10 Signs Your Insulin Doses Aren't Optimal

No matter which type of diabetes you have, if you’re taking insulin you need to remember that the dosing prescribed by your doctor is just an educated guess. And, as an added challenge, your optimal insulin dose can change due to weight loss or gain, stress, growth hormones in/and out of the teen years, more or less exercise, and changes in what you eat. Here are 10 signs that reveal your doses are inaccurate and due for a tune-up.

Sure, lows are part of diabetes, especially if you take insulin. But if they’re happening daily, something needs to be adjusted. It might be your basal rates (in pumps) or your long-acting insulin dose (from pens or vials). It might be your insulin-to-carbohydrate ratio for meals, or the amount you’re taking to correct high blood sugars. It’s time to call your doctor.

Is your sugar always high after breakfast? High when you wake? High before bed? If you feel like you’re constantly battling highs, the first place to increase (with support from a certified diabetes educator, as needed) is your basal rates or long-acting insulin dose. Your background insulin doses are like the foundation of your house: it’s got to be sturdy or everything will eventually collapse.

How many times a week are you treating low blood sugars with ravenous binge-eating? The average simple low doesn’t typically cause that unrelenting appetite. But a dose of insulin that is several units more than you need can leave you craving carbs for hours. Then you take more insulin to correct the high from eating too much, and the yucky cycle continues. It’s time to adjust your doses.

Certainly, if you know you’re not trying to take proper amounts of insulin then an A1c over 8 is no mystery. But if you’re doing everything you can and you’re still above 8 percent, endocrinologist Dr. Paul Rosman says your basal rate or long-acting insulin dose is in need of a serious tune-up. When you aren’t getting enough background insulin, the entire day is a constantly battle. Continued…

The easiest time of day to test is morning. Don’t eat past midnight the prior night. Don’t eat breakfast. Once you’re up, test your blood sugar every two hours until lunch. Discuss changing your dose with a doctor or diabetes educator based on your results.

Dr. Rosman explains that those struggling to get their A1c below the 7 percent mark usually lack enough insulin with their meals. It’s time to determine your insulin-to-carbohydrate ratio. While an ICR doesn’t always work perfectly because of fats and proteins having some impact on blood sugars, it is crucial as a starting place when dosing for meals. Continued…

Test your blood sugar. Eat exactly 15 g of carbohydrate. Take the fast-acting insulin dose as your doctor instructed for snacks of 15 g. Two hours later, test your blood sugar. If it’s in your goal range, your ICR is accurate (X units for every 15 g of carbs). If it’s high, you need X units for every 10 g at your next experiment. If it’s low, you need X units for every 20 g at your next experiment.

Lows after correction doses are often caused by two things. You may be ‘stacking’ your insulin (taking insulin atop insulin that was administered recently, and thus both doses are peaking one after another). This usually happens when you’re either snacking for an extended period of time, or when you’re trying to get a post-meal blood sugar down before that earlier dose has had a chance to do its job. Continued…

With more insulin is that your Correction Factor (CF) is simply wrong…or maybe you’ve just been guessing! Your CF is the number of points 1 unit of fast-acting insulin will reduce your blood sugar in a normal environment (which means it’s been at least 2 hours since eating, no exercise, etc.). Testing your CF is straight-forward, but be sure to ask your CDE for support as needed. Continued…

Take 1 unit of insulin. Two hours later test to see how far that 1 unit was able to reduce your blood sugar. Use that result to determine if it worked or if you need more. If it didn’t work, then you need to do another test at the next opportunity with a half or full 1 unit increase. The typical CF for a type 1 is 1:25 or 1:50. Type 2s may find much more stubborn CF’s due to insulin resistance, like 1:10.