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Dear Diabetes: Will My Insulin Dose Change?

Understanding the factors that may affect your treatment dose

If you live with type 2 diabetes and insulin is a part of your treatment, you may feel confused and frustrated if your doctor changes your dose. Does it mean that you are doing something wrong?

Not necessarily. Diabetes is a progressive disease. If your doctor adjusts your therapeutic insulin dose, it can be a sign that you, along with your care team, are taking positive steps toward managing your diabetes.

To understand why this is, let’s start with the basics. Insulin is a hormone produced by the pancreas whose primary function is to lower one’s blood sugar. By secreting just enough insulin to meet the body’s needs at any given time, the pancreas is able to keep the amount of sugar circulating in the blood at a consistent, healthy level.

In type 2 diabetes, the pancreas is either having trouble producing enough insulin, or the insulin that it does produce isn’t working as effectively as it should. If your doctor has said that it is time to start taking therapeutic insulin, the point is to give the pancreas a little extra help. (Learn more about the hormone insulin.)

While therapeutic insulin is a manmade form like that the body naturally produces, there are a few challenges that explain why insulin doses are often adjusted. First, everyone’s insulin requirements are different – insulin isn’t one-size-fits-all. Second, if too much insulin is in a person’s blood stream (or if it’s working too effectively), it can result in blood sugar levels that are lower than they should be – a condition known as hypoglycemia that can be dangerous. In order to help minimize low blood sugar levels, doctors often start their patients on relatively low doses of insulin. Once they see how the person’s blood sugar reacts, they can adjust the dose. After you first start insulin therapy, these kinds of adjustments are totally normal. Incrementally increasing or decreasing a dose to achieve the best therapeutic effect is called “dose adjustment” or “titration.

“Insulin isn’t like a pill – there aren’t set doses,” says David Marrero, PhD, president-elect of Health Care and Education for the American Diabetes Association. “When you first start taking insulin, there’s a trial and error period until you find your personal sweet spot.”

Even if a person has been on therapeutic insulin for a while, his or her doctor may still need to make regular adjustments to the dose. Blood glucose levels – and an individual’s response to insulin – may change based on a number of factors, including exercise and stress levels, weight loss or gain, the type and concentration of insulin therapy and other factors ­– including the natural progression of type 2 diabetes. Again, these adjustments don’t mean that a person is necessarily doing anything wrong. Instead, the adjustments are a natural – and an essential – part of diabetes management.

Some people who switch from one type of long-acting therapeutic insulin to another may start off with a similar dose but then gradually adjust the amount depending on the rate the insulin is released into the circulation. Talk to your doctor about any dose questions you may have; changes in insulin therapy should be made only under medical supervision.

As Marrero explains, “You’re just working around the variables to try to achieve the goal of diabetes management: to get your blood glucose to as near-normal levels as you can.”

In fact, adjusting your insulin is so important that if your doctor doesn’t propose making changes, you may want to bring the subject up yourself. Here are some situations in which Marrero suggests that you may want to discuss an adjustment:

  • you frequently have low blood sugar reactions
  • your blood sugar is frequently higher than the targets set by your doctor
  • you’ve lost or gained a lot of weight
  • you’ve started a new exercise program
  • you’ve made considerable changes to what you eat
  • your doctor switched you from one type of long-acting insulin to another

The bottom line is that a changing insulin dose doesn’t mean you’re doing anything wrong. Instead, it’s often a sign that you’re doing something right.

Catherine Price is a freelance journalist and type 1 diabetic who has written for The New York Times, Slate, Popular Science and O Magazine, among others. Her newest book, Vitamania: Our Obsessive Quest for Nutritional Perfection, is available February 2015 from Penguin PressYou can follow Price on Twitter @Catherine_Price. Price is a paid contributor for The DX. All opinions contained in this article reflect those of the contributor and interviewee, and not of Sanofi US, its employees, agencies, or affiliates.

© 2015 The DX: The Diabetes Experience

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