ASK GINGER - Is it normal to need to adjust my insulin doses sometimes?

Dear Ginger,

It seems like the amount of insulin I need changes, sometimes just for a day, like around exercise, or sometimes it's like it's changed for a big period of time, and I'm going low a lot. I started trying to eat healthier, and I kept having a ton of lows, so how I do eat better but not crash all the time? Is it normal to have changes so quickly?

-Becca

Hey Becca!

What you need to do is learn about "titrating" your own insulin dose!

What is “titrating”? Titrating is the medical term used to describe when you’re continuously adjusting and measuring your dosage. When it comes to diabetes, we’re obviously talking about insulin.

To date, I have never had a low-blood sugar episode I couldn’t treat myself, and this is largely because I have learned how to titrate my insulin doses without the help from any doctors. In fact, there is no doctor who could understand my insulin needs better than I do. And the same goes for YOU! YOU have to learn how your diabetes works around stress, exercise, your period,  tanning on the beach in hot sun,  travelling across different time zones, etc.

You don’t have to know it “perfectly,” but instead you are making an effort to learn how to anticipate what parts of life will change your insulin needs and be proactive about your insulin doses instead of letting things happen that will majorly throw your blood sugar out of whack.

I am constantly titrating my insulin doses – my long-acting insulin, and my bolus doses to cover meals. Because my work (personal trainer & yoga instructor) and my major hobby (powerlifting) are so active, I have really needed to learn how to anticipate what my blood sugar is going to do after I exercise, after I eat certain foods and at what times. I don’t exercise at the same time every day and I don’t get to eat at the exact same times every day, so the tools I have to keep myself from dropping low are my blood sugar monitor, glucose tabs, and the ability to adjust (increase and decrease) my insulin doses based on what I know I’m going to be doing or based on what kind of activity I just did.

When & Why would you titrate your insulin dose if your doctor told you to always take X-amount?

As I’ve become more active, increased muscle mass and improved my diet, my insulin needs have changed. This is true of anyone, diabetic or not, but a non-diabetic’s body titrates all on it’s own. As a diabetic, YOU have to consciously adjust those doses yourself.

If you suddenly decided to add more exercise into your day-to-day life, and you don’t adjust your insulin doses along with that, you’re going to suffer a lot of lows, and not only find yourself in dangerous situations, but you’ll probably get really frustrated, too!

For example, if you decide you’re going to take bread, ice cream, candy, pasta and potatoes out of your regular diet, you’re going to majorly reduce the amount of insulin you need. Not only from your boluses for meals, but from your overall basal rate or long-acting insulin dose. MAJORLY!