Type 2 Diabetes: Is It Time to Start Taking Mealtime Insulin?
Mealtime insulin, also known as rapid-acting or bolus insulin, is taken before meals by people with diabetes to manage blood sugar levels after eating. Mealtime insulin can be very effective in helping diabetics maintain stable blood sugar levels, but when is the right time to start this kind of insulin? As an endocrinologist, I consider many factors before prescribing mealtime insulin to a patient, since incorporating mealtime insulin into your daily routine can be a big lifestyle change. But even though it’s a serious commitment, mealtime insulin can be the key to diabetes control for many patients.
Why is insulin important?
Type 2 diabetes occurs when your body doesn’t make enough insulin to control your blood sugar levels. Insulin is a hormone made by the pancreas that helps your body use sugar as energy. When you eat, the carbohydrates in your food are broken down into sugar. That sugar needs to be absorbed to be used as energy. During a meal, insulin signals to your muscles, fat, and liver that they need to absorb incoming sugar to use or store. Without insulin, the sugar doesn’t know where to go, so it stays in your blood. These high blood sugar levels can cause increased thirst and increased urination in the short-term; long-term, uncontrolled blood sugar levels can cause serious damage to your kidneys, eyes, and feet, as well as raise your risk of heart attack and stroke.
In people with type 2 diabetes, the body becomes very insulin resistant, which means you need a lot more insulin than normal to control blood sugar levels. Eventually, your pancreas can’t keep up and isn’t able to make the large amount of insulin you need. That’s where diabetes medications come in.
Your diabetes treatment path is unique to you.
After you receive a diagnosis of type 2 diabetes, your doctor will likely advise you to make some lifestyle changes, like adjusting your diet and adding more exercise into your daily life. Additionally, you’ll be prescribed medications to treat your diabetes, usually starting with oral medications. We will try these to help your body produce more insulin and respond better to the insulin you already make. If oral medications aren’t enough to control blood sugar levels, then we add either non-insulin injectable or insulin therapies. Eventually, most people with type 2 diabetes will require insulin injections to continue controlling their blood sugar levels. There are several different types of insulin to choose from, and often patients take a combination of insulin and non-insulin medications.
When non-insulin therapies alone aren’t doing enough to keep your blood sugar levels stable, you’ll probably start initially on a long-acting insulin. Examples of long-acting insulin, also known as background or basal insulin, include insulin glargine (Lantus, Toujeo), insulin detemir (Levemir), and insulin degludec (Tresiba). At first, you may take non-insulin oral or injectable medications along with long-acting insulin; the insulin keeps blood sugar steady when you’re not eating, and the non-insulin medications prevent your blood sugar from spiking after you eat. However, as time passes, the non-insulin drugs might not be enough to cover the rise in blood sugar post-meal. When I see patients who say they’re taking all their medication, avoiding sugary beverages, and limiting their carbs, but their blood sugar levels are still elevated and they’re not reaching their goals, then we start talking about the next step: moving to mealtime insulin.
Typically, patients will continue to take their long-acting insulin and then add mealtime insulin on top of it. Examples of mealtime insulin include insulin aspart (NovoLog), insulin lispro (Humalog), and insulin glulisine (Apidra). If patients are hesitant to make the commitment of taking mealtime insulin before every single meal, we can start slowly. They can take mealtime insulin before their largest meal of the day and see how they do. Usually, if patients see their sugars have really improved on just one mealtime insulin dose a day, they’re willing to expand that to two and then three doses a day. It’s definitely hard at first to incorporate mealtime insulin into your daily life, but it gets more doable with time. I tell patients once it becomes a habit, you’ll realize it’s not really that big of a deal. It just becomes part of your lifestyle. Initially, when you’re adding something new to your already-busy lifestyle, it can seem overwhelming and difficult. But once people get the hang of it, it becomes much easier.
Committing to mealtime insulin means committing to a healthier future.
I always try to motivate my patients to think long-term. Yes, in the short-term, taking a shot before each meal can seem like a hassle. But in the bigger picture, you’re giving your body what it needs to function properly, and you’re avoiding the scary consequences of not controlling your diabetes. Twenty years down the line, you could be living a healthy life, or you could be on kidney dialysis, dealing with an amputated foot, or losing your eyesight. I bring this up to patients not to scare them, but to help them understand their decisions today will really impact them in the decades ahead. Commit to your diabetes treatment plan, consistently refill your prescriptions, and always be honest with your doctor about how you’re feeling and what your numbers look like. Managing diabetes means creating a lot of new habits, but it’s worth it to keep you healthy today and in the future.