Earlier this month I was contacted by the Community Awareness Coordinator at the American Recall Center and asked to participate in their campaign to raise awareness of medication safety through creating a blog for “Talk About Your Medicines” Month (October).
First and foremost I want to apologize for not posting my blog until the last day of October. I am the ultimate procrastinator! (This month has been crazy anyway – a lot going on with school, starting the application process for internships, volunteering, getting over bronchitis, getting all kinds of blood work and vaccinations, work, interviewing for a new position at work, etc….) But I am finally here, today, to talk a bit about the primary medication (insulin) I use and general advice I have for others who may just be beginning insulin therapy.
I take NovoLog, a fast-acting insulin. I DO NOT use a basal insulin (such as Levemir or Lantus) because I use an insulin pump. However, these guidelines/recommendations for use apply to all insulins.
In the course of my life with Type 1 diabetes I have used so many insulins: Regular, Lente, UltreLente, Humalog, Lantus, and Novolog. Incidentally, there are actually still a few I’ve never used: NPH, Apidra, and Levemir. As you can see, there are many different insulins! Each one acts differently than any of the others, though some are fairly similar to one another. Each one has a different onset time (the amount of time between injection and when the insulin actively begins lowering your blood glucose), a different peak time (the timeframe in which the insulin has the greatest effect on your blood glucose), and a different duration (the amount of time it works in the body to actively lower your blood glucose). Some insulins are made to work quickly and are primarily used in the case of correcting high glucose levels or when eating. This is called a bolus. Others are made to work in a less dramatic and longer-lasting way to deal with the glucose occasionally released by your liver – these are given at set times of the day. This is called basal insulin. (Note, if you use an insulin pump your basal doses and boluses will all be handled with a fast-acting insulin typically associated with boluses.)
If you are a first-time insulin user, it’s important to remember that you need to follow your doctor’s orders. Give your insulin when he/she directs you, in the amounts or ratios he/she directs you to use. DO NOT adjust your rate on your own until and unless you truly understand what could happen. Remember: insulin is a potent and potentially dangerous medication, if used incorrectly. An overdose can easily cause serious or even life-threatening low blood sugar reactions, requiring emergency medical care. For what it’s worth: I change my dosage ratios on my own…….but I’ve had Type 1 diabetes for 22 years. I’ve used insulin since the day I was diagnosed. That’s a lot of experience. If I were new to using insulin, I would NOT be comfortable making those changes without first calling my doctor. As it is, I still occasionally email my doctor between appointments to ask for advice or to let him know of any issues I am having and ask his opinion on changes to my dosages.
If you are new to using insulin you need to be sure to ask your doctor:
- What are the symptoms of low blood sugar (hypoglycemia)?
- What is the best way I can treat low blood sugar?
- How should I handle my insulin doses if I am sick and unable to eat?
- What should I do if my blood sugar levels are high and aren’t coming down with the dosage you’ve recommended to me?
- What, if any, other side effects should I be aware of? (Note: some people DO have allergies to certain rDNA insulins – this often, but not always, presents as skin rashes/painful welts/hives!)
- What should I do if I feel I may be allergic to the insulin you’ve prescribed?
- What, if anything, should I do to adjust insulin/food intake for activities involving exercise?
- How should I be matching insulin intake to food intake?
Unfortunately, I have seen too many horror stories of people new to insulin therapy being handed a vial of insulin and some syringes, told to ‘take X units of this insulin (a bolus insulin) before every meal and take Y units of this insulin (a basal insulin) before bed and before breakfast’…and that is all the instruction they are given. These people have little to no understanding of how insulin works or how it will affect them, and aren’t given guidelines on how insulin and food work in proportion to one another. These people often experience frustrating highs and lows, without understanding why. Be an advocate for yourself and ASK QUESTIONS.
Also, remember to store your insulin appropriately. This means that unopened insulin needs to be refrigerated. Open vials and pens are typically good for 28 days at room temperature. If insulin gets too warm, it may lose potency and not work as intended. If you are noticing unexplainable high glucose levels, this is something to consider – could your insulin have gotten too warm?
Finally, if you are using older insulins which can be mixed (your doctor will let you know), you need to be sure to gently mix your cloudy insulin before use, and draw each insulin into your syringe in the order your doctor directs you. All newer insulins are ‘clear’ and cannot be mixed with one another. If you are not explicitly directed to mix insulins, DON’T DO IT - you could contaminate whole vials of insulin….and insulin is expensive!
Ultimately, be safe!