The short acting insulin as we all know works right away. They should be taken right before the meals. Notice, i did not give you a time here. Because it depends on the person. Sometimes, people do better 5 min or 15 min or right at that the time of meal. So, you will have to see what is better for you.
The biggest problem I get is when patients have to start 15, 20 or more insulin with their meals. They freak out. “You want me to take 20 units of insulin when my sugars are 95 in the morning? You trying to kill me? I will get a low and pass out! You call yourself a specialist? WTF?” Or something like that.
I walk them through some scenarios. Let’s say that you wake up one fine Saturday morning and you and your friends go to IHOP and you pig out on their pancakes, biscuits, hash browns, eggs, you name it. Don’t forget the juice and milk. Let’s say that your sugar before you had that fine meal was 95. What do you think your sugar is going to be after that meal without any insulin?
They usually give me that ‘yeah, don’t be a smart ass’ look. They play along and say 300 or 400 or some high number. I tell them after they eat that meal, i want their sugars to be at least under 180 if not lower. How are we going to get there without insulin?
They usually understand quickly.
But, I give them a brand new problem that will haunt them for the rest of their lives. I ask them how much are you going to take with that IHOP meal? 15, 20? Let’s just assume that the very next day, you are not so hungry and you have some toast and sausage at home. How much insulin you going to take for that meal? 5, 10?
That is million dollar question. The holy grail of diabetes education.
Then I tell my patients just to guess. Just make up a number. Really, I do.
It depends on the patient of course, but some I will tell them to take anywhere from 5-15 units. Others I will say 20-30 units. I will give them a range and they can play within that range and go outside that range if they want to on special occasions (IHOP). It’s a crap shoot. Yes, it really is. It’s a shot gun approach that really bothers some patients.
The answer lies in carb counting. Once you know how to count carbs, you will be better at figuring out how much insulin to take with different meals. This takes time to learn, and patients get better with it over time and life is good.