Questions about diabetes

Basic information about insulin

What is insulin and how does it work?

Insulin is a hormone. It is made in an organ called the pancreas. Insulin helps the body use glucose for energy. When you eat, much of your food is broken down into a sugar called glucose. Glucose is absorbed into the bloodstream from the small intestine. From there it is taken up by the cells of the body with the help of insulin to be used as energy. Without enough insulin, the glucose cannot enter the cells and it builds up in the blood. This is called hyperglycemia. This happens when a person has diabetes. When the pancreas cannot make enough insulin, insulin can be given as injections. Because insulin is a hormone and is made from protein, it must be taken by injection because if it was taken orally, it would be digested in the stomach.

How is insulin made?

Recombinant DNA technology is used to make human insulin. The chemical components of human insulin have been slightly modified to make insulin analogs. Rapid acting insulin analogs start to work within minutes, allowing you to take your insulin 15 minutes before a meal. Rapid-acting insulin acts more similar to the way insulin is released after meals in people without diabetes. Long-acting insulin analogs are modified so they are absorbed slowly and work longer.

Novo Nordisk has been making insulin for more than 80 years. In diabetes care, our firsts include the first hospital dedicated exclusively to diabetes care, the first long-acting insulin (NPH), the first Lente® insulin products, the first purified insulin, the first insulin pen delivery system, the first meglitinide oral antidiabetic agent, the first delivery system with a memory, and the first combined blood glucose monitoring and insulin dosing system, the first insulin pen enhanced with a colorful design for children and teenagers, and the first insulin analog approved for pump therapy.

What are the different types of insulin?

There are several types of insulin. Rapid- or short-acting insulin is usually taken before meals. Intermediate- or long-acting insulin is usually taken at supper or bedtime. Some types of premixed insulin provide rapid-acting and intermediate-acting insulin in a single dose. This type of insulin is usually taken before breakfast, before the evening meal, or at both times. Talk with your healthcare provider or diabetes-care team to determine which insulin is right for you.

What type of insulin can be used in an insulin pump?

Rapid-acting insulin analogs can be used in insulin pumps. The rapid acting insulin analog made by Novo Nordisk has been approved for use in pumps since 2001.

What is a rapid-acting insulin analog?

A rapid-acting insulin analog is a modified form of human insulin. This modification allows the insulin to be absorbed and work faster. As a result, it starts working within minutes, allowing you to take your insulin and eat right away. Rapid-acting insulin analogs are also considered to act similar to the way insulin is released after meals in people without diabetes, which is a significant goal of insulin therapy.

What are the advantages of rapid-acting insulin analog?

A rapid-acting insulin analog has several advantages over Regular insulin.

It can be injected within 15 minutes of starting a meal, making it more convenient.
It doesn't last in the body as long as other types of insulin. Rapid-acting insulin analogs are also considered to act similar to the way insulin is released after meals in people without diabetes, which is a significant goal of insulin therapy. Rapid-acting insulin can improve blood glucose control after meals.

How is insulin supplied?

Some insulin analogs are available in prefilled disposable pens. Most insulin is available in 3-mL cartridges and 10-mL vials.

Is a prescription necessary for insulin and supplies?

Prescriptions are not needed to get some of the older types of insulin, but they are needed for the more modern types of insulin analogs. Depending on the laws in your state, you may also need prescriptions for needles and syringes.

What are some sample insulin plans?

Your healthcare provider will help you develop an insulin plan that is right for you. Your plan will be based on your lifestyle, eating habits, and exercise habits. Some examples of insulin plans include:

2 Injections of a premixed insulin analog - The rapid-acting insulin analog part of the premix starts working right away. You can eat as soon as you take your insulin. The intermediate-acting part provides longer-term insulin coverage. This plan gives the advantage of providing insulin coverage at mealtime and in-between time.

1 injection of a long-acting insulin analog - this plan is often used by people with type 2 diabetes. The injection is usually taken at bedtime or at dinner to provide up to 24-hour insulin coverage and to prevent high fasting blood glucose in the morning.

