Why do the long acting insulins gets to go first? Why can’t the short acting insulin be started before the long acting insulins?
“Because Johnny, that is not the way we do things in our house”. Well, that’s crap.
You can consider starting short acting insulin before you start a long acting insulin in some cases. Sometimes, some patients eat more at dinner and that is their biggest meal and you can get away with just one shot of short acting insulin just with dinner. Given that this is the main problem, this handles it very nicely.
The truth is we should probably start with short acting insulin first because that is where the problem is with most patients that have an A1c under 8.5.
When people have A1c under 8.5, their main problem is after meals.