Did you know . . .
. . . that people taking insulin for control of their diabetes don't
have to eat every meal "on schedule"?
. . . that it's possible to get tight control of your
blood sugar levels without sacrificing your lifestyle to the timing of when a shot of NPH
or Lente insulin has its peak effect?
. . . that you don't need to use an insulin pump to take advantage
of this new flexibility?
During the 1980's, diabetes specialist developed new ways to use insulin that permit increased flexibility for many patients taking insulin.
One new method of using insulin is called the "basal/bolus" system. or MDI (multiple daily injections).
The ideas used in the basal/bolus system are based upon the knowledge gained from portable insulin pumps, and even the words "basal" and "bolus" are borrowed from the jargon used with these pumps. One type of insulin (Lantus)
is given once daily (rarely, twice seems to be needed) to mimic the
pump's use of a basal rate. Doses of short-acting insulin
(usually an insulin
analog,
Humalog,
Novolog,
or
Apidra)
are given as
boluses before meals.
This system has sometimes been jokingly called the
'the poor man's pump,"
since it requires considerably less cost to use than it does to use a battery-driven computerized portable insulin pump.
Many physicians have only recently learned about the basal/bolus system, and don't yet have a feeling about which patients might benefit from it. And the thought of diabetic patients skipping
meals may give some dietitians gray hair! But, if you are willing to
work hard at it, the new freedom you will get from the basal/bolus
system might surprise you, your doctor, and that dietitian!
Advantages . . .
- The main advantage of the basal/bolus system is to make you feel better about your diabetes and yourself. With a moderate degree of effort, you'll find new flexibility in your meal timing. With more work, you can adjust your insulin to enable you to eat varying sizes
of meals anytime you want!
- You'll also notice fewer insulin reactions, if they were due to a mismatch between your insulin's peak effect compared to your meal timing.
- And, if you're willing to do a huge amount of work, you can probably get your glycosylated hemoglobin into the normal range, and keep it there most of the time.
Most people on the basal/bolus system seem content to gain the increased flexibility and lose their insulin reactions. However, you may read about the DCCT study, and learn that tight control of your blood sugar level might be of benefit in decreasing the risk of complications, such as eye or kidney disease. Or, perhaps you're a young woman planning a pregnancy, and therefore you want to get your diabetes into "perfect" control before becoming pregnant. The basl/bolus system can be used to obtain very tight control of the blood sugar levels.
- Most importantly, YOU will be in control of your life. You'll be using the information from your blood sugar readings, rather than collecting them to show to your doctor several months later. You won't have to make excuses to friends or family members about meal timing. You will be able to control your blood sugars, just as tightly as you are willing to work on it.
. . . and the Drawbacks
-
It's difficult to learn. Getting the hang of how much bolus insulin to use before meals is a learning process that might take several weeks. You'll probably be on the phone to your diabetes educator daily
for the first week or so, as you learn how much bolus insulin to give. The dose of bolus insulin will vary depending on how much food you plan to eat (principally the amount of carbohydrate in the upcoming meal), your blood sugar level at the moment, and any exercise that you plan in the next few hours. Some patients end up giving a different dose of bolus insulin every time!
-
You must be willing and able to take charge of your diabetes. Some physicians worry about whether patients can learn all the detail of such a complex medical program; if you're motivated, you can do it.
-
You'll need to see a diabetes specialist who knows the system, and who has the resources to teach you how to do it. You (and whoever is cooking for you, if you don't make your own meals) will need to discuss meal planning in detail with one of the few diabetes dietitians who are comfortable with the system, and you'll need to have ready access to a nurse who's a Certified Diabetes Educator who can help you learn to juggle your insulin doses.
-
And it requires multiple fingersticks and multiple insulin injections every day. Multiple blood sugar tests, at least four every day, and sometimes as many as ten or more per day, might be needed to keep track of how you're doing. And or course, you'll be getting one (or perhaps two shots) of Lantus each day, plus a dose of bolus insulin before every meal. That's four or five shots a day, as Lantus cannot be mixed with other insulins in the same syringe.
-
Fortunately, new insulin delivery devices (the insulin pens), make the shots a snap. Talk to your diabetes physician or diabetes nurse educator, and get a demonstration of the pens.
-
A final warning: You'll
gain weight, unless you really pay close attention to your meal plan. Imaging "pigging-out" on your favorite junk foods, without seeing your sugar level rise!
It's possible with the basal/bolus system. Just take extra rapid-acting insulin before the planned
"pig-out." But, if you do this often enough, you'll see your weight climb. The reason? Insulin controls the blood sugar level by storing away extra calories as extra fat!
Is it worth it?
If you have very stable work hours, and do about the same thing every day at
about the same time, and have a normal glycosylated hemoglobin,
it's simply not worth the bother. Or if the thought of fingersticks drives
you bonkers, this system would drive you double-bonkers.
But, maybe it's worth a discussion with a knowledgeable
diabetes doctor.
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