Intensive insulin therapy - this plan can give you more flexibility when it comes to meals and activity level. It usually means taking a long-acting insulin analog and a rapid-acting insulin analog. An example of a 4-injection plan would be 3 injections of a rapid-acting insulin analog before meals and 1 injection of a long-acting insulin analog at bedtime. This plan is intended to mimic your body's natural flow of insulin release.

Three injections of a rapid-acting insulin analog and one injection of a long-acting insulin analog.

What is intensive insulin therapy?

Intensive insulin therapy usually means having an insulin plan that includes taking a long-acting insulin with a rapid-acting insulin. The goal of intensive insulin therapy is to keep your blood glucose as close to normal as possible. It can help your body meet your need for insulin like your body did before you had diabetes. Intensive insulin therapy can help you better manage your blood glucose, add more freedom and flexibility to your life, and may help you reduce your risk of diabetes-related complications. To use intensive insulin therapy, you may need to take insulin and use your blood glucose meter when you are away from home. Fortunately, insulin delivery systems are available that offer a convenient alternative to the sometimes inconvenient vial and syringe.

Can insulin be taken with other medications?

Yes. But several substances may affect the way insulin works. Some of these medications can increase your risk of hypoglycemia (low blood glucose), while others may cause hyperglycemia (high blood glucose). As a result, your healthcare provider may need to adjust your insulin dose. In addition, you may need to monitor your blood glucose levels particularly closely. It's very important to talk to your healthcare provider about any medications you are taking.

How should insulin be stored?

Keep unopened insulin containers in the refrigerator. Once an insulin package is opened, it's okay to store it at room temperature for as long as the label instructions permit. Always check the storage and disposal information for your insulin before you use it. Keep insulin products from becoming too hot or too cold and out of bright light and sunlight. Never use insulin after the expiration date on the label. The labels and expiration dates on insulin products vary, so read the labels carefully. Many people find that their injections are less painful if the insulin is at room temperature. If your insulin looks discolored or lumpy, don't use it. Many people find prefilled disposable insulin pens a convenient alternative to vial and syringe. Talk to your diabetes-care team about your options for insulin injection.

What is insulin resistance?

Insulin resistance is a condition that is seen in people living with type 2 diabetes. It is when the cells and tissues in the body can no longer use insulin properly. This causes glucose to build up in the blood. Insulin resistance continues to get worse over time. Your body begins to need more and more insulin to take the glucose out of the blood. Sometimes a diabetes pill can be prescribed along with your insulin that can help the cells and tissues use the insulin better. Weight loss can also improve insulin resistance.

What are some of the possible side effects of insulin therapy?

The most common side effect of insulin therapy is hypoglycemia or low blood glucose. This can be very serious if not recognized and treated right away. Checking your blood glucose frequently can help you avoid hypoglycemic episodes. People on insulin therapy should have a glucagon emergency kit available. Other side effects of insulin can include redness, swelling, or itching at the site of injection. Contact your healthcare provider if you have any irritation at your injection site or if you experience frequent hypoglycemia.

Does insulin therapy cause blindness?

No, insulin therapy does not cause blindness. In fact, if blood glucose levels are kept in a good range, blindness can often be prevented. High blood glucose levels over time can lead to a condition called diabetic retinopathy. This is a condition of the eyes that, if left unchecked, can lead to blindness.

Sometimes it seems that as soon as a person starts taking insulin, they suffer from diabetes complications. Can insulin cause these?

No. Insulin does not cause diabetes complications. When insulin is taken according to your diabetes-care plan, it can be a safe and effective way of treating your diabetes. Unfortunately, there are 6.2 million Americans who have diabetes but don't yet know it. These people and those whose diabetes is not well managed are at risk for serious health conditions such as heart disease, kidney disease, and problems with their blood vessels and nerves. These conditions can become life-threatening. Keeping your blood glucose levels as close to normal as possible can help to reduce your risk for developing complications of diabetes.

