Diabetes: Understanding Your Insulin Treatment Plan

Patient Expert
View as:|
1 of 14

If you have diabetes and require insulin therapy, there are some important things to know about the different types of insulin, how to make an insulin treatment plan, what to do if you forget a dose, and the risks of not taking your prescribed insulin. Let’s take a look.


Understanding insulin

A healthy pancreas produces insulin to help process glucose (sugar) out of the blood. If you have insulin-dependent diabetes, you can’t produce enough insulin yourself and need to use prescribed insulin to help manage your blood sugar level. The insulin is delivered by injection — using a syringe, or a pre-filled insulin injection “pen” – or by infusion, from a wearable insulin pump.


Four primary types of prescribed insulin

There are four types of insulin:

  • Rapid-acting insulin, also known as “bolus” insulin
  • Short-acting insulin
  • Intermediate-acting insulin
  • Long-acting insulin

Typically, a long-acting or intermediate-acting insulin is taken once or twice a day, and rapid-acting insulin is used before meals and snacks.


Premixed insulins

There are also premixed insulin combinations of intermediate-acting and short-acting insulin in one vial or pen. Premixed insulins include Humulin 70/30, Novolog 70/30, Humalog 75/25, and ReliOn 70/30. The numbers correlate to the percentage of each type of insulin. Premixed insulin is usually taken two to three times per day.


Creating your insulin plan

The goal of your insulin plan is to provide enough insulin to keep your blood glucose levels within a targeted range. Your insulin plan will map out the type(s) of insulin recommended by your health care provider, how much to take, and when.

To meet your ongoing insulin needs, your doctor will typically prescribe a long-acting (basal) insulin to be taken once or twice a day, along with rapid-acting insulin to be injected before food. The dose usually is the same every day.

Beyond the long-acting basal insulin, you will typically take rapid-acting insulin according to one of the following methods.


Fixed-dose method

On the fixed dose method, you take a set amount of insulin before each meal. The amount of insulin taken does not change based on your blood glucose reading. The challenge is that to come up with a dosage that will help blood glucose levels stay within the range, your food intake needs to include the same amounts of carbohydrates consistently, and there is no accommodation for eating different amounts at each meal.


Sliding scale

The sliding scale varies your dose of insulin based on your blood glucose level. The higher your blood glucose, the more insulin you take before eating.

With the sliding scale, you take a blood glucose reading before eating. You then will have guidelines on how much insulin to add as a correction, in addition to your fixed dose to cover the food you eat. This method often works better in that it allows for greater control over glucose levels and corrects high levels.


Carbohydrate counting

With carb counting, you will determine how much rapid-acting insulin you need to match with the food you at eating. It takes trial and error to calculate two crucial numbers:

  • Insulin to carb ratio: The grams of carbohydrates covered by one unit of insulin. On average, one unit of insulin can cover 12 to 15 grams of carbohydrate.
  • Correction factor, or insulin to glucose ratio: How many blood glucose points will one unit of insulin lower. Generally, to correct a high blood sugar, one unit of insulin is needed to drop the blood glucose by 50 mg/dl.


Carb counting vs. sliding scale

When the methods are followed precisely, experts consider carbohydrate counting and sliding scale to be equally effective.  But the sliding scale method requires that you have consistent carbohydrate and calorie intake every day. The carbohydrate counting method is more flexible and may allow you to meet blood sugar targets because it accommodates for different carbohydrate intakes at different meals or on different days. It does, however, require significantly more calculating.


Insulin pump users

If you have an insulin pump, your insulin plan will be different. The pump is typically programmed to release rapid-acting insulin 24 hours a day to maintain your blood sugar within a targeted range. The amount of insulin delivered can be different, at different times of the day. The insulin pump also allows you to program it to give you an additional dose of insulin – called a "bolus" – before eating.


Creating your plan

As you can see, creating an insulin plan is often a complicated process. You will work with your doctor – or more often, a trained and certified diabetes educator (CDE) – to develop your insulin plan. A CDE is a health professional trained in diabetes prevention and management. CDEs help you develop your insulin plan, along with nutrition/eating and exercise plans. They can teach you everything from how to do an insulin injection, to how to count carbohydrates. Your insurance or HMO usually covers their services.


Planning for contingencies

You can also work with a CDE to create plans for specific situations, such as:

  • When you forget to take your insulin
  • When you are exercising
  • When you are sick — especially if you are vomiting — which can affect blood sugar levels


If you forget to take your insulin

If you forget to take your rapid or short-acting insulin before eating, experts recommend that you take it as soon as you remember, up to two hours after eating. You should, however, be careful to avoid an episode of low blood sugar.

It’s also important, after forgetting either basal or bolus insulin, to monitor your blood glucose levels more carefully for the next 24 hours, to avoid any highs or lows.


Risks of not taking your insulin

Not taking your insulin is very risky for your health, according to the American Diabetes Association, as complications can quickly develop. Specifically, the risk is a life-threatening condition known as diabetic ketoacidosis, which can cause kidney damage and even death. Diabetic ketoacidosis can develop in as little as 24 hours. The signs and symptoms include:

  • Extreme thirst
  • Frequent urination and high urine volume
  • Nausea or vomiting
  • Abdominal pain
  • Weakness
  • Fatigue
  • Shortness of breath
  • Confusion