Mealtime Insulin: 10 Things Doctors Want You to Know

Medically Reviewed By William C. Lloyd III, MD, FACS
Written By Karon Warren on September 5, 2020
  • African American family sharing meal outdoors and laughing
    With mealtime insulin, timing is everything.
    If you’re living with diabetes, particularly type 2 diabetes, you may find long-acting insulin is no longer sufficient to control your blood sugar level. In that case, your doctor may recommend mealtime insulin to supplement your insulin intake. Unlike background insulin, this fast-acting insulin is used to supplement your insulin needs during meals; it peaks quickly, usually between 15 and 20 minutes, and processes through the body in approximately 2 to 3 hours. With this different approach, there are some essentials doctors want you to know as well as some misconceptions and mistakes you should avoid.
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    1. “Most patients should take the insulin within 15 minutes of starting to eat.”
    Rapid-acting insulin is recommended at mealtimes because it is absorbed quickly and starts working in approximately 15 minutes. This means you must time your injection accordingly. “Patients have the misconception they need to inject more than 30 minutes before the meal like insulins used in the past, such as regular human insulin,” says Dr. Sofia Vasquez, endocrinologist with Tenet Florida Physician Services in Hialeah, Fla. “Current analog insulins can be injected 15 minutes before, during the meal, or 15 minutes after [the meal], and they will still be effective.”
  • Man injecting insulin into stomach
    2. “Pay close attention to dosage amounts for mealtime insulin.”
    Because they work differently, doses of mealtime insulin vary noticeably from background insulin, so pay close attention when preparing an injection. “Make sure to give the correct prescribed rapid-acting insulin with meals, not a long-acting insulin,” says Dr. Ikna Krysiak, an endocrinologist with Tenet Florida Physician Services in Fort Lauderdale, Fla. “Interchanging them can lead to a low glucose. [Also], remember to use the glucose reading before the meal to decide about dosing if given a ‘sliding scale.’”
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    3. “Taking mealtime insulin does not mean your diabetes is worse than that of others.”
    For some patients, taking mealtime insulin in addition to background insulin is a signal their diabetes is out of control. “Those with type 2 diabetes sometimes feel that taking mealtime insulin means that ‘my diabetes is really bad,’ when, in fact, they should be looking at it in a positive way,” says Dr. Lisa Sumlin, PhD, RN, ACNS-BC, a board-certified adult clinical nurse specialist and diabetes researcher at the University of Texas in Austin, Texas. “You are improving blood glucose control.”
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    4. “Don’t skip your mealtime insulin because your blood glucose is normal.”
    Unless your sugar is below 80 mg/dL or you are not eating, don’t skip your mealtime insulin. “One of the biggest mistakes diabetic patients make is avoiding injecting before the meal when the sugar is normal,” says Dr. Vasquez. “As long as the meal is being ingested, the mealtime insulin can be administered. Compliance with your diabetic regimen that includes mealtime insulin is essential in the treatment of diabetes to avoid complications and live a healthy and normal life.”
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    5. “Carefully incorporate carbs into every meal.”
    Don’t skip the carbs just because you are taking mealtime insulin. “Carbs can be a valuable part of each meal, but need to be limited in diabetics as they elevate glucose,” says Dr. Krysiak. “The important things to remember are that the insulin is needed for every meal that has carbs in it and that you try to be consistent about having the same amount or portion of carbs with each meal to prevent highs or lows after that meal.”
  • African America man injecting insulin into stomach
    6. “When taken as prescribed, mealtime insulin does not lead to diabetic complications.”
    Adding mealtime insulin to your diabetic treatment plan is not the start of a downward spiral with the disease. “Some patients with type 2 diabetes feel that if they start on mealtime insulin, the insulin leads to bad outcomes like amputations and death,” Dr. Sumlin says. “It is not the insulin that leads to the complications, but rather the uncontrolled diabetes that leads to complications. Starting insulin can be viewed positively because it provides better diabetes control and decreased risk of complications.”
  • Endocrinologist showing patient diabetic equipment
    7. “Work with your doctor to ensure you know how to properly take mealtime insulin.”
    A key component in the proper dosing of mealtime insulin is knowing how to correctly inject the insulin. “Make sure you know how to use either the insulin injection pen and/or syringe and vial,” says Dr. Sumlin. “I have had patients who have missed or given too much insulin due to improper use of injection mechanisms.” If you have trouble with dosing and injection, ask your doctor for a demonstration. Do not leave until you feel comfortable with the procedure.
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    8. “Talk to your doctor if you experience hypoglycemia after eating.”
    Correctly taking mealtime insulin should help control your type 2 diabetes; however, if your glucose levels continually drop, talk with your doctor. “If your dose of mealtime insulin is causing hypoglycemia after you eat your meal, then it is important to let your physician know to assess if the dose is correct for you,” says Dr. Pavan Chava, section head of endocrinology at Ochsner Health System in New Orleans, La.
  • African American middle aged couple cooking dinner together
    9. “Don’t try to compensate for missed doses.”
    Even the most adamant type 2 diabetes patient may miss a dose of mealtime insulin at one time or another. When that happens, do not try to overcorrect to compensate for that missed dose. “If the insulin injection is missed, say for breakfast, do not try and double the amount for lunch,” Dr. Sumlin says. “This can lead to a low blood sugar. Just take the amount scheduled for each specific meal.”
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    10. “Taking mealtime insulin is not an unusual treatment option.”
    Incorporating mealtime insulin into your treatment plan is not an uncommon occurrence among type 2 diabetes patients. It is not a bad thing or last-ditch effort to treat the disease. “There are many people with type 2 diabetes using mealtime insulin, and they are content with using insulin because they know with good control they can live longer lives without diabetes complications,” Dr. Sumlin says. 
Mealtime Insulin: 10 Things Doctors Want You to Know

About The Author

A graduate of the University of Southern Mississippi, Karon is a successful long-time published journalist who covers health, finance, insurance, business, real estate, lifestyle and travel. Her work appears in numerous online outlets and print publications across the country. She also is a member of the American Society of Journalists and Authors.
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Medical Reviewer: William C. Lloyd III, MD, FACS
Last Review Date: 2020 Sep 5
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