Once a person takes insulin, will he or she always need to inject insulin?

People with type 1 diabetes will always have to take insulin because the cells in the pancreas no longer produce insulin. For those with type 2 diabetes, the cells in the pancreas are not producing enough insulin to meet the needs of the body, so insulin has become part of their diabetes-care plan. It is most likely that they will continue to need insulin as a part of their care plan.

Does insulin still need to be taken if a person is sick?

Yes. You should still take your insulin even if you are not feeling well and not eating your usual diet. Talk to your healthcare provider about the need to adjust your insulin on sick days. With the help of your healthcare provider, create a sick day action plan. This plan will remind you of valuable information at a time when you are not feeling your best. Your plan of action should include:

When to call your healthcare provider
Contact information for your healthcare provider (including nights and weekends)
When to check your blood glucose level and urine ketones
Adjustments to your medications
Foods and fluids to consume
Special instructions for taking over-the-counter medications

What are some important questions to ask the doctor when taking insulin?

It's helpful to make a list of questions to review with your doctor. Remember to leave some room after each of your questions to write down the answer for future reference. Some questions you may want to include are:

When was the last time my A1C was tested? What was my result and what does it mean? How often should this test be done?
How often should I check my blood glucose levels at home?
What are my target blood glucose levels?
When was the last time I had a lipid profile? What were my results and what do they mean? How often should this test be done?
What is my blood pressure? Is it okay? If not, what should I be doing?
What dietary guidelines should I follow?
How can I reduce my risk for diabetes-related complications?

Is insulin injected into a vein?

No, insulin is injected into the fat layer just beneath the skin in either the abdomen, thighs, or backs of the upper arms.

Do people with type 2 diabetes have to take insulin because they have failed in their diabetes self-management?

By the time many people have been diagnosed with type 2 diabetes their bodies already have been working hard to lower their blood glucose levels by making extra insulin. Most have only about half of the cells in the pancreas left that make insulin. The cells in their body have also become "insulin resistant" and can't make good use of the insulin the pancreas is making. Blood glucose levels may have been high for many years. And these years of high blood glucose levels may have already caused diabetes-related complications, such as damage to the heart, eyes, and nerves.

As type 2 diabetes progresses, the body's ability to make enough insulin naturally dwindles. Over time, even two or three types of diabetes pills may not be enough to manage blood glucose levels, and insulin becomes necessary. This doesn't mean the person with type 2 diabetes has done anything wrong. It just means that diabetes has progressed to a point where diabetes pills are no longer effective in controlling the disease.

Does taking insulin cause weight gain?

Although many people with type 2 diabetes do gain weight while taking insulin, careful meal planning and regular physical activity can help prevent weight gain. Work with your healthcare provider to choose an insulin plan that is less likely to result in weight gain. Research shows that some insulin plans, including a long-acting insulin analog instead of NPH insulin, can limit weight gain.

Monitor the effectiveness of your diabetes-care plan and to serve as a guide for you and your diabetes-care team
Show the relationship between blood glucose, food, exercise, and insulin
Help manage sick days and hypoglycemia (low blood glucose)
Record long-term blood glucose management
Help you achieve a blood glucose range as close to normal as possible, which may help you reduce your risk for diabetes-related complications

Why is it important to control postprandial blood glucose?

Elevations of the blood glucose level after eating can happen even if the fasting blood glucose levels are within a normal range. When this occurs the average blood glucose level or A1C will be elevated. High postprandial blood glucose levels and high A1C levels are associated with a much higher risk for diabetes-related complications. These can include heart attack, kidney damage, damage to the blood vessels and nerves, and vision problems. That's why it's important to keep your blood glucose level as close to normal as possible, especially after meals.

What is "physiologic control"?

