When you have diabetes, sometimes it feels like no matter what you do, your insulin is not working how it should. There are many very real reasons why it may not be working – the dose may have been too small, you could be injecting into scar tissue, the insulin could have denatured (gone bad), to name a few. Then there’s insulin resistance, which is happening more and more for people with type 1 diabetes, despite it being a key characteristic of type 2 diabetes.
Here are some insulin hacks/tips to help make sure your insulin is working as effectively as possible:
- Rotate, rotate, rotate! – if you don’t rotate where you give injections or where infusion sets/pods, you’re going to develop scar tissue that causes the insulin to get absorbed haphazardly at best. You can typically use your CGM in scar tissue without issue, so if you find yourself in need of new sites for insulin, consider swapping where you wear CGM with where you give insulin for a while.
- Hydrate – believe it or not, hydration is a very simple solution to helping ensure your insulin (and your CGM) works properly. Water or electrolyte drinks without carbohydrates are preferred hydration methods.
- Time your bolus right – most rapid-acting insulins take about 15 to 30 minutes to start working in the body, so if you’re eating foods with a high glycemic index and/or high carb content, you’ll want to get ahead by giving the insulin ahead of the meal, also known as pre-bolusing. If your meal is more mixed with fat and protein, you may want to extend the bolus if you can (for those on a pump) or give some at the start and some later. Bonus tip: If you can’t seem to get boluses in early enough before you eat, try eating your non-starchy vegetables and protein before eating the carbohydrates. This is effectively a pre-bolus because it delays the absorption of the carbohydrates in your body.
- Move your body – we all know that it’s important to stay physically active, but moving your body has a huge impact on the body’s absorption of insulin. It can be hard to start a new routine even without diabetes, so make sure to learn more about exercise with diabetes. If you’re struggling with post-meal high blood sugars despite timing boluses correctly and ensuring your carbohydrate ratios are appropriate, try taking a brisk walk after you eat.
- Check your insulin doses – whether you want to check your basal insulin to see if it’s working for your body or your bolus insulin, coordinate with your medical team and do some extra monitoring to see how the doses are working. If your CGM graphs are spiking after meals consistently, maybe the insulin to carb ratio needs to be made more aggressive. If you’re going low, maybe it needs to be less intense. If you feel comfortable identifying patterns and making your own adjustments, consider making changes. If not, reach out to your diabetes team.
- Consider switching up your diabetes management routine – sometimes what was working for your diabetes for a while just doesn’t fit your life anymore. That’s okay! Life changes, our bodies change, and diabetes should fit into your life not the other way around. Maybe it’s adding inhaled insulin or adding a GLP-1 agonist; maybe it’s switching insulin pumps or taking a pump break. You have a lot of options and nothing has to be a forever commitment.
- Keep the insulin you’re using at room temperature – this is especially important for insulin pump users. If you fill an insulin pump with insulin that is cold, you’re more likely to get bubbles. And bubbles mean high blood sugars that are unpredictable because you are not constantly watching your tubing. So, keep the open vial at room temperature and when you fill the tubing, try to keep the infusion set above the bottom of the cartridge to try and let the bubbles rise and come out during the priming process. It’s a little more work with a potential big payoff.
Diabetes is a lifelong journey, sometimes you may be very motivated to increase your time in range and wear all kinds of devices, where other times you may want to do just enough to stay safe. These tips will help make sure you aren’t working harder than you need to keep your blood sugars where you want them.
Written and clinically reviewed by Marissa Town, RN, BSN, CDCES
