You think over a lot before buying a car but you don’t give a second thought to your insulin program which can dictate your daily activities as a diabetes patient. A good insulin program can help you in controlling your diabetes very successfully but many patients are not educated well about how to select the best insulin program which can meet their requirements. So let’s find out that what you should look for in an insulin program and if existing program is the best one for you.
What is the Insulin Program?
This is the arrangement of administration of different kind of insulin (like basal insulin and bolus insulin) into the body at different time in a day so that the blood glucose level before and after meal can be efficiently controlled.
Basal Insulin
It is important for the liver’s glucose secretion to provide continuous supply of glucose to the body cells to meet the energy requirements. Any disturbance in amount of basal insulin at any instant can hike the blood glucose level and increase the production of ketones or the acid by products of fat burning process. If no glucose is utilized by the cells then these ketones can start accumulating and if the condition of no utilization of glucose persists then diabetic ketosis condition can arise which can be life threatening.
Requirement – Every patient’s requirement for basal insulin is unique but it is generally high in early morning and lower in mid day. It happens due the increased production of blood sugar rising hormone at night which leads to high requirement of basal insulin in morning and with daytime activities the blood glucose level comes down which requires needs less insulin.
Analogs in use – glargine (brand name Lantus) and detemir (Levemir) are long acting basal insulin analogs and offers peakless background insulin for day and night. It has been injected once a day.
Bolus insulin
It is required to control the rapid increase in blood sugar after eating a meal. Carbohydrates increases the blood sugar level in about 10 – 15 minutes which reaches the peak point in 30 – 90 minutes after eating depending upon the size and contents of the meal.
Requirement – It is required around mealtime and its doses should be timed so that the insulin peak activity matches the timing of peak time of blood sugar increase.
Analogs in use – aspart (NovoLog), glulisine (Apidra), and lispro (Humalog) are rapid acting insulin analogs which acts within 5-15 minutes of administration and its peak activity reaches in 30-90 minutes. They can be taken few minutes before meal and it will clear the blood glucose rapidly without leading to hypoglycemic condition.
Regular insulin – It is short acting insulin and takes 1-3 hours to reach its peak activity. They can be taken 30-60 minutes before meal and it lasts up to 6 hours, it can sometimes cause hypoglycemic conditions.
Intermediate insulin – It is used to cover meals which are consumed after 4-6 hours after the injection. Its peak activity is broad and unpredictable which can cause drop in blood sugar level before lunch if the meal is delayed.
Each insulin has its benefits and drawbacks and therefore a right combination of basal and bolus insulin is necessary for controlling diabetes. Here are some popular insulin programs which will give you an idea of what should be the combination of these two insulin in your insulin program.
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#1: The Beater
It was a standard program which uses regular insulin and it is very simple to use because only two injection were required for the day. In breakfast, you have to take NPH plus aspart, lispro, or glulisine and you have to take NPH plus aspart, lispro, or glulisine at dinner. In this program, the intermediate acting insulin achieve its peak activity around lunchtime and gradually decreases in the afternoon. Since you are not taking any bolus insulin during lunchtime and the intermediate acting insulin is also wearing off then you can experience high blood sugar level immediately after eating. This afternoon high insulin condition can also arise if your basal insulin dissipates before dinnertime injection. A light eating is required at night with this program to prevent the hypoglycemic condition when the evening dose of insulin is active at its maximum level.
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#2: The Economy Compact
This plan overcomes the shortcomings of the beater insulin program and you require three injection for the day. At breakfast, you require NPH plus aspart, lispro, or glulisine; at dinner you require aspart, lispro, or glulisine and you require NPH at bedtime which will help to cover any low blood glucose level issues. In this program, the change in timings of intermediate acting injection (which is changed from dinnertime to bedtime) shifts the insulin’s peak activity from night to early morning which works in favor of the patient as this peak activity will control the hormone induced increase in blood glucose level. The morning shot of intermediate acting insulin will cause a drop in blood sugar level before lunch and it will not able to control the increase in blood sugar level after eating the lunchtime meal. To control such condition, a shot of rapid acting insulin will be required.
#3: The Station Wagon
This program is a multiple insulin injection therapy because you require five shots of insulin injections on different time of day which are:
- At breakfast, you require aspart, lispro, or glulisine
- At lunch, you require aspart, lispro, or glulisine
- At dinner, you require aspart, lispro, or glulisine
- At snacktime, you require aspart, lispro, or glulisine
- At bedtime, you require NPH
Intermediate acting insulin will be taken once a day at bedtime and it will cover the early morning hormone induced rise in blood glucose level and its long lasting action will provide background insulin throughout the day. Since you are taking bolus insulin at each mealtime therefore it gives the flexibility to your mealtime. These benefits makes this program a reliable and efficient program in controlling diabetes.
#4: The Muscle Car
This is much efficient than the previous program because it offers steady and peakless coverage for twenty four hours and like station wagon program, you can also take mealtime insulin. The timing of injection throughout the day are:
- At breakfast, aspart, lispro, or glulisine
- At lunch: aspart, lispro, or glulisine
- At dinner: aspart, lispro, or glulisine
- At snack: aspart, lispro, or glulisine
- Once a day, glargine or detemir at consistent times
Although, glargine or detemir can be given at anytime but it should be given through different syringe because mixing with another type of insulin can alter its activity. If you want flexible meal, snack, and exercise times then this program can provide you this benefits with its mealtime insulin but you should be willing to take multiple injection in a day.
#5: The Engineered Import
This therapy utilizes the insulin pumps which are computerized devices with size of a cell phone and containing rapid acting insulin. These pumps are programmed to give basal insulin coverage throughout twenty four hours by providing tiny pulse of insulin by every few minutes interval. Bolus insulin can be provided at the mealtime with just a touch of button. It is delivered by a small infusion set which is a small and soft plastic tube inserted just below the skin. It must be changed after few days to prevent any infection and to ensure consistent absorption. The computerized program provides the basal insulin in precise manner and it can be adjusted according to the increased or decreased requirement of basal insulin requirement of the body during conditions like premenstrual period, pregnancy, stress, illness, or extended exercise.
The best insulin program is a program which provides a great control over blood glucose level for twenty four hours without causing any inconvenience and therefore, you should consult your doctor for one such program. A careful selection of insulin program can reduce the ill effects of diabetes on the body improves the quality of your life. So choose you insulin program as soon as possible!!
Note: If you have high blood pressure in addition to diabetes and have been prescribed a beta blocker, it is important to note that metoprolol side effects include low blood sugar and the drug increases the risk of this in those taking insulin isophane (NPH) and certain other antidiabetic medications.