Physiologic control is when a treatment plan most closely follows the natural insulin cycles of the body. The pancreas normally releases insulin in response to increased glucose in the blood (bolus insulin). At other times, a very low level of insulin is present in the blood (basal insulin). Rapid-acting insulin analogs are helpful when trying to achieve "physiologic control." Unlike other types of insulin, a rapid-acting insulin analog can be injected immediately before a meal. It starts to work faster than other types of insulin and it peaks when the glucose levels are highest in the blood after a meal (postprandial). It also does not last as long as other types of insulin in the blood. This mimics the natural insulin pattern and helps to provide "physiologic control." A long-acting insulin analog can be taken to cover the need for basal insulin.

Injecting insulin

What if a person is concerned about giving themselves insulin injections?

Make sure that you have voiced this concern to your diabetes-care team. They are there to help you understand your need for insulin and to support you. If you do not have confidence using a syringe and needle, there are other ways to inject insulin. The needles on some insulin delivery systems are much finer and shorter than those on a syringe.

How is insulin injected?

Always wash your hands and the site before injecting insulin. Pinch the skin at the site and push the needle into the skin fold. Push down the plunger or button all the way and hold it down for several seconds to ensure your full dose has been delivered. Then, withdraw the needle. To avoid needle sticks, do not recap the needle. Instead, safely dispose of it in a sharps container (Many states have laws on how to dispose of diabetes products. Talk with your pharmacist or local waste authority about how to do this correctly). Do not reuse needles. Talk with your healthcare provider about what injection technique is best for you.

Is it necessary to swab the skin with alcohol before injecting insulin?

No. This is not necessary because you cannot sterilize your skin. The area you inject with insulin should be clean, however. The American Diabetes Association does not recommend wiping the skin with alcohol before injecting insulin. If you do decide to use an alcohol swab before injecting your insulin, wait until the alcohol has dried before injecting. This will help keep the injection from stinging.

Does insulin need to be shaken before injecting it?

Insulin should never be shaken because this will make bubbles. What you do with the insulin before injecting it depends on the type of insulin that you are taking and your insulin delivery method. Talk to your healthcare provider or diabetes-care team and always read and follow the instructions that accompany your insulin delivery device.

Where should insulin be injected?

Insulin works best when injected into the fat layer just beneath the skin. Some areas of the body to use include the abdomen (except a 2-inch circle around your belly button), thighs (top and outer parts), and backs of the upper arms. Insulin should be injected in the same areas, but not the same exact spot, to avoid the buildup of lumps or scar tissue. Where you inject insulin can affect how rapidly it works. Before you begin taking insulin be sure you understand how to prepare and inject insulin, and how fast it may work. Talk with your healthcare provider about where you should inject insulin.

What if air is injected by mistake?

Injecting air under your skin doesn't harm you, but could be painful, and the air in the syringe takes the place of the insulin and decreases your intended insulin dose. To help prevent this problem, you may want to consider switching to a prefilled disposable insulin pen. They are also portable, self-contained, convenient, and discreet, provide accurate dosing, allow for multiple uses, and use smaller needles than syringes. Ask your healthcare provider if a prefilled insulin pen might be right for you.

Are there alternatives for more precise control over insulin dosing?

Some insulin pens are calibrated to deliver insulin in one-half unit increments.

What are the advantages of prefilled disposable insulin pens?

There are a number of advantages to using a prefilled disposable insulin pen.

Convenience-they are portable and come in their own self-contained carrier.
Use short, thin needles
Discreet-they are small enough to fit in your pocket or purse
Offer easy-dial dosing mechanism
Easy dose correction-just dial backwards or forwards to correct your error
No need to refill or change cartridges. Pens are easily disposed of when empty.

Is there some way to make sure a person is taking the correct insulin dose?

There are prefilled insulin pens available that have easy-to-read dials, which can help ensure that the correct amount of insulin is taken. If you dial the wrong amount, you can just move the dial to the right amount. These pens are also very convenient and discreet. Ask your healthcare provider if a prefilled insulin pen might be right for you.

Is there a way to see a prefilled disposable insulin pen without having to buy it?

Prefilled disposable insulin pens are available with a rapid acting insulin analog, premixed insulin analog and the long acting-insulin analog. You can see a demo at insulindevice.com or ask your healthcare provider or pharmacist if he or she has one you can examine more closely.

