Jason C. Baker, M.D., is assistant professor of clinical medicine and attending endocrinologist at New York-Presbyterian/Weill Cornell Medical Center in New York, New York. He earned his medical degree at Emory University in Atlanta, Georgia, and completed an internship and residency in internal medicine at New York University Medical Center/Bellevue Hospital Center in New York. Dr. Baker completed a fellowship in endocrinology, diabetes, and metabolism at Montefiore Medical Center/Albert Einstein College of Medicine in Bronx, New York. He is board-certified in internal medicine and endocrinology, diabetes, and metabolism.
Dr. Baker’s interests include disease management through education and lifestyle interventions, prevention of type 1 diabetes, and the impact of diabetes on international health. He is the founder and board chair of the nonprofit organization Marjorie’s Fund, a type 1 diabetes global initiative dedicated to education, care, and research for type 1 diabetes in resource-poor settings. Dr. Baker is involved in numerous global health efforts in diabetes, including projects in Uganda, Rwanda, Ethiopia, India, The Gambia, Egypt, and in 2012, he was named international endocrinologist of the year by the Metro New York Association of Diabetes Educators. He was also included in the October 2013 “People to Know” edition of Diabetes Forecast magazine, a publication of the American Diabetes Association, received the Humanitarian Award from the Diabetes Research Institute in 2014, and was a dLife Diabetes Champion in 2015.
When you give yourself a basal insulin injection, the insulin stays in a pool at the injection site, which slowly leaks into the bloodstream over the duration of action of the insulin.
This question depends on the basal insulin you are on. In general, I advise patients to take their basal insulin later in the day (midday or later). That way if the insulin wears off, the person is awake and can treat a high blood sugar level appropriately. If the basal insulin is taken in the morning, and wears off over night, the person’s blood sugar levels may rise when they are asleep and thus wake in the morning with high levels of blood sugar. However, the timing of administration is less important with some newer basal insulins. Always talk with your doctor before you start a new type of insulin, and ask about timing constraints.
Everyone responds to insulin differently, and some insulins may act for longer or shorter in one person than another. Your doctor will likely follow your sugar control, to determine if the insulin is working appropriately. They can monitor your sugar levels by using fingersticks, a glucose sensor, or a HbA1c test. Through trial and error, your doctor will be able to determine the best insulin for you.
You don’t need to wait to eat after taking your basal insulin. Most basal insulins, other than NPH, can be taken independent of eating. And no, there aren’t any foods that will interfere with your basal insulin injection.
If you miss your basal insulin dose, you shouldn’t double up on the next dose, as this can result in hypoglycemia. You should talk to your doctor about what to do if you delay or miss a basal insulin dose, as the protocol will differ depending on the type of basal insulin you are on. In general, if you’re on a once daily basal insulin regimen and forget to take your basal insulin dose, you should take it when you remember. Try to get back on schedule by approximately two to three hours over the next few days to avoid overlapping insulin levels. If you’re on NPH insulin or another twice daily basal insulin regimen, you should ask your doctor what to do when you miss a dose, but don’t double up. This may result in low sugar levels.
Your basal insulin dose is based upon keeping your blood sugars at goal independent of eating, so high sugars after eating shouldn’t be treated by increasing your basal insulin dose. Doing so could result in hypoglycemia.In general, your basal insulin dose should be increased only when your fasting sugar levels (or when you have fasted for at least six hours) are above goal on at least three different days. Talk to your doctor or healthcare provider about the best way to adjust your basal insulin doses.
Usually this refers to using a variety of medications, both oral and injectable, in one person to control their sugar levels. The mechanisms of action of these medications are thought to be complementary. For example, if a person is on basal insulin, they may also be on oral diabetes medications to help control their mealtime sugar levels and help minimize the needed dose of basal insulin. Patients may also be on other types of insulin that control mealtime sugar levels, which is called basal/bolus or MDI (multiple daily injection) therapy. Patients may also be on a combination of insulin and other injectable medications such as GLP-1 agonists. There are many combinations that can be individualized to provide the best diabetes control possible.
Everyone responds to insulin differently, and some insulins may act longer or shorter in one person than another. While some basal insulin is advertised as lasting 24 hours or longer, this may not be the case for everyone. Your doctor will likely follow your sugar control to determine if the insulin is working appropriately. Again, through trial and error, your doctor will be able to determine the best insulin for you.
When you travel with insulin and needles, you should request a travel letter from your healthcare provider stating you have diabetes and must keep all of your diabetes supplies on you at all times. Additionally, always travel with at least three times the supplies you think you’ll need on your trip to ensure you will not run low. Keep your diabetes supplies together within your carry-on to help TSA employees appropriately and efficiently screen your luggage. Never put any of your supplies in your checked luggage on an airplane, as temperatures may be too high or too low in the cargo hold. Keep the insulin you are traveling with at room temperature or lower. When you arrive at your destination, find appropriate refrigeration for the insulin. Lastly, always travel with sugar sources to ensure you can quickly