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Taking Control of Your Diabetes

by Steven V. Edelman, MD and Friends

Copyright © 2001, Steven V. Edelman, MD

Excerpted with permission of the publisher, Professional Communications, Inc.

Excerpted from Chapter 10 – Insulin Therapy Must Be Custom-Fit for You

Insulin Algorithm

It doesn't make any sense to give the same amount of Regular or fast-acting insulin every day before every meal, no matter if the blood sugar is 80 or 350 mg/dl (4.44 - 19.44 mmol/l). It always boggles my mind to hear one of my patients tell me that they discovered that their blood sugar was high before a meal and that they did no take any extra Regular or fast-acting insulin to help compensate for it. Insulin algorithms are an important part of achieving glucose control on a day-to-day basis, in addition to helping make decisions about long-tem adjustment. The term "sliding scale' has also been used for this type of approach. The problem is that many caregivers may not know how to design or utilize a proper sliding scale or algorithm, and as a result, this valuable tool is not widely used and is sometimes in appropriately discouraged.

Our premeal insulin does should be adjusted according to the blood sugar level, the amount and types of food to be eaten, and anticipated exercise. Some patients base their premeal insulin dose on the amount of carbohydrates in the meal (carbohydrate counting). However, for many of us, we are creatures of habit and eat the same amounts and types of food most of the time. I advocate using an insulin algorithm based on personal experience, trying different doses with certain types and amounts of meals (Figure 10-2).

In a short time, with the help of premeal and postmeal home glucose monitoring, most of us will have a fairly well-defined mental "insulin menu." An insulin menu is basically how much insulin you need for a certain type of food. For example, when I eat pizza, I always add an extra 8 to 10 units of Humalog to my usual dose in order to avoid excessively high postmeal glucose values (Table 10-3).

Insulin pens

Insulin pens allow for easier administration of a multiple-injection regimen. Insulin pens are severely underutilized in the United States, mainly because of ignorance and the infrequent use of multiple-injection regimens. Insulin pens are small, pen-size devices that contain a reservoir and needle for the accurate and convenient delivery of insulin (Figures 10-3 and 10-4). Normally insulin pens are used for the premeal injections of Regular or fast-acting insulin. Insulin pens can also deliver the long-acting and premixed insulins. Insulin pens are used by 90% to 95% of insulin-treated patients in Europe, Asia, and Scandinavia with excellent results. Don't forget that the needle of an insulin pen does not get dull because it is not shoved through the thick rubber stopper of an insulin bottle. There is no question that the injection from an insulin pen is much less painful than pricking your finger to test your blood sugar.