2 types of insulin
Since my diagnosis I have taking two different types of insulin every day. For the first few years I could combine the two doses in one syringe — N and R insulin. One was “short acting” and one was a “long acting”. Here’s a chart:
“Rapid Acting” came about 10 years on after my diagnosis and I was told I couldn’t mix the two insulins as they would combine and the fast acting insulin would kind of absorb into the long acting, causing it to not work correctly. I didn’t ask questions, I just started to take more shots.
Rapid Acting insulin begins to work in your system within 15 minutes of injecting it. It starts breaking down the sugars in your blood right away and peaks within an hour. Depending on the meal and amount of exercise I’m doing (or plan to do) I usually inject 6 to 8 units per meal (up to 4 times a day). This is a “Bolus” insulin.
The Long Acting insulin stays in your system and does the light work. I have found it best to take a high dose of long acting in the morning and at night, 30 units about 12 hours apart. This is a “Basal” insulin.
Both insulins keep your blood sugar levels down, but they do it at different rates.
If you’re going through your day and you eat an average sized apple (high fructose) you probably don’t have to “bolus” for it. Your long acting insulin can take care of that, as long as you’re moving and keeping your blood circulating. If you eat an apple and fall asleep, you might need to take a small bolus unit upon waking.
Diabetics have to take all of that into consideration. I have to anticipate how my day is going and know when to eat / take insulin. I have to work out the amount of insulin for each meal. Sometimes I misjudge and take a little too much insulin, which causes my blood sugar to drop.
When I go out during the day (to work, run errands, day trip, whatever) I generally bring my bolus insulin with me. If I get hungry and want to eat something I can just inject some insulin / problem solved.
Insulin pump therapy is also available. Instead of injections a diabetic can wear an insulin pump on their person and just plug in the proper numbers to take at meal times.
I have never worn a pump. I’ve always been an injection guy. I have found the system that works for me and I’m sticking to it (with slight changes from day to day).
As stated above, my fast acting “bolus” injections are around 7 units of insulin. My slow acting “basal” injections twice a day are 30 units. What happens if I accidentally inject the wrong insulin? That could never happen?? RIGHT???
Taking 7 units of a slow acting during the day does not affect too much. My numbers might go lower after my next meal, but it’s not a significant amount to really worry about.
Taking 30 units of rapid acting insulin is when it gets bad.
It’s happened once.
In 2009 I was living in Portland with my girlfriend Stacey and spent most days riding my bike around the city instead of driving. One night we decided to watch a movie on a laptop in bed before falling asleep. I had taken my night time dose of long acting insulin and got into bed.
Portland life was relatively new, and riding a bike so much was definitely new. Any changes to your daily routine requires a change of insulin doses to better manage sugar levels. I had been getting low blood sugar a lot more recently due to these changes.
Pretty immediately after getting into bed I passed out. Stacey woke me up with some bedside glucose tablets to make sure I got my sugar up before going to sleep for the night. 5 minutes later I pass out again. She wakes me up and tells me to eat something. I walk to the kitchen to get something small, maybe a piece of bread will help me last through the night..?
Oh no.
I took 30 units of my rapid acting insulin 15 minutes ago. It has already started to work and my blood sugar is dropping RAPIDLY.
I HAVE 4 MEALS WORTH OF INSULIN IN MY SYSTEM AND THERE’S NO WAY TO GET IT OUT.
Call an ambulance.
I start eating high carbs / fruits / bread. She calls an ambulance.
I have no way of really keeping my blood sugar up and end up passing out on the bed before they arrive. My panic stated before passing out apparently caused me to be panicked while being passed out. A lot of moaning and some thrashing about (I can’t describe it as I was passed out at the time).
EMT’s arrive and give me a glucagon shot.
Stacey and I explain what happened (I don’t remember specifics, I was still in shock) But eventually my blood sugar gets back up to above normal.
I think I was able to fall asleep after that nightmare, but I don’t really remember how.
