Insulin Use Strategies – Diabetes Daily

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Do insulin use strategies differ significantly between patients who achieve optimal (<6.5%) A1c levels vs. those with higher (>8%) A1cs?

We aimed to find out as part of our first-ever data-driven journalism effort.

We asked hundreds of survey participants questions about the following basal and bolus insulin use habits:

  • Bolus insulin timing patterns
  • Administering insulin for protein
  • Timing of insulin corrections
  • Number of basal injections per 24 hrs.

There were no significant differences observed in the timing of insulin correction doses (a similar proportion of people in the low and high A1c brackets reported taking correction doses with insulin still on board) among patients with type 1 and type 2 diabetes. There were also no significant differences observed in the number of basal injections (single injection vs. two or more) per day among any groups.

Bolus Insulin Timing Patterns

More people in the lower (<6.5%) A1c bracket reported taking their insulin at least 5-10 minutes before eating (pre-bolus) as compared top those with their reported A1cs among patients with type 1 diabetes (30% vs. 18%). Interestingly, we discovered that patients with type 1 diabetes in the higher (>8%) A1c bracket were significantly more likely to vary the timing of their bolus insulin between meals (59% vs. 43% in the lower A1c group). This result was somewhat surprising, as we initially hypothesized that varying insulin timing based on circumstances (meal composition, etc.) might be a useful habit to optimize glycemic control. However, it is also possible that the higher likelihood of varying bolus insulin timing observed among those with a higher A1c level is reflective of forgetting insulin boluses at or prior to the meal or snack, or indicative of nonchalance with respect to appropriate bolus timing.

Those with lower reported A1c levels (<6.5%) tended to pre-bolus insulin for meals, and were significantly less likely to vary their bolus insulin timing as compared to those with higher reported A1c levels (>8%) among patients with type 1 diabetes.

Notably, we found the opposite trend among patients with type 2 diabetes. Those with lower reported A1c levels were significantly more likely to vary the timing of their bolus insulin doses (53% vs. 40% in the higher A1c bracket).

Administering Insulin for Protein

Although carbohydrate intake has the most pronounced effects on blood glucose levels, it is well-established that protein intake can also have an effect. While there was no association of this habit with A1c among those with type 2 diabetes, the differences among those with type 1 diabetes were striking: 44% of patients with optimal A1c levels reported incorporating protein intake in the bolus insulin calculation as compared to only 23% of those in the higher A1c bracket.

Patients who reported lower A1c levels (<6.5%) were significantly more likely to account for protein in calculating their mealtime insulin doses as compared to those with higher reported A1c levels (>8%) among patients with type 1 diabetes.

To learn more about dosing insulin for protein, check out this article.

Discussion

Overall, there was a trend of administering insulin for meals earlier and a significant tendency to consider the protein content of their meals in calculating insulin doses among patients with type 1 diabetes who reported lower (<6.5%) A1c levels as compared to those with higher (>8%) reported A1cs. These trends were not observed among the type 2 diabetes population in this survey study.

Also, there were differences in the likelihood of varying bolus insulin timing among patients with type 1 and type 2 diabetes among the different reported A1c brackets, underscoring the heterogeneity of these populations as related to insulin use patterns.

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What do you think of these results? Do you pre-bolus or vary insulin timing based on specific circumstances? Do you consider the protein content of your meal when calculating your bolus insulin dose? What other insulin dosing strategies do you utilize to help you stay in control? Please share this article and your thoughts in the comments below.

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