Even when you think you’re doing everything right with your diabetes care regimen, it can sometimes seem like your blood glucose levels are hard to control. One potential source of difficulty that you may not have thought of is how you time your injections or boluses of rapid-acting insulin with respect to meals.
Since the first rapid-acting insulin, insulin lispro (brand name Humalog), came on the market in 1996, most diabetes experts have recommended taking it within 15 minutes of starting a meal (any time between 15 minutes before starting to eat to 15 minutes after starting to eat). This advice is based on the belief that rapid-acting insulin is absorbed quickly and begins lowering blood glucose quickly. However, several years of experience and observation suggest that this advice may not be ideal for everyone who uses rapid-acting insulin. As a result, the advice on when to take it needs updating.
The goal of insulin therapy is to match the way that insulin is normally secreted in people without diabetes.
Basal insulin. Small amounts of insulin are released by the pancreas 24 hours a day. On average, adults secrete about one unit of insulin per hour regardless of food intake.
Bolus insulin. In response to food, larger amounts of insulin are secreted and released in two-phase boluses. The first phase starts within minutes of the first bite of food and lasts about 15 minutes. The second phase of insulin release is more gradual and occurs over the next hour and a half to three hours. The amount of insulin that is released matches the rise in blood glucose Continue reading