Happy Saturday! Welcome to Ask D'Mine, our weekly advice column hosted by veteran type 1, diabetes author and community educator Wil Dubois. This week, Wil takes on what it means if the insulin you just injected seems to be "leaking," and the age-old diabetes question: "What foods can I eat?" Read on for the answers!

{Got your own questions? Email us at AskDMine@diabetesmine.com}


Michelle, type 1 from Oregon, writes: When I inject insulin, occasionally I'll get a little bit of insulin that comes back out. Should I take another shot to make it up, or is it probably not enough to worry about? I can't tell how much is coming out, and I don't want to go high!

Wil@Ask D'Mine answers: You know what? This same exact thing happens to me sometimes, too. But until you asked I'd been doing the ostrich thing and burying my head in the sand. If I don't think too much about it, it can't hurt me, right?

Of course, just like hiding your head in the sand rarely deters lions, leopards, hyenas, or other predators; hiding from diabetes doesn't work either. Literary License Alert: don't flame me, all you zoologists out there. I know perfectly well that ostriches don't really hide their heads in the sand, can out-run most predators at 40 miles per hour, and can kick the shit out of a lion with their powerful legs.

Innovation 2015

Wait a sec, you're thinking... Wil, aren't you a pumper? Why are you taking shots? Well, I haven't told anyone this yet, but I'm an ex-pumper right now. After my summer pump follies, I decided, screw this! And I went back to Levemir in syringes, Humalog in the Luxura HD pen; and then recently added an iPod with the RapidCalc app and a iBGStar meter that my friendly local drug rep brought me. That "gift" is what actually what inspired me to buy the iPod. (And now that I have my first iDevice, I can see what all the fuss is about.) Of course, my health insurance won't cover the strips at all, for any level of copay, so the meter end of this nifty system will be short lived.   :-(   Paying a buck-thirty for each test strip not only isn't sustainable for my family budget, I don't want to get to the point where I don't test when I should 'cause I'm freaking out over the Starbucks-like-price of a single finger stick.

Uh... Sorry, Michelle, I got side-tracked there didn't I? I blame the iBG Star-induced lack of coffee this morning. Now, back to your insulin question.

What you're seeing is called either "backflow" or "leakage." And insulin experts have been talking about this pretty much since the first insulin shot back in 1922. As leakage is the slightly more common term, we'll stick with it today. It's a small amount of insulin that comes back up out of the subQ space through the hole you just poked in your skin.

How much insulin is leaked in leakage? Less than 1% of the dose. The larger the dose, of course, the greater the leakage in total volume, but the percentage remains constant. Should you try to replace the missing insulin? No. As a type 1 your dosing is too small to give yourself a 1% of dose correction, even if you wanted to. And if you were a type 2 injecting 100 units, replacing the one unit lost to leakage would be silly. Frankly, a 1% dosing error isn't going to make any difference. Diabetes just isn't that precise.

Hey, and while we're on the subject of leaking, several studies have shown that needle length has no bearing on leakage. Long and short needles leak about the same. Recent research also shows that, contrary to urban medical myth, obese people are simply more prone to leakage than skinny people are, again, regardless of needle size. So for any of you fluffy people out there, don't be afraid to use short needles.

To see if there's anything that can be done to limit leakage, I reached out to Dr. Larry Hirsch, MD.  He's the global Vice-President of diabetes care for BD, the big maker of all small things sharp. More importantly, he's one of us. He's a type 1 since kiddo-hood, and still uses good ol' fashioned syringes himself (BD ones, of course). Dr. H. told me the there's not too much that can be done about leakage when using syringes but that pens are a whole 'nother kettle of fish altogether. "Syringes are rigid systems, and when you depress the plunger, the force is transmitted instantly, and the insulin or other drug flows." But "pens are complex hydraulic systems, and this is why we instruct everyone to count slowly to at least five, if not ten, after depressing the thumb or dosing button."

