Diabetes: 10 Things Your Doctor Won't Teach About Insulin
by Ginger Vieira Health Writer & Patient Advocate
When a doctor prescribes insulin to someone with type 2 diabetes, they typically deliver a more basic education compared to the incredibly detailed advice a type 1 diabetic receives. Those fundamental lessons around insulin, blood sugar management, and nutrition are critical in life with any type of diabetes. Here are 10 things every type 2 taking insulin needs to know...not only to improve your blood sugar, but to give you more freedom and success, too!
When you receive your prescription and instructions on how much to take, you need to know: doctors are guessing your insulin doses
There is no ‘one-size-fits-all’ dose for insulin. Your doctor makes an educated guess based on your weight, age, gender, etc. It’s up to you to identify if your doses are accurate for you based on your blood sugar.
Your doctor will tell you how many carbohydrates to eat for 3 meals a day and 2 snacks a day
The most common is “45 grams per meal and 15 grams per snack.” This type of ‘sliding scale’ insulin dosing/meal plan regimen is archaic, rigid, and unnecessary. If your healthcare team took the time to teach you about carb-counting and calculating your insulin dose based on your chosen meal, you would be free to eat when and what you want. Cont…
This is called an “insulin-to-carbohydrate ratio.”
It’s simple: Test your blood sugar. Eat exactly 15 grams of carbohydrate. Take the fast-acting insulin dose as your doctor instructed for snacks. 2 hours later, test your blood sugar. If it’s in your goal range, your ICR is accurate (X units for every 15 grams of carbs). If it’s high, you need X units for every ‘10’ grams at your next experiment. If it’s low, you need X units for every ‘20 grams’ at your next experiment. And so on.
Speaking of meals, your doctor probably isn’t going to recommend a low-carb diet, either
Most endocrinology offices resist embracing the benefits of reducing carbs for diabetes management, even though the American Diabetes Association has started to encourage it. Reducing your carb-intake can be life-changing. Aiming for 100 grams or less per meal will quickly reduce the insulin you need. If you do reduce your carbs, you will eventually need to reduce your long-acting insulin, too.
Basal testing assesses if your long-acting (background) insulin dose is accurate by fasting for part of the day and watching whether your blood sugars stay in-range, rise, or fall
When food isn’t present, you can see if your long-acting dose needs to change. The easiest time of day to test is morning. Don’t eat past midnight the prior night. Don’t eat breakfast. Test your blood sugar every two hours until lunch. Discuss changing your dose with a doctor or diabetes educator based on your results.
Doctors often assume that type 2s can’t experience hypoglycemia (low blood sugar) if your A1C and blood sugars are still high
You can. The wrong combination of carbs + insulin OR insulin + activity can cause low blood sugars. Keep juice boxes or fast-acting carbs like raisins or jelly beans with you at all times. Common symptoms include difficulty concentrating, hunger, and dizziness. You should only need 15 to 30 grams of carbs to treat the average low blood sugar.
When you lose weight, eat a healthier diet, and become more active, your insulin needs will decrease
If you’re suddenly experiencing low blood sugars throughout the day, and you’ve been making improvements in your lifestyle and weight-loss goals, it’s time to drastically reduce your medication doses with the help of a medical professional. Even a daily 30-minute walk can decrease your insulin needs. Don’t give up!
You have medication options
Most doctors have their go-to medications that they prescribe to every type 2 patient they see — but you have options. There are so many different types of oral and injectable medications to choose from. It may not be a replacement for insulin but they can help improve your blood sugars, making it easier to stay in your goal range, along with your insulin regimen. Do your research, and make decisions with your doctor as a team.
If you aren't hungry, you simply don't take your fast-acting insulin for that meal
Type 2s are often left with the impression that they must take their insulin which means they must eat that meal. Without teaching patients how to take fast-acting insulin based on carb-counts and when they want to eat, you might eat even if you're not hungry. Don’t let your insulin dose force you to eat.
Insulin is not a punishment or a death sentence
Insulin has gotten a bad reputation in the diabetes world. It’s easy to assume that being prescribed insulin means your health is too far gone, and you’ll automatically be on insulin for the rest of your life. The reality is that insulin can be what gives you your health back! Don’t let stigma leave you feeling shame or guilt. Insulin can save your life and provide you with a healthier future.
