Mealtime Insulin 101

Dr. Page-Wilson: I'm Dr. Gabrielle Page-Wilson. The course of diabetes is different for every individual. Having said that, we know that over the course of 10 years after you've been diagnosed with diabetes, usually over half of patients require insulin in order to maintain good glucose control. Dr. Messer: Caroline Messer, M.D, endocrinologist. So there's glucose that's swimming around in the bloodstream, and it's banging into everything that's in the body. So it's banging into the nerves of vision, it's banging into the kidneys. We called that microvascular changes, so over time there's a risk of injury to all of those different end targets. There's also macrovascular risks, so that's the bigger vessels. So, blood vessels leading to the heart and the brain. Dr. Mezitis: I'm Dr. Nicholas Mezitis, endocrinology. Mealtime dosing of insulin is very important because it gives flexibility and it also allows us to optimize the blood sugar profile. Dr. Page-Wilson: Most people are familiar with long-acting insulin or basal insulin and usually that type of insulin lasts for 24 hours and basically controls your blood sugar and keeps it steady when you're not eating. And then there are short-acting insulins; that's usually used as a mealtime insulin. You take that injection about 30 to 45 minutes before a meal and it wears off after about six hours. Maria Rodriguez: Think of mealtime insulin as standing at the bus stop before the bus passes. If you're standing there and the bus passes, you're not getting on that bus. So think of insulin like it has to be on board and you have to inject it before eating so that the insulin is able to regulate the blood sugar for the meal you're going to eat. Dr. Page-Wilson: Patients who tend to have elevated blood sugars following meals are really well suited to mealtime insulin. Mealtime insulin allows you to cover the carbohydrates in the foods that you're eating in a very specific way. You can actually tailor your insulin dose to the quantity of carbohydrates in your food. Jennifer Stack: My top techniques for helping people to adhere to their mealtime insulin is to start small with changes in your eating habits, because it's so important that our mealtime insulin matches up with the amount of carbohydrate we're having at a meal. You can start by planning three to four simple meals. Use the diabetes plate where 50% of what you're going to consume at that meal are non-starchy vegetables. A quarter of that plate will be some kind of grain, legumes, beans, vegetables that are high in fiber. And the remaining quarter of your plate can be filled with lean proteins. Jennifer Stack: Now, this doesn't mean that your meals will always be this cut and dried and simple, but it makes it easier to get into a routine that you feel you can master and you feel that you can stick with.