In other words, if you press a plunger on a syringe, it moves the insulin out. Bam! But when you press the button on a pen you're moving insulin to move insulin. The base of the plunger compresses the base of the column of insulin and pushes it up the needle. It seems like a small difference, but the pen method actually takes longer to move the insulin into your body. Who knew?

Since talking to Dr. H., I've been holding my Luxura pen in place longer after the satisfying click-click-click of "delivery." Just yesterday one of the nurses at the clinic asked me why I was holding the pen against my arm so long. "Because Dr. Hirsch told me to, that's why," I replied.

Oh. And we should also talk about "dribbling," too. This has nothing to do with the Harlem Globetrotters. It's an insulin pen thing. It's insulin that, rather than coming back up out of you, is dribbling out of the tip of the needle after the pen is removed from your skin. It comes, largely, from the pen being pulled out too soon, and is caused by the hydraulic nature of how pens work. Quoting Dr. H. again, "This is the one main advantage of a syringe over a pen - when you bottom out the plunger, the dose is 'in.' You don't have to wait to remove the needle."

OK. I get that. But when it comes to fast-acting shots, I'd rather use the pen and hold it in place for a quarter-minute than mess with syringes all day long. It still takes less time to use a pen right than to fill a syringe from a vial.


Gary, type 2 from Washington, asks: What foods can you eat with type 2 diabetes and what foods can't you eat?

Wil@Ask D'Mine answers: Foods you can eat: hamburgers, tacos, pizza, tofu, Caesar salad, cottage cheese, pumpkin seeds, ice cream, bagels, pears, ostrich steak, burritos, spaghetti, kosher fish, haggis, oatmeal, Greek yogurt, mushrooms, and cotton candy.

Foods you can't eat: none.

There's nothing you can't eat. Obviously, some foods are healthier for you in general than others, but that isn't what you asked. We're just talking diabetes and blood sugar here, so all you registered dietitians need to leave the room.

(See also: D-blogger Joann's great video noting how we can "eat anything but poison... or cookies, made with poison.")

But while there's nothing you can't eat, there are some things you can't (or shouldn't) drink. Regular soda. Bottled iced tea with sugar in it. Some energy drinks. That's because while a type 2's body can handle most food (that cotton candy was probably a bad example); it can't handle the sugar rush of liquid carbs in these kinds of drinks. It's too much, too fast. Liquid sugar overwhelms any diabetes therapy we have in our arsenal.

But food? No problem. You can eat potato chips, funnel cake, T-bone steak, Zesta crackers, mac n' cheese, carrots, water cress, nachos, lobster, waffles, tuna, raisins, couscous, eggs, and sauerkraut.

Ah. But one other thing you didn't ask: how much of each of those foods can I eat? The Devil is always in the details, damn him! That's the real problem of diabetes: not what can I eat, but how much of it can I eat? Some type 2s can eat a whole baked potato without hurting their blood sugar. Others, maybe only half. Or a quarter. Or two bites. To quote our good friend Bennet: YDMV (Your diabetes may vary).

The solution is to learn how much of what you want to eat your diabetes can tolerate, and you do that with your handy-dandy blood glucose meter. Do a fingerstick before eating, and two hours later. The goal is to keep the blood sugar rise from the food to around 50 points. If your blood sugar rise is under 50 points you can eat that much of that. If it's more than 50 points you need to try less of that next time.

All this food talk is making me hungry. I'm off for some string cheese... or maybe, since the dietitians are still out of the room, some spray cheese in a can.


This is not a medical advice column. We are PWDs freely and openly sharing the wisdom of our collected experiences — our been-there-done-that knowledge from the trenches. But we are not MDs, RNs, NPs, PAs, CDEs, or partridges in pear trees. Bottom line: we are only a small part of your total prescription. You still need the professional advice, treatment, and care of a licensed medical professional.

Disclaimer: Content created by the Diabetes Mine team. For more details click here.


This content is created for Diabetes Mine, a consumer health blog focused on the diabetes community. The content is not medically reviewed and doesn't adhere to Healthline's editorial guidelines. For more information about Healthline's partnership with Diabetes Mine, please click here.