Two months on insulin

So you were started on insulin two months ago, and have your next doctor's visit coming up soon. Starting insulin was a major step in improving your health, and it's time now to get beyond simply knowing how to "shoot up" -- it's time to do even better!

Here are some thoughts to discuss at your next visit to your doctor, if you haven't already discussed them with your diabetes team:

* It's about time for another A1C lab test. A1C testing is typically done every three months, and if you've been on insulin for the past two months, it's quite likely that an A1C level done at the three-month mark will be lower than it was before you started on insulin.

* Whether you are on insulin by needle-and-syringe, or by insulin pen, discuss about the opposite option. There are pro's and con's for both ways to give insulin. And ask if using an insulin pump might be a good idea for your case.

* Has your weight increased? Typically, folks on insulin can easily gain weight (insulin allows excess calories to be stored away very efficiently, as extra flab). If your weight is increasing, talk to your diabetes team about how to adjust your meals, exercise, and insulin doses to avoid continuing problems with weight gain. And that's important to discuss, even if you had lost considerable weight due to out-of-control diabetes before starting insulin. If you haven't discussed your meal plan recently with a diabetes dietitian, ask for a consultation to do so.

* How often should you be checking your BG levels? If the levels have stabilized since you started insulin, probably less often than before, but plan to do more if illness strikes or if your insulin doses are changed, or other medications are needed.

* How often should you call to report BG levels? The first few weeks on insulin, you probably were on the phone fairly often, but now that things are settling into a routine, it's still important to call. Ask about what would be appropriate reasons to call: how high or how low would be a worry; what about acute illnesses, etc.?

* If you were started on a single daily shot of a long-acting insulin (in which case it probably was Lantus, Levemir, or NPH), and your BG levels are bouncing around from one time of a day to another, ask about whether your BG levels could be even better by splitting the single shot to two shots a day, or by adding a rapid-acting insulin such as Humalog, Novolog, or Apidra.

* If you were continued on diabetes pills when starting insulin, it may be time to cut back on their dose, especially if you have been having hypoglycemia now and then.

* If you didn't get a prescription for a rapid-acting insulin already, it's time to ask for one. Even if your BG are perfect on one shot per day of a long-acting insulin, you may someday have some acute illness where using rapid-acting insulin would be needed, so having a vial or pen in the frig is a good idea.

* And if you didn't get a prescription for glucagon already, it's time to ask for one. Be sure someone else is taught how to administer this treatment for hypoglycemia -- it's only for use if you are knocked out from a severe hypo, so someone else would have to give you the glucagon shot.