Treatment Diabetes: insulin and diet (part 2)

Continuation of the article about diabetes and diet.

DIET AND INSULIN

Is it all right for me, as someone who takes insulin, to have a lie in on Sunday or must I get up and have my injection and breakfast at the normal time?

Your insulin treatment needs to fit your chosen lifestyle as much as possible and you should be able have a lie in on a Sunday if you wish! Some trial and error might be necessary and we would encourage you to monitor to see what works for you. If you are on twice-daily insulin and you delay your first injection by several hours, then you may need to reduce this first dose, especially if you are having breakfast and lunch as one meal. If you are taking long-acting insulin first thing in the morning, it may be possible to change the timing of this insulin permanently to allow you the flexibility of lying in when you choose. If you only take short-acting insulin in the morning, it is much easier to omit this insulin and miss breakfast. You should make an appointment with your diabetes nurse to discuss the options of changing your insulin regimen to suit your lifestyle.

I have two injections a day: morning and evening. I keep regular times for breakfast and evening tea but I would like to vary the time that I take lunch. What effect would this have on the control of my diabetes?

As you are taking two injections a day, it is most likely you are on a mixed insulin or a medium-acting insulin. Because insulins have a peak of activity, it is important that you cover this peak with food or you will increase your risk of a hypo. If you are having a later lunch you may have to include a mid-morning snack and be prepared to increase this to avoid a pre-lunch hypo. Trial and error and careful monitoring will give you the best guide to how much you can alter the timing of your lunch. If you feel you need more flexibility of mealtimes, multiple injections may be a better alternative for you. Your diabetes team can discuss options with you.

Sometimes I suffer from a poor appetite. Is it all right for me to reduce my insulin dose on such occasions?

The answer to this question depends on the number of insulin injections you take each day. If you use basal bolus insulin, it is easy to omit or reduce your mealtime insulin to match your food intake. You should never omit the long-acting dose. If you take insulin twice a day, and your appetite is reduced, you are at risk of a hypo if you miss a meal completely. It is never easy to deal with a variable or erratic meal pattern if you are on premixed insulin, but you could consider reducing the dose, using blood tests to help you decide how much insulin to take. If your appetite continues to be poor, or if you are losing weight unintentionally, you should see a dietitian for advice about food choices when your appetite is poor.

To be continued…