Can insulin injections be less painful?

The needles used with prefilled disposable insulin pens are often shorter and thinner than those used on syringes. Some short, thin needles are silicone coated and electropolished to reduce friction.

Managing diabetes supplies can be inconvenient. Are there any other options?

Some people find that using vials and syringes for their insulin therapy is inconvenient. Prefilled disposable insulin pens are easier to carry and use.

What causes lumps at injection sites?

The technical term for these lumps is lipohypertrophy. These hard lumps are made up of fatty deposits and can form when a person injects insulin near the same place each time. Children seem to be the most susceptible to these growths. This is because children seem to favor an injection site, which can cause the lump or growth. Injecting into this lump can be less painful for the child; however it's also less effective. The insulin absorption rate is not consistent when injecting into these lumps. To prevent these growths or lumps, it's important to rotate the area you inject.

How many times can a pen needle be used?

It's recommended that each needle be used only once and then discarded. It's the same as is recommended for standard syringes. Reusing a needle puts you at greater risk for infection or painful injections.

Can the needle be left on insulin pens between uses?

No. It's recommended that you remove and dispose of the needle after each use. Depending on the temperature, the pen can expand and insulin can leak out or the pen can contract and air can get inside.

What factors affect insulin absorption?

Absorption rates vary from person to person. It is believed that the more fat at an injection site, the slower the insulin is absorbed by the body. The temperature of your body based on outside influences also has an effect on absorption. Cold temperatures or cold compresses can actually decrease absorption while hot temperatures, such as from a hot shower or sun bathing, can speed up the absorption process. Smoking can also decrease absorption, while massaging or exercising the injected area will speed up the absorption process.

In addition, your absorption rate differs depending on the injection site, which can affect your blood glucose levels. For instance, did you know that your abdomen provides for the quickest absorption? Next, absorption is best in your upper arms, buttocks, and thighs, in that order. It's recommended that you inject your insulin into the same body part. However, be careful not to use the same injection area within a site over and over again to avoid tissue growth or lumps. Talk to your healthcare provider regarding the best site for you to use to inject your insulin.

How does exercise affect insulin absorption?

Exercise increases insulin absorption, because during exercise and often for hours afterwards, blood glucose levels go down. You should always check your blood glucose levels before you start or change your exercise program and also if you change your medication or meal plan. The best time to exercise is 1 to 3 hours after meals for most people with diabetes. That's the time when blood glucose levels are highest and your risk of low blood glucose is lowest.

It is best not to exercise when your insulin is at its peak effect. Also, do not exercise if your blood glucose level is too low. You should always have a high-carbohydrate snack on hand in case of a low blood glucose problem. No matter which type of diabetes you have, always check your blood glucose within 15 minutes after you stop exercising.

If you have type 1 diabetes, do not exercise if you test positive for ketones. Exercise usually lowers blood glucose, but if you have ketones, strenuous activity could make blood glucose levels go even higher.

Always talk to your healthcare provider before beginning or changing your exercise program.

Mixing insulin can be difficult. Is there an easier way?

Premixed insulin analogs provide both rapid-acting and intermediate-acting insulin in a single preparation. Talk to your healthcare provider to see if a premixed insulin analog may work for you. Any change in insulin should be made carefully and only under medical supervision.

Can rapid-acting insulin analogs be mixed with other insulin?

Yes, with some other types of insulin. They cannot, however, be mixed with long-acting insulin analogs. Talk to your healthcare provider about taking a Rapid-acting insulin with another type of insulin. Any change in treatment therapy should be made cautiously and only under medical supervision.

Can a person switch from Regular insulin to rapid-acting insulin?

If you have achieved glycemic control with Regular human insulin, you may decide to switch to a rapid-acting insulin analog for increased convenience and flexibility. You may find that your dosage of a rapid-acting insulin analog will be the same. It's important to note that any change in insulin must be done under strict medical supervision, and each person's dosage and injection schedule is individualized.

