Timing of Insulin

DSCN2322Back in the days of Regular insulin, taking injections at least 30 minutes before a meal was important because it took quite a while for the insulin start working. Nowadays most people use rapid-acting insulin (Humalog, Novolog, or Apidra), which we think of as starting to work in 10 to 15 minutes. But how many people actually take it 10 to 15 minutes before eating? When we first had rapid-acting insulin available one of its claims to fame was that it started working rapidly and we could take it right before the first bite of a meal, or even right after eating.

What we know now is that taking rapid-acting insulin 10 to 15 minutes prior to eating really can lower the A1C. Of course, that requires some planning and knowing how much we’re going to eat. It still makes sense to wait when someone who does not know what or how much they are going to eat, or when eating away from home. It’s always safer to know the food is ready and available before injecting rapid-acting insulin.

Some guidelines for when to take rapid-acting insulin are as follows: if the blood glucose is below 100 take insulin right before eating a meal, if the blood glucose level is in the 100s wait ten minutes, and if the blood glucose is in the 200s wait 20 minutes.

As far as long-acting insulin goes, Lantus can be given any time during the day/evening as long as it is consistent from day to day. For those who take Lantus or Levemir twice a day, taking it consistently about 12 hours apart is a good plan, although personally I take Lantus at 7 am and 10 pm and that works well for me. The point is to be consistent so your background insulin coverage is consistent. I once worked with a teen-ager who could only remember to take her Lantus if she took it at noon – and that’s fine!

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Write Down Your Insulin Pump Settings

Here’s an important tip for those who wear an insulin pump:

Write down your pump settings and put them in a safe place. Literally, write them on a piece of paper or an index card and put the paper/card somewhere you’ll remember (the safe, the “pump” file, the butter compartment, your jewelry box, your safe deposit box…you get the idea).

Feel free to also put your pump settings in your phone (in your “notes,” or whatever), but also write them on a piece of paper and here’s why: when your pump malfunctions (and there’s no guarantee that it will, but there’s also no guarantee that it won’t), your phone may not be available. You may have lost it, left it behind, upgraded to a new one, or your phone, too, could malfunction (timing is everything).

Just play it safe and keep an old-fashioned, hand-written copy of your pump settings around somewhere. Who knows, taking this extra precaution may protect you from ever needing it!

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The first question

While I mean in no way to diminish the seriousness of the problem of poverty, I saw – in this story – many parallels to how we work with people and kids who have diabetes. We diabetes professionals can start by using “compassion, not punishment” and asking simple questions such as “how are you?” and “what do you want to talk about today?” rather than imposing our own agenda. Even the general public can use these principles in how they think about and interact with those who live with diabetes. It is so important that we never assume we know what someone’s experience is. And even more important that we don’t judge based on our assumptions. All we have to do is ask.

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Protecting Ourselves from Sitting

When I first read this article I started getting pretty fired up. Actually, it was after I read the title of the article. Really? It doesn’t take a rocket scientist to figure out that sitting for long periods of time (aka “sedentary lifestyle”) would lead to things like diabetes. But then I read further and discovered that even those of us who exercise regularly and sit for long periods of time (work at a computer, anyone?) are at risk for negative health outcomes.

So I started thinking about how I can make my completely inactive (computer-based) job more active. Here’s what I came up with:

1) fidget

2) walk around whenever I’m on the phone

3) go for a walk after lunch

4) take stretch breaks

5) run/walk up and down the stairs several times a day

6) perform breathing exercises while working

Ok. That’s what popped into my head. Any other ideas?

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Which diet is best?

This one is right up there with “what should I eat?” as far as the most common questions diabetes educators hear. For my answer to the “what should I eat?” question, please see my book.

But in terms of the “best diet” – I leave that to the nutrition experts. I’ve quoted David Katz, MD, before, who says that the “best diet” is the one you’re willing to stick with. And every year for five years now, U.S. News & World Report has been reporting on the “best diet.” This year, for the fifth time, they once again say that the DASH diet is best. The DASH diet was originally created to help people lower their blood pressure, and later this meal plan was adapted for weight loss. It includes lots of fruits and vegetables, low-fat dairy and whole grains.

No matter which one you choose, the important thing is to adopt an eating plan that is sustainable, tastes good, and promotes health for the long run.

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10 Reasons to Start Fresh in 2015

Many New Year posts are about resolutions, full of enthusiasm and excitement for making changes, blah blah blah. But sometimes a new year can bring feelings of “here we go again” or “why bother” or ” ugh.” Maybe we didn’t reach our goals in the old year, or maybe we did, but just don’t have the energy to keep up the effort. Here are ten reasons to keep going, keep working, try harder, or start fresh with managing blood glucose levels in 2015:

10. Increased energy

9. Increased productivity

8. More stability in mood

7. Clearer mind

6. Healthier blood vessels

5. Longer life

4. Ability to focus on other things/people

3. Feeling good about ourselves

2. Being a role model for someone else

1. A healthier you (me)

Happy 2015!


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Making Peace with Diabetes

It’s easy to hate diabetes. And it’s easy to be frustrated with the tasks of managing diabetes. It’s easy to get angry when the numbers don’t fall where we want them.

But there’s another way to approach living with diabetes. Rather than getting angry, frustrated and full of hate, we can find peace. If diabetes is part of us, and we like ourselves, then there must be something about diabetes that we can accept… Does diabetes make us more self-aware? More open to meeting others? Better at math? More in touch with our bodies, science, health care? Does it help us to advocate for ourselves and others? Has it turned us into writers, videographers, health care professionals, technology developers, artists, or activists?

If we dig deep enough, we just might find something about diabetes that has brought peace to our lives. And then we might be able to make peace with diabetes. And that might even help us live better with it. I’m wishing everyone a peaceful diabetes experience (even with the ups and downs).

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Hope and Diabetes

Hope is one of the most important things we can incorporate into successful management of this chronic disease. Hope can help us maintain a positive attitude. Some people hang their hope on a goal A1C, a cure, or a prevention, or better treatment options. Others hope for a bright future, a good job, success in life, happiness, great relationships, fun, adventure, and so on. Regardless of what we focus our thoughts on, the point is to be hopeful.

A quick search on the word hope turned up definitions including an optimistic attitude, a feeling of trust, a feeling [that things] will turn out for the best, and synonyms including confidence, promise, expectation, and optimism. Personally, these are the words I want to associate with…in life and in diabetes. This week I am focused on hope.

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It’s that time of year again…

With snow comes shoveling, and with shoveling comes hypoglycemia, aka low blood glucose. Yesterday I shoveled three times – morning, mid-day, and late afternoon. I think it finally stopped snowing during the night. Then at 1:30 this morning, when I awoke with a low blood glucose, I remembered the lag effect. And it hadn’t let up as of 9:30 this morning when I was still low!

The lag effect is a situation where extended periods of activity on one day cause low blood glucose many hours later (sometimes up to 24 hours later). The lag effect is not a reason to avoid being active, rather be aware of times when this might happen; prepare for treating lows, use a temporary basal decrease (if you are on an insulin pump), or eat a little more.

If only I had timed this better. A perpetual low tomorrow would have been nice!

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Proud to be a Nurse

I am proud to be a nurse and to share this video about what the nursing profession is and what nurses are doing. I appreciate the recognition of nurses as innovators. From large, far-reaching projects to small, grass roots initiatives, nurses strive to make life and health better for people everywhere. Thank you to all the nurses who have paved the way for me and for current and future generations of nurses.

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