If a person accidentally injects fast acting insulin instead of long acting, what do you recommend they do? Calling the endocrinologist for advice is assumed. What foods do you recommend? What foods should be avoided? Am I correct in assuming that the person’s blood sugar should be stabilized at 4 hours? What does one do if one gives double long acting instead of fast acting?

Actually, there is not much reason to call the endocrinologists unless you haven’t learned how insulin works. Fast acting insulins would start working in about 15 to 30 minutes; the analogs would hit their peak at about 1 to 2 hours and pretty much be gone by 4 to 6 hours. A bigger dosage would last a bit longer. Original Regular insulins would be a bit slower but the same kind of pattern. Therefore, one would take fast acting sugars right away (juice, regular soda, fruit) and also some food that would last for the 1 to 2 hour peak as well as the 4 to 6 hour duration i.e., ice cream or pizza with high fats would be good choices to counteract the peaks and valleys of these fast-acting insulins. You could similarly treat somewhat more inconveniently with juice or regular soda every 20 to 30 minutes for 4 to 6 hours and that, too, would work. The goal is only to counter-act the insulin effect and thus avoid any significant hypoglycemia.

For Lantus or Levemir, as well as NPH, the goal would be to cover the insulin effects which are significantly longer and do enough blood glucose readings to make sure that this continued. So, NPH starts in about 2 to 4 hours, peaks in about 6 to 8 hours and then slowly works its way downward for about 12 to 16 hours. Lantus and Levemir are significantly slower than NPH without much peak and then a prolonged peak at around 8 to 14 hours and some tail effects that could last as long as 20 to 24 hours. So, more food, especially carbohydrates, at those peak times and ice cream, pizza and other high-fat foods that last for many hours would also work well just as frequent bursts of food for each of these hours. All decisions with food would be figured out by blood sugar monitoring every 2 to 4 hours.

SB