Where can I get advice and support for pump users?

Talk with your diabetes-care team to help you find the right support team for you. You may also want to visit: insulin-pumpers.org.

Does an insulin pump have to be taken off to go through the metal detector at the airport?

No. Let airport security personnel know that you are wearing an insulin pump and allow them to inspect it without removing it from your body. If you experience any problems, ask to speak with the security checkpoint supervisor. Please remember that the cap must be removed when flying since the cap covers the opening that allows for pressure change.

Can an insulin pump get wet?

Yes. Accidents happen. As long as the cap is on tightly, it should be fine. However, even without the snap-on cap, the pump is practically waterproof. Users have showered and accidentally submerged their pump without any problems except that the housing needed to be dried out with a paper towel.

If an insulin pump is dropped on a hard surface, will it break?

When you purchase your pump, ask about fragility. Most pumps can be accidentally dropped on a variety of surfaces and remain unharmed.

What can be done to ensure a person is getting the right insulin dosage with a pump?

To help ensure you're getting the right dosage with your pump, remember to:

Monitor your blood glucose levels 3 or more times daily (or as recommended by your healthcare provider)
Keep blood glucose as close to normal as possible
Frequently change your injection site
Frequently check your cannula to ensure it's not kinked or leaking and to ensure air is not in the tube
Frequently change your infusion set according to your diabetes-care plan
Check your battery often to avoid mechanical failure
Always follow the manufacturer's recommendations for the pump you are using
Maintain good hygiene by keeping the injection site and your hands clean
Visit your diabetes-care team or healthcare provider as recommended
Review your diabetes-care plan with your healthcare provider and diabetes-care team periodically

Managing blood glucose

Why is monitoring blood glucose levels so important when taking insulin?

Monitoring blood glucose levels is important because you want to keep your blood glucose levels as close to normal as possible. This will help reduce your risk for short-term adverse effects such as high and low blood glucose levels and long-term complications, which can affect the eyes, kidneys, and nerves. The main reasons for checking blood glucose regularly are to:

Monitor the effectiveness of your diabetes-care plan and to serve as a guide for you and your diabetes-care team
Show the relationship between blood glucose, food, exercise, and insulin
Help manage sick days and hypoglycemia (low blood glucose)
Record long-term blood glucose management
Help you achieve a blood glucose range as close to normal as possible, which may help you reduce your risk for diabetes-related complications

What are the recommended blood glucose goals?

The American College of Clinical Endocrinologists suggests the following blood glucose goals:

A1C levels of 6.5% or less
Before meals: 110 mg/dL or less
2 hours after meals: 140 mg/dL or less

However, it is important to remember that your individual goals may vary. Talk to your healthcare provider about your personal blood glucose goals.

What can be done to prevent hypoglycemia or low blood glucose?

With insulin therapy, it is very important to establish a routine. Meals and snacks should be taken at the times that have been set up as part of your diabetes-care plan. Care must be taken not to skip meals. Adjustments to your diabetes-care plan may be necessary if you participate in vigorous physical activity. When you first begin insulin therapy, it is very important to monitor your blood glucose levels at home so that you can see how your body reacts to changes in eating and physical activity. It is important to recognize the symptoms of hypoglycemia so that you can act quickly to increase your blood glucose to a safe range. Some of the symptoms of hypoglycemia include sweating, dizziness, weakness, and shakiness. Make sure that your diabetes-care plan includes steps to take if you begin to have symptoms of hypoglycemia. If not treated promptly, mild or moderate hypoglycemia can quickly progress to severe hypoglycemia causing you to lose consciousness. Untreated severe hypoglycemia can lead to brain damage or even death. If you take insulin, keep a glucagon emergency kit handy for those around you to use in the case of severe hypoglycemia. Report any episodes of hypoglycemia to your healthcare provider.

Why do blood glucose levels vary from day to day even when the same amount of insulin is taken?

