Instructions

A Choice of Insulins

In addition to rapid-acting insulin, we now have “ultra rapid” insulins with onset and peak that are even earlier than traditional rapid insulins. These insulins combine traditional rapid-acting insulin with additives that stimulate more rapid absorption by the blood vessels below the skin, thereby producing an earlier onset and peak. Studies have shown that ultra-rapid insulin taken at mealtimes can produce a marked reduction in the post-meal glucose spike.

Fiasp, Lyumjev

(insulin + vasodilator)

•5-10 min earlier onset & peak

•50% greater activity during first 30-60 min

Speeding Insulin 2: Timing of Bolus Insulin

Even when using rapid-acting or ultra-rapid insulin, it is usually necessary to dose 10-15 minutes before the onset of a meal in order to prevent a significant postprandial glucose peak. The higher the premeal glucose, and the more rapidly the meal digests, the earlier the insulin should be taken. For example, when the glucose is above-target and a high-glycemic index meal (one that digests rapidly) is planned, it is best to give the insulin dose 30 to 40 minutes before the meal. This helps bring the glucose down a bit before the meal kicks in. At the opposite extreme, when the glucose is near a hypoglycemia threshold and the meal consists of slowly-digesting foods, it is best to give the insulin dose 15-20 minutes AFTER the onset of the meal.

	High GI	Moderate GI	Low GI
BG Above Target Range	30-40 min. prior	20-30 min. prior	10-15 min. prior
BG Within Target Range	20-30 min. prior	10-15 min. prior	0 min. prior
BG Below Target Range	0 min. prior	5-10 min. after	15-20 min. after

Does Timing Matter?

Looking back at the top graph which we saw earlier, showing my post-meal peaks when I took my insulin right before my meals, you can see the improvement made when I started taking my insulin 15 minutes before eating. The post-meal rises are barely noticeable.

Bolus with meal

Bolus pre-meal

Research has shown that taking insulin prior to eating can reduce the net glucose rise by approximately 40 mg/dl in people with insulin-requiring type-2 diabetes.