Sunday, February 10, 2013

To Inject Or Not To Inject

By Chiqui Raveloski

Having type 1 diabetes for 41 years, I believe,  had given me a valid insight on what works when it comes to insulin therapy - MDI ( Multiple Dose Insulin Injection) vs. Insulin Pump therapy. The answer is - they both equally work. Both therapies will ultimately depend on how dedicated you are when it comes to keeping up with your personal health as a diabetic. 

A closer look at insulins:

For those who prefer tables ( me ):
Action Times for Insulins
InsulinStartsPeaksEndsLow most likely at:Usage
Hum/Nov/Apidra10–20 m1.5–2.5 h4–6 h2–5 hdesigned to peak, covers meals and lowers high bgs
Regular30–45 m2–4 h5–7 h3–7 h
NPH1–3 h4–9 h14–20 h4–16 hintermediate, less peaking, larger action
Lantus1–2 h6 hr18–26 h5–10 hdesigned for flatter and longest action, background insulin action for keeping your BG flat when fasting
Levemir1–3 h8–1018–26 h8–16 h
I used the NPH/Regular insulin for a long time. Mainly because those were the only 2 insulins available in my early years as a diabetic. It was a lot of work and felt like I was "chasing" my blood sugars and trying to fix highs and lows. If you look at the table, you'll notice that between the 2 insulins, you will have 4 different times that you need to watch out for the peaks. Blood sugars tend to drop at this point, that is if you did not eat enough and gave yourself more insulin than you should. Additionally, after 7 hours, the Regular insulin would have subsided and another dose of Regular is necessary to cover you for the whole day. This therapy seemed like I was more subjected to more highs and lows. Checking blood sugars regularly is essential for this combo to really work.

Then came Lantus and Lispro ( Novolog and Humalog). I remembered my endocrinologist saying "this is the closest you can get to an insulin pump". Referring back to the table, Lantus lasts for 26 hours, it's a "background" insulin, one peak, that's all. I injected Lantus at night only. Novolog/Humalog lasts for 6 hours, peaks at 4 hours. Combining the two, you will have less peaks. The key to this therapy is the carbohydrate counting. 

Carbohydrate counting is very essential in managing diabetes. Carbs = sugar = hi/low blood sugar. When I started the Lantus / Novolog combo, my endocrinologist and I had to set a Carb to insulin ratio. My ratio was 1 unit of Novolog = 10 grams of carbs. So, every time I counted the carbs  I consumed, I would calculate the amount of  Novolog I would have to inject. A lot of work, but it works. The beauty of this therapy for me is I feel like I have more freedom if I do not feel like eating. The only time I injected Novolog was when I ate. Again, checking blood sugars regularly is essential for this combo to really work.

Then came my insulin pump. I started using the insulin pump 10 years ago and I love it. I tell the nurses I work with that an insulin pump is so much like the PCA pumps -  a basal rate, then a demand dose - without the "lockout". Insulin pumps work the same way. It uses one kind of insulin - Lispro (Novolog/Humalog). My endocrinologist and I had to set my basal rate (which actually changes several times within a 24 hour period).  Then, when I eat, using the carb to insulin ratio,  I bolus to cover for what I ate. Again, checking blood sugars regularly is essential for this combo to really work.

If there is anything else I had learned in years of being a type 1 diabetic is that checking blood sugars regularly is very essential in managing diabetes. I check my blood sugar as soon as I wake up in the morning, before meals and 2 hours after each meal ( so I can make a correction dose ), before going to bed. and last but not the least, before driving. Checking blood sugars first thing in the morning gives me a better idea of "where I am" for the day. Blood sugar checks before driving prevent the occurrences of the "unwanted" hypoglycemia while driving.

MDI and insulin pump therapies are both effective in controlling blood sugars. As a matter of fact, when I need a break form the insulin pump, I revert back to the Lantus/Novolog combo for a while....and vice versa. Every insulin dependent diabetic has their own insulin therapy that they follow. Please talk to your physician regarding questions about your insulin therapy.The key is knowing and accepting the fact that both equally require work and commitment. Yes, I do have my moments of discouragements when the going gets tough. But like what they say, "When the going gets tough, the tough gets going". Take responsibility. Having diabetes is not a death sentence. It is a way of life.

Important links:

Information in this post is for informational purposes only. It is NOT intended to replace the advice of your physician. If you have questions about your diabetes, please call your physician. If you feel ill, please seek medical attention immediately.


  1. Thanks for an informative and thoughtful posting. Shared this with my cohort.