The level of glucose in your blood depends on a lot of different factors. For instance, the amount and kind of food you eat, your activity and stress levels, and whether or not you are sick can affect your blood glucose levels. Even the time of day you perform the test can affect your reading. The important thing is to try to keep your blood glucose levels as close to normal as possible. You'll want to check your blood glucose regularly so you can determine if your diabetes-care plan is managing your diabetes.

What is "physiologic control"?

What is basal/bolus therapy?

In people without diabetes, the pancreas continuously releases a small, steady "basal" flow of insulin to keep blood glucose in a normal range. When you eat, the pancreas releases a short "burst" or "bolus" of insulin to handle the glucose load from the meal. Insulin plans can be designed to mimic this natural pattern of insulin release. Generally, these plans combine a long-acting insulin with a rapid-acting insulin. The long-acting insulin is intended to simulate the basal insulin secretion. It helps control your background blood glucose levels. A rapid-acting insulin analog provides a short burst of glucose-lowering activity. It works to lower the postprandial (after a meal) blood glucose rise that occurs as your body digests the food you've just eaten.

What is basal insulin?

In people without diabetes, the pancreas continuously releases a small, steady "basal" flow of insulin to keep blood glucose in a normal range. A long-acting insulin analog can be used to mimic this basal insulin.

What is bolus insulin?

When you eat, the pancreas normally releases a short "burst" or "bolus" of insulin to handle the increased glucose in your blood after a meal. Blood glucose is usually highest about an hour after a meal. High glucose levels signal the body to release more insulin into the bloodstream to help the glucose get into the cells where it can be used as energy. This natural bolus of insulin can be mimicked (copied) by using an injection of a rapid-acting insulin analog before each meal.

Why would a person who has been taking diabetes pills for a while now need insulin? Does this mean he or she has type 1 diabetes? Why would he or she need to inject insulin when others only have to take pills?

Why is it important to control postprandial blood glucose?

What causes a high fasting blood glucose in the morning, even though the bedtime results are in target range? How can an insulin plan be adjusted to deal with the Dawn phenomenon and/or rebound effect?

A high early morning blood glucose can be caused by:

Not enough insulin in your body in the morning. This means that you are not taking enough insulin in the evening or that the insulin you're taking is not long-acting enough to cover you until the morning.
Your blood glucose level dropping too low in the middle of the night. As a result, your body will release some of the glucose that is stored in your liver. The next morning, your blood glucose will be too high. This is called the Somogyi or rebound effect.
A normal reaction called the Dawn phenomenon that occurs during the early morning hours. Hormones are released that cause the liver to send some of its stored glucose into the blood. These hormones also make the cells of your body less responsive to insulin.

It is important to determine why your blood glucose is high. Checking your blood glucose levels at about 3 AM for several nights can help determine the cause so that the right adjustment can be made to your diabetes-care plan. An insulin pump can often correct the problem. Talk to your healthcare provider to see if a pump would be right for you.

What would cause a recent deterioration in blood glucose?

If your readings have recently changed, you should talk with your healthcare provider and diabetes-care team. Blood glucose levels can become higher if there is stress to the body such as pregnancy, illness, or infection. Decreased physical activity or increased food intake may also be responsible. Other things that can affect your blood glucose levels include improper insulin storage or inadequate injection techniques. Your diabetes-care team will want to review your diabetes-care plan with you to help you get your blood glucose levels back on track.

Lifestyle issues

Why is the timing of meals so important for someone who takes insulin?: Unlike the insulin that your body makes, insulin that is injected has to have time to be absorbed before it can work. Rapid-acting insulin analogs should be injected right before eating because they start to work right away. This mimics the natural pattern of insulin release by the body- surging when the food is being digested and then returning to a lower level between meals. It's important to make sure you eat within the time frame your insulin will be working to help prevent hypoglycemia (low blood glucose).
How long before a meal should insulin be injected?: Rapid-acting insulin analogs can be taken within 15 minutes of starting a meal.
What are some things to keep in mind when traveling away from home?: A good rule of thumb to follow is to take twice as many supplies as you would need normally and a good supply of snacks. This will help with time zone changes or unexpected delays you may experience while you are away from home. Never leave insulin where it may get too hot or too cold. Always keep insulin in a cool, dry place. Your healthcare provider can help you adjust your diabetes treatment plan to travel-related changes and time zone changes. If you travel often, you may want to ask your healthcare provider whether a prefilled disposable insulin pen might be right for you.
How does one travel by plane or train with diabetes supplies?: When traveling by plane or train always find out in advance if your airline or train carrier has any special rules for passengers who need to carry insulin supplies on flights. Always let airport security people know that you have diabetes and are carrying supplies with you. Make sure your supplies are in the original packaging with original prescription labels. Remember to keep lancets capped and be sure your glucose meter has the maker's name on it. Be sure to carry snacks and purchase meals for in-flight since most airlines do not serve meals anymore.
What is carbohydrate counting and what does it have to do with insulin therapy?: Carbohydrate (carb) counting is a meal planning method used to count carb content, rather than calories, fat, or protein content in food. This method of meal planning is often used by people with diabetes, especially those on an intensive insulin therapy plan. Your insulin dose is usually adjusted according to your premeal blood glucose result and the amount of carbs you expect to eat. Ask your healthcare provider to refer you to a registered dietitian for assistance in learning how carb counting can help you manage your diabetes.
Once people start insulin therapy, will they be able to do the same activities and eat the way they ate before starting insulin?: People who take insulin can still lead very full and active lives. The amount of insulin that your body needs, however, will depend on how much you eat, when you eat, and your activity level. Talk to your healthcare provider and diabetes-care team about specific aspects of your meal and exercise plans. They can help you balance your lifestyle with your diabetes-care plan. Also, there are prefilled disposable insulin pens that can simplify taking insulin. Ask your healthcare provider if a prefilled disposable insulin pen might be right for you.
Isn't insulin only for people with type 1 diabetes? Why do people with type 2 diabetes sometimes need to take insulin?: In type 1 diabetes, the pancreas stops producing insulin. This occurs when the body's immune system begins to attack the beta cells of the pancreas. Beta cells are the cells that produce insulin. No one is certain why the immune system does this. Insulin is always required to treat type 1 diabetes.; In type 2 diabetes, the body makes some insulin but not enough. Or, the body prevents the insulin you do produce from working properly.; Many people who have type 2 diabetes can take pills instead of insulin for a while. Because diabetes is a progressive disease, at some point, most people with type 2 diabetes will need to take insulin.
What are some things to consider when thinking about an insulin pump?: Insulin pumps are miniature, computerized pumps, about the size of a pager, which are worn on your belt or in your pocket. They deliver a steady, measured dose of insulin through a cannula (a flexible plastic tube) with a small needle that is inserted through the skin into the fatty tissue and taped in place. In newer catheter products, the needle is removed and the soft, Teflon® catheter remains in place. On your command, the pump releases a bolus (a surge) of insulin; this is usually done just before eating to counter the rise in after-meal blood glucose.; For many people, the insulin pump enables them to enjoy a more flexible lifestyle. Pumps deliver very precise insulin doses for different times of day. Many people prefer this continuous system of insulin delivery to periodic injections. Because the pump can release an incredibly small dose of insulin continuously, this delivery system most closely mimics the body's normal release of insulin. However, the insulin pump is not an artificial pancreas so you still need to monitor your blood glucose level to adjust your insulin dose. To use a pump, you must be willing to check your blood glucose at least 4 times a day and learn how to make adjustments in insulin, food, and exercise in response to those results. An insulin pump will not cure diabetes, in fact, it may initially require more work than your previous treatment plan.; You'll want to check with your insurance carrier about pump and supply coverage, although most carriers do cover these items if you meet specific criteria.

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NovoNordisk - Changing Life with Diabetes

Questions about diabetes

Basic information about insulin

Injecting insulin

Managing blood glucose

Lifestyle issues

Basic information about insulin

Injecting insulin

Managing blood glucose

Lifestyle issues