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Using Mealtime Insulin Safely

Some people worry about the safety of mealtime insulin because they are concerned about low blood sugar. While that is a valid concern, you can take steps to prevent this and to react quickly if it should occur. For example, keep back-up snacks on hand in case blood sugar drops too low, and don't guess at the appropriate dose. Rapid-acting insulin analogues are new products that provide more natural blood sugar control.


Insulin Is Scary

Let's all be honest here. Using insulin can be scary. In particular, the risk of dangerously low blood sugar can be very scary. But the great news is that you can take steps to avoid low blood sugar and to be well prepared if it happens. This article focuses specifically on steps you can take to use mealtime insulin safely.

What Is Mealtime Insulin?

In order to use mealtime insulin safely, it's helpful to know a little about how it works and how it differs from long-acting insulin. If you're on mealtime insulin, chances are you are also on a long-acting ("basal") insulin. The long-acting insulin provides a steady background level of insulin, which is great but doesn't do much for the spike in blood sugar that occurs after meals. Mealtime insulin is designed to work quickly and over a relatively short period of time to handle these post-meal blood sugar spikes. 

Which Mealtime Insulins Are Safest?

At least theoretically, the new insulins, known as rapid-acting insulin analogues, should be less likely to cause dangerously low blood sugar, compared to regular insulin. These rapid-acting insulins start working quickly, peak quickly, and then drop off fairly quickly, mimicking natural healthy blood sugar control.
These rapid-acting insulins work so quickly that you can wait to take them until your food is right in front of you, unlike regular insulin, which is generally taken about 30 minutes before eating. As you can imagine, a lot can happen in 30 minutes, and sometimes you might not eat in time, which could lead to low blood sugar. Interestingly, though, research does not consistently show that the new rapid-acting analogues have a large advantage over regular insulin in terms of low blood sugar risk. 
So which insulins are rapid acting? Apidra®, Humalog®, and NovoLog® are the three rapid-acting insulins. Some of these also come premixed with an intermediate-acting insulin to reduce the number of shots you need per day.
While convenient, the premixed insulins usually require you to eat consistent meals and snacks, which just isn't possible for some people. If your schedule or lifestyle doesn't allow consistent eating, using separate mealtime insulin and long-acting insulin instead of a premixed one may be a better option.
What if you are doing great on an "old-fashioned" insulin regimen without the latest, greatest new insulins? Even if research suggests that a different insulin regimen may be safer, you might be better off with your familiar regimen that's already working for you.
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