insulin can be used as a short-term treatment to help quickly bring down your blood sugar levels.
But you may also need to start insulin as a treatment if other medications havent helped managed your blood sugar levels or are not appropriate for you.
Some people may need to take insulin at specific times in their life when diabetes may be harder to manage, like during pregnancy or a severe illness, or after surgery.
When you take insulin, its still important to keep going to your appointments and manage your condition with healthy lifestyle choices. Staying active and eating a healthy diet will reduce the risk of complications from your diabetes.
One of the of starting to take insulin for some people can be weight gain. This can be difficult to cope with on top of finding out you have type 2 diabetes or a change to your treatment. Were here to support you if you want to chat anything through or if you want help with weight loss. Do contact our helpline to talk to one of our trained advisors.
Getting Started With Insulin If You Have Type 2 Diabetes
New to insulin? Learn about insulin dosing and timing and how often to test your blood sugar levels if you have type 2 diabetes.
If you have type 2 diabetes, it is likely that your treatment regimen will change over time as your needs change, and at some point, your healthcare professional may suggest that you start taking insulin. While this might feel scary, there are millions of others living with type 2 diabetes and taking insulin, so its definitely manageable.
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Can I Mix Rapid
You can mix a rapid-acting insulin with an intermediate-acting insulin, according to your doctors instructions. Rapid-acting insulin should always be drawn into the syringe first. This will keep the intermediate-acting insulin from getting into the rapid-acting insulin bottle. After mixing rapid-acting insulin in the same syringe with an intermediate-acting insulin, you must inject the mixture under your skin within 15 minutes. Remember to eat within 15 minutes after the injection.
Making The Switch To Insulin
Making the transition is much easier than it used to be because most patients are started on a long-acting insulin that does not need to be matched with food intake.
Insulin pens that are preloaded are replacing insulin that needs to be drawn up into a syringe. Patients may still be worried about giving themselves injections, but because the needle is so tiny the adjustment is often quick.
Toujeo and Lantus are long-acting forms of insulin that are available in a prefilled injectable pen.
There’s also a type of rapid-acting insulin, Afrezza, that can be inhaled through the mouth via an inhaler.
And a new class of medication called sodium-glucose cotransporter 2 inhibitors is also available now, according to Mazhari. “It works via a different pathway that’s not pancreas-dependent, offering another medical therapy option for patients with type 2 diabetes.”
The key to an easy transition to insulin is education.
“Patients need to know how to take their insulin properly since there are many formulations on the market, including short- and long-acting insulin and premixed,” Mazhari said. “Most can be started on a long-acting insulin once a day, though for some patients short-acting or mealtime insulin may be necessary as well. Insulin doses need to be further adjusted depending on blood sugar readings.”
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Insulin Therapy Can Help Lower Your Blood Sugar
If you have type 2 diabetes, managing your blood sugar levels is a key part of staying healthy and reducing your risk of long-term complications. To help lower your blood sugar, your doctor might recommend one or more of the following:
- lifestyle changes
- insulin therapy
- weight loss surgery
Insulin therapy can help many people with type 2 diabetes manage their blood sugar and reduce their risk of complications.
Several types of insulin are available. They broadly fall into two categories:
- fast/short acting insulin used for meal time coverage
- slow/long-acting insulin, which is active between meals and overnight
There are several different types and brands available in each of these two categories. Premixed insulins are also available, which include both kinds of insulin. Not everyone needs both kinds, and a prescription for insulin should be individualized for the persons needs.
Anyone Can Get Type 1 Diabetes
It isnt completely clear what causes type 1 diabetes, but we know that diet and lifestyle habits dont. Type 1 is thought to be the result of an autoimmune response, where your body attacks the cells in your pancreas that make insulin. Insulin is a hormone that acts like a key to let blood sugar into your bodys cells for use as energy. Sometimes infection with a virus seems to trigger the autoimmune response. Many people with type 1 diabetes have family members with type 1, but most dont.
The peak age for being diagnosed with type 1 diabetes is around 13 or 14 years, but people can be diagnosed when theyre much younger and older .
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If Not Controlled At The Right Time Diabetes Can Lead To Kidney Failure Partial Or Complete Blindness Nerve Problems Loss Of Limbs And Increase The Risk Of A Heart Attack
Insulin, which is produced by the pancreas in the body, helps control the bodys blood sugar level. Regular insulin intake along with a proper diet and exercise plan is recommended for type 2 diabetes patients to help maintain their blood sugar level. If not controlled at the right time, diabetes can lead to kidney failure, partial or complete blindness, nerve problems, loss of limbs and even increase the risk of a heart attack. However, there are several myths around injecting insulin due to lack of awareness.
A study, published in the American Medical Associations biomedical journal JAMA Network Open, also found that the relative risk of death due to diabetes itself was much stronger among individuals who were underweight. The findings suggest that there is an urgent need to develop diabetes management programs that are tailored to Asian populations and the subsequent strong implementation of these programs in Asia.
Why do Type 2 diabetics need insulin?
The pancreas, that produces digestive enzymes, is also responsible for producing insulin, a hormone that helps regulate blood sugar levels. Insulin helps the body use the carbohydrates in food for energy. If a patient develops Type 2 diabetes, their pancreas stop producing sufficient insulin that is required for the body to control blood sugar level, said Dr Roopak Wadhwa, consultant, department of diabetes endocrinology and metabolism at Fortis Hospital.
Tips while taking insulin injections