The ins and outs of multiple daily injections
I have had diabetes for almost fourteen years and for ten of those years, I used multiple daily injections (MDI) of insulin to manage my diabetes. As it sounds, this type of insulin therapy means using syringes and/or pre-filled insulin pens to inject insulin into the body multiple times per day.
As with any aspect of managing diabetes, the multiple daily injections therapy comes with its own set of challenges, challenges that can be discouraging at times. The following list of tips comes from my own experience and I hope may help you with your own MDI.
Nine multiple daily injections tips
1. Understand how MDI works. MDI has two main components that work in unison: Long-acting basal insulin and rapid-acting insulin. Long-acting insulin is usually injected twice per day (for me, it is fasting in the morning and postprandial with dinner), while rapid acting is typically injected with meals throughout the day.
Long-acting insulin is designed to provide insulin coverage for approximately one day and rapid-acting insulin provides coverage for insulin needs around meal time.
2. Be prepared for the pain. I admit this is not the most of encouraging points for a list. But, it isn't a secret: living with diabetes means developing a pain tolerance. Injecting insulin is where it started for me. When I was first diagnosed, one of the biggest fears I had to overcome was my phobia of needles. Those first few weeks of MDI were not fun for me at all. However, being prepared mentally to accept the pain helped me get on track.
3. Be sure to test your sugars often. Knowing your blood sugar levels when using MDI is important, not only to manage your injections, but to know how much to inject. Failure to test and make the appropriate adjustments could lead to an emergency situation if you inject more than you need, for example.
I usually test between 8 and 10 times each day day.
4. Keep track of your injections. When using multiple daily injections, you should keep track of both the number of times you inject and the amount of insulin you inject.
Having a record can help you when you miss a dose or need to make other adjustments.
5. Store your insulin properly. An open insulin vial can be stored at room temperature, but when exposed to direct sunlight or higher than recommended temperatures, it begins to lose its effectiveness. When it gets hot during the summer months, I find it helpful to carry a cold storage bag for my insulin.
6. Paying attention to your ratios. My ratios on MDI changed every few months and I had to adjust every so often. It is important to pay attention those ratios because it affects long term A1c management.
7. Be careful if you reuse syringes. When on multiple daily injections, I personally reuse syringes. My endocrinologist approved, and -- at the time -- I didn't have insurance, so it became part of my routine as a cost saving measure. I only reuse syringes for three to four days.
Remember, there are dangers when it comes to reusing your syringes (e.g. breaking the needle, etc.). Choosing to reuse syringes is entirely a personal decision, but be sure to discuss with your doctor.
8. Use multiple syringes when mixing insulin. Short-acting insulin typically appears clear in the vial, while long-acting is cloudy. When mixing insulin, you traditionally go from clear to cloudy. Mixing has always created a challenge for me, so I simply use different syringes for short- and long-acting insulin and keep track of them.
Tip: Keep a cap on the syringe you're not using when mixing insulin to keep track of which syringe you've used.
9. Be prepared when injecting in public. When I was using multiple daily injections, it was inevitably that I had to inject in public. Personally, I have no problem injecting in public. However, be prepared for judgmental looks from other people (yes, those looks are real). If you are a private person, then finding a bathroom or a place shielded from prying eyes might be helpful.
Recently, I switched from MDI to an insulin pump. I switched to the pump because it is affordable (my insurance covers it) and because it isn't as time and labor intensive as injections. Although I do not have the CGMS yet, my testing has dropped to 5 or six times a day, and I am experiencing a tighter grip on my diabetes management.
Switching to an insulin pump doesn't mean I wouldn't go back to multiple daily injections. Managing diabetes means finding a routine that works and sticking with it.
I was on MDI for 10 years and it worked very well for me.