A few posts ago I extracted some very valuable information from an article CDE and dietitian, Hope Warshaw wrote titled, “Rapid-Acting Insulin, Timing It Just Right” and I’d like to share a little more of her knowledge.
Fine-tuning the timing of your premeal boluses or injections is important, but no more so than knowing how to count the carbohydrates in a meal or snack. If you don’t know how to count carbohydrates or to match your insulin dose to the amount of carbohydrate you plan to eat, speak to your health-care provider. Many people find themselves in a reactive mode when it comes to dosing insulin, taking it in response to high blood glucose rather than using enough of it before a meal to cover the rise of blood glucose in the hours after a meal or snack. Experts agree that it’s much harder to bring high blood glucose back down than to control blood glucose levels with sufficient insulin in the first place.
Glycemic Index: The glycemic index of foods as well as the fiber and fat content dramatically affect how quickly or slowly blood glucose level rises. (The glycemic index ranks foods based on how quickly they raise a person’s blood glucose.) One tip since most people’s blood sugar rises most quickly in the morning is to eat low glycemic foods at breakfast like yogurt or a bowl of oatmeal with a piece of fruit rather than foods with a higher glycemic index such as some cold cereals, pancakes, or muffins.
In general, foods and combinations of foods that have a low glycemic index and high fiber content will raise blood glucose more slowly. Conversely, foods with a high fat content tend to cause a delayed rise in blood glucose. The extent to which the glycemic index or fat content of a meal speeds or slows the rise in blood glucose following a meal varies from person to person.
Meticulously timing your rapid-acting insulin dose and carefully calculating your dose according to the carbohydrate you will eat is usually best for blood glucose control, but it may not always be possible. There are times when you know exactly when and how much you will eat and times when you don’t. The following tips may help you adjust for the realities of daily life:
High blood glucose before a meal. If your blood glucose is high before a meal, use how much your blood glucose level falls in response to one unit of insulin to calculate a dose of rapid-acting insulin to cover the high, then wait until that insulin begins to lower your blood glucose before you eat.
Claudia Shwide-Slavin, a dietitian and certified diabetes educator in private practice in New York City, advises the following: “If your blood glucose level is between 140 mg/dl and 180 mg/dl, take the rapid-acting insulin and wait half an hour before eating. If it’s between 180 mg/dl and 200 mg/dl, wait 45 minutes. If it’s higher than 200 mg/dl, wait at least an hour.” If a person is hungry or must eat at a specific time, Shwide-Slavin recommends limiting the amount of carbohydrate at the meal by eating mainly protein and nonstarchy vegetables.
Low blood glucose before a meal. If your blood glucose is low before a meal (below about 80 mg/dl), “Wait to take your insulin,” says Shwide-Slavin. “Let the food have 15 minutes to raise your blood glucose before taking your insulin.”
So, a few few more helpful hints to put your management “in the zone.”