Frustrated with your glucose values? Not sure why things are changing or so difficult recently? Before tossing in the proverbial towel, ask yourself these simple questions. You just might find answers.
Am I pre-meal bolusing?
A properly timed bolus can result in excellent after-meal control. However, a bolus given too late can result in significant blood glucose spikes. Understanding how long it takes for insulin to get absorbed from fat tissue to the bloodstream and take effect is critical. Learn more about your specific insulin action here.
Timing of a meal bolus is as important as the dose amount!
It is best to give bolus insulin before eating. How long before depends on what you are eating and your pre-meal blood glucose level. Learn more about bolus timing here.
- The higher your blood glucose, the earlier a bolus should be given. If your blood glucose is well above your target, it is best to give the bolus then wait at least 30 minutes before eating.
- Near your target blood glucose? Wait 15 minutes to eat.
- Below target? Correct the low blood glucose, wait until you are over 70mg/dL, then take the bolus and eat.
I swear I was sleeping. What happened?
Do you notice your blood glucose rising the moment you roll out of bed? No matter what time you wake up! This is a very perplexing pattern that is actually quite common and results from a surge of morning counter regulatory hormones that all work against insulin. Not to worry, you’re not doing anything wrong; blame it on Cortisol, Epinephrine, Glucagon and Growth Hormone!
If you wear an insulin pump, and the timing of your morning (fasting) rise is consistent, then a basal rate change can be helpful. However, if you wake at different times, you might benefit more from a "wake up bolus" as it’s virtually impossible to set basal times to match varying wake times. In addition, a basal increase will rarely affect these quick, morning surges. Rather a bolus (or burst) of insulin is needed to fight this battle!
Try delivering a Wake Up Bolus (via injection or via pump). Get ahead of the curve with a very small bolus of fast acting insulin the moment you roll out of bed. For some, a 0.5u bolus is enough to stop the rise. Others need a few units. No matter what the need, work with your care team to determine what's right for you.
Does coffee have sugar?
“I swear I did not add anything to my coffee!” For many, a seemingly innocent cup of black coffee can cause havoc on blood glucose control. While there is no sugar in coffee (unless you add it!), the rush one gets from caffeine can result in a surge of glucose from your liver.
Just like a Wake Up Bolus, try delivering a Coffee Bolus. Be sure to work with your care team to determine what's right for you.
Have I been rotating?
Location, location, location. Not only is this key for real estate, it’s critical for insulin absorption. Injecting insulin into fresh tissue gives you the best chance for even, predictable insulin action. If you are one who favors a particular spot, know it needs a rest to regenerate fresh tissue. Learn more about injection site rotation here.
Try a new location! You will be amazed at the difference.
Did I do the 2u?
If you use an insulin pen, each new pen needle must be primed (filled) with insulin before you give yourself a bolus. “What? No one ever mentioned this to me!” Well, now ya know and this should change a few things. Always prime a new needle and look for insulin to flow out before delivering your actual dose. This helps remove any air from the needle or cartridge. If you haven’t been giving a 2u “air shot” we can’t be certain you are receiving the full bolus.
Is my insulin expired or compromised?
While most insulin is viable for 30 days after opening, not all are. Be sure to know how long your insulin is good for by reading the package insert or reviewing this extensive chart.
Then, mark the discard date on either your vial or pen with a Sharpie.
Beyond viability time, be sure your vial or pen has not been sitting on a window sill or exposed to direct sunlight and/or heat. Both heat and light degrade insulin protein molecules and render insulin ineffective. This will surely be the cause of unexplained high BGs!
When did I change my inset & tubing last?
Well known fact...nobody enjoys changing their pump set. Unfortunately, if you avoid the inevitable, you are at risk of seeing those pesky rising glucose values. As a rule of thumb, try hard to change all parts of your pump (inset, tubing, cartridge) every three days. If you’re not convinced, conduct an experiment by tracking your daily blood glucose average during a set wear time. You will likely see higher blood glucose values after day three of wear.
I’ve tried all of the above and am still having trouble. What now?
We understand diabetes affects people differently and are glad you’ve taken the time to do early troubleshooting. If you are still having trouble, please let your care team know so we can work together to identify your specific needs.
Timing of Meal Insulin and Its Relation to Adherence to Therapy in Type 1 Diabetes