A lot of people have asked me questions about how I manage my type 1 diabetes via multiple daily injections so that’s what this post is about.
Firstly, I want to say that this is what I do and what works for me and before you try to change anything to your diabetes management, you want to talk to your doctor. Insulin dosages vary person to person depending on their weight, activity level, stress level, diet, insulin resistance, medications, etc.
I use Lantus insulin as my long acting “basal” insulin and Humalog insulin as my fast acting “bolus” insulin.
My Lantus routine
Every night around 10pm I give an injection of Lantus. Based on my weight which hovers between 130-140 pounds, I am to give about 20 units per day. This does work for me. However, I try to exercise each day and eat a diet that is void of processed foods and low in glycemic load. These two factors cause my insulin needs to decrease. If I’m exercising and eating the way I try to, I use about 12 units of Lantus. If I don’t do one of these, I will need about 15-16 units of Lantus.
I just want to note that when I removed wheat out of my diet, I lowered my Lantus by about 5 units, daily. Kind of amazing.
Anyway, Lantus is advertised as a 24 hour insulin you take once a day. If you open up the folded pamphlet that comes with Lantus and read it, you’ll discover Lantus lasts closer to around 20-21 hours. So being aware of this, each day around dinner time, I give a extra unit or two of insulin in order to combat the dying out of Lantus in my system. Or I do a really short workout and that takes care of things, too.
How do I deal with dawn phenomenon?
Well, I had a hard time with it when I gave my Lantus in the mornings because it would run out just before I woke up and cause me to wake up pretty high unless I slept around 75-80 (in that case dawn phenomenon didn’t do anything to me). So that’s why I give Lantus at night. Each morning, I notice that if I wake up at 7:30am or before 7:30am, I don’t deal with the dawn phenomenon. If I sleep past that time, I will start to go up pretty quickly. I don’t know why my dawn phenomenon seems to kick in so late, but it does. By experimenting with testing at different times in the morning before you give insulin or eat, you can pinpoint the general time your body starts pushing your blood sugars up each morning. I do find that if I sleep under 100, dawn phenomenon doesn’t do anything. But sometimes I don’t feel safe sleeping at that blood sugar level, because perhaps I did more exercise than usual or something and in those cases I’ll try to sleep between 110-140. Being in that range in the early morning typically causes a dawn phenomenon spike for me so I try to get up at the same time each day and give insulin and eat first thing.
My Humalog routine
I use Humalog as needed and before meals. I just count carbs and take note of my insulin/carb ratio which is about 1:15. Most of my meals let me give below 2-3 units of insulin so I don’t usually have to worry about really high or low post meal blood sugar swings. I do notice that sometimes I’m really stressed and sometimes forget to drink water. As a result my blood sugar climbs considerably. I give an extra amount of insulin with meals to combat this. If the stress is a bit chronic (long term) I’ll up my Lantus instead of my Humalog-which I reserve for very temporary situations.
I inject in public as needed. I inject in my abdomen, hips, arms, and above my breasts (click here for a video of that). I reserve my hips and arms for times my blood sugar is kind of low (around 75) and my abdomen and the fatty tissue above my breasts for the times I’m ready to eat or over 120 because those areas tend to yield faster results with the insulin. I rotate a lot more than I used to because it helps avoid the buildup of scar tissue-which absolutely affects insulin absorption and makes it more random. After giving an insulin shot, I put my fingers over the area and press gently for a few seconds. This is supposed to help the insulin get absorbed. I don’t use insulin pens because sometimes I am not sure how much insulin I got or sometimes insulin leaks from the site. I like the small child-sized syringes by BD that hold up to 30 units of insulin and have a very short and fine needle. If you are not thin or average weight, you’ll want a longer needle in order to ensure the insulin gets properly absorbed.
Carrying and caring for insulin
I carry a case with my meter and Humalog insulin at all times. I keep Lantus in the fridge in the butter compartment. I don’t keep Humalog anywhere near my Lantus because I don’t want to risk giving a huge amount Humalog when I intended to give Lantus. I’ve done that twice and it resulted in me seeing the paramedics on both occasions. After 30 days I dispose of Lantus and Humalog (even though I have plenty left). I never refrigerate my Humalog because it lasts 30 days without refrigeration and it is supposed to be disposed of after 30 days anyway.
Does it work for me?
So that’s how I do it. I have managed to use the method described above for 5 years now and keep my A1c below 6% the entire time. Shots work if you understand some insider info and consider appropriate timing and carb counting. I had to learn a lot of this the hard way or through my doctors. If any of this info is news to you, talk to your doctor about it. Make sure you understand the ins and outs of the insulin you use. It totally affects diabetes management.
Please read this part again:
Please remember that changes to your diabetes management should be done carefully and *technically* with the approval and guidance of a physician. Don’t get hurt and then blame me