Make Daily Cycles of Insulin More Efficient

Kelsey Bonilla Health Guide
  • Over the past few weeks, Kelsey's implemented a system of working smarter, rather than harder, to maintain her blood sugars. Follow along here to find out what she's learned!


    Little Changes, Big Difference

    Little Changes, Big Difference - Part 1:Blood Sugar Trends

    Little Changes, Big Difference - Part 2: Food Composition and Insulin Timing

    Little Changes, Big Difference - Part 3: Activity Level


    As I pondered what factors tend to throw a kink in my blood sugar control, one of the little reminders I jotted down as "AM/PM" which is a cryptic reminder that my daily cycle of insulin efficiency need to be taken into account when I'm bolusing throughout the day. What does that mean?

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    Well, you've likely heard of "dawn phenomenon" or the Somogyi effect. These terms refer to the tendency for blood sugar to rise during the early morning hours. Diabetics commonly complain of going to bed with a normal blood sugar, not eating anything, and still waking with high blood sugar. The answer is to compensate for this phenomenon with an increased basal rate. During my pregnancy, my doctors and nurses helped me to understand that my body was more insulin resistant during the morning hours. Thus, I only consumed 15 grams of carbohydrate at breakfast as opposed to the 45 grams I could have at lunch and dinner.


    After more careful observation, I have noticed that my relative insulin resistance lasts throughout the morning, until at least noon. Becoming aware of my body's varying ability to efficiently use insulin has helped me to bolus more accurately throughout the day.

    If I ate a banana and peanut butter (my favorite!) at 4:00 or 5:00 p.m., I would only bolus about 2 units of insulin to cover it. However, this meal is usually my morning routine at my desk when I arrive at work between 8:30 and 9:00 a.m. During these hours, this same meal requires nearly 3 units of insulin. The only thing that changed was the time of day, but my insulin needs were significantly higher.

    In the afternoon, my basal rate drops and my insulin needs become less and less. By dinner, my insulin to carb ratio is 1:20 as opposed to 1:15 during the first two meals of the day. Actually, I am due for a basal test in the late afternoon, which I suspect will demonstrate that I need even less basal insulin between 4:00 and 7:00 p.m. Currently, whenever my blood sugar is 130 mg/dl or less as I leave work, I have to snack or I will be low before dinner.

    Each person will experience different fluctuations in their insulin needs throughout the day, but it's noteworthy that most people will have times of the day when they require more insulin and times when they'll need less. Being able to pinpoint when those times occur will help tremendously in your blood sugar control.

    Once you're aware of when your body most efficiently uses insulin and what times of the day you experience insulin resistance, you can cater your diet to fit your body's needs. For example, if I want to indulge is something sweet, my best time would be 5:00 p.m. and the worst times would be anywhere between 7:00 and 11:00 a.m. This is unfortunate because I love breakfast baked goods like scones, croissants, and muffins. But, if I wait to eat something like a cookie or other baked good in the late afternoon, I can use less insulin and will be more likely to maintain my blood glucose level at a healthy range.


Published On: September 16, 2008