So, how do you know if you need more insulin? First of all you have to be able to recognize the symptoms you have when you need your insulin adjusted. If you are low at certain parts of the day on a regular basis you have to start suspecting that a change needs to be made to decrease insulin or add snacks. The trouble is trying to figure out what to do. Maybe you are having symptoms such as always feeling hungry even though you have eaten, peeing all the time and then having an unquenchable thirst. Maybe you have had a wet bed in the morning and cannot figure out why. Perhaps you are always very tired with all the other symptoms. These are all symptoms of high glucose and insulin may need to be increased, or maybe you need to add exercise to your daily routine. You must start looking for patterns in your glucose levels. You can only do that if you record your numbers either by downloading your numbers on the computer (using a downloadable meter) or by writing your numbers ina log. You can only find patterns if you are consistently recording for at least several days (5 is a good number). Even if you are not recording every day, most of the newer meters have time and day documented for each test so, going back a few days should only take a few minutes. That is not the only thing you need to pay attention to though. You really need to make an effort to test before each meal and 2 hours post meals and at bedtime. A fasting glucose (the one first thing in the morning) is very important. Even though you may not like to test that often it is needed anytime insulin needs to be adjusted. Knowing how to look at your own records can help you find trends of high blood glucose readings and low readings the mornings. Keeping good records of what happens after exercise or if you have a high fat meal at your favorite take out restaurants can give you good clues on what to manage Downloading or writing your logs ( a job that gets lost - cause it is not fun):Any time you want to know why you are having low readings or high readings you really have to look at the map of where your glucose levels are heading and where they have been. If you are on multiple daily injections of insulin or pumping insulin you should really be checking your glucose level at least four times per day. The best times are when you wake up, before your midday meal, before dinner, and before your bedtime or evening snack. Even if you do not take insulin at these times, the recorded information helps determine when your glucose might be going up or down. For example, if your blood glucose is high at dinner, you need to see the lunch and breakfast readings to see if the rise took place in the morning or the afternoon. Measuring one glucose level per day really gives little information and if you cannot determine how close to the meal you tested the reading will not give any information that is useful. And you really must have clean and dry hands for accuratereadings. If it is a struggle to test often you should try to test at least twice daily at two meals in a row or one fasting (before the first meal of the day) and a 2 hour post meal test. You need several days ‘of readings to really get a good idea of what is going on, so you might want to change up which meals you are testing. On one day test before breakfast and lunch, next day lunch and dinner and so on. You do not get any good information from testing after the beginning of a meal or right after a meal is eaten. So, if you have already started eating…. Forget the test. Glucose readings are a map showing how well the amount of insulin you are taking is matched with what you need. If the levels are all running high or low you have to realize that something is not matched correctly. Most people have a mix of highs, lows, and target levels. You may find it difficult to put the puzzle together. (Sometimes it takes a while). It is important to know how much insulin was taken. Taking insulin before you eat is the most effective way to dose. (Taking insulin after you eat is like flooding your engine with fuel before you have flipped the switch to get the motor to run). Other things that are important to know are the grams of carbohydrate eaten at each meal or snacks, the type and length physical activities (such as chores, yard work, shopping, and long walks and workouts), as well as stresses that tend to affect glucose level such as illnesses, menstrual cycles, emotions (good or bad), and episodes of going low Having organized information is very meaningful. Try to line up meals of the same time of day in a column so that a pattern of high or low glucose at a particular time can be detected. Don’t think of keeping track of your glucose records as something you have to do forever; that might seem overwhelming. Try it for a couple of weeks, and then take a few minutes to really look at the numbers and really try to understand what they mean. Ask yourselfif the numbers relate to the way the insulin works with the food eaten. Look for patterns and trends. Is your blood glucose level consistently high or low at certain times of day? Play Sherlock Holmes and look for the clues. Here are some examples: April is 17 years old and has the type 2 kind of diabetes. She uses diet, exercise, and pills to control her diabetes. Here are some of her trends: April’s blood glucose level tends to go high overnight. From bedtime one day to breakfast the next day she is high. She may need more medicine or eat a smaller bedtime snack. Her glucose tends to drop between lunch and dinner when she is more active. She plays volleyball after school on most days. She may need less medicine on the more active days or more carbohydrate at lunch on those days. Walking tends to lower her glucose level. When she is not as active, her glucose levels rise after dinner. Maybe a daily walk after dinner is just what she needs. Austin is a 20-year-old collegejunior, Austin takes multiple daily injections (MDI) of insulin. Here are Austin’s trends: When Austin is skipping his morning snack his blood sugar is lower by lunch meal, so he shouldn’t forget to eat it. When he has morning runs, he may need a larger morning snack or less fast-acting insulin. Austin’s blood glucose levels rise from lunch to dinner. Perhaps he needs a larger dose of fast acting insulin for his carbs at lunch. Exams seem to cause his blood glucose to be higher, so maybe he needs an extra (correction) dose of insulin on test days. Without any activity after dinner, Austin’s glucose level tends to be high at bedtime. He might need extra fast acting insulin at dinner if no activity is planned. Following evening exercise, Austin’s blood glucose level tends to go lower overnight. Perhaps he needs a larger bedtime snack on those days or less insulin for the evening meal when the exercise is after the meal. Things to consider when looking at your records: If you areadjusting your insulin doses (correcting) more than twice a day, you need to look at your diabetes logbook to find the reason of your higher levels or consider the possibility that changes are needed in your overall insulin regimen. Or maybe you are forgetting to dose for something. “Grazing” tends to produce unpredictable readings even if the snacks are covered with a bolus of insulin. A person should limit the amount of grazing that goes on. Keeping snacking to once or twice per day will help. Note that different levels of exercise may have very different effect on glucose levels also. Try not to correct immediately for highs that are a result of excitement related to adrenalin. This may lead to lows. Stress has different effects on glucose levels. Most people have higher readings when stressed but there are folks who will have a low glucose in response to stress. Stress comes in many forms… anger, frustration, hormone release, environmental influences. You cannot alwayseliminate stress but you can learn how to deal with it and dose for it. **** Leave a comment on the blog about your experiences in adjusting your insulin. *****The information provided on this here should not be taken as medical advice or instruction. Consult your health-care professionals before taking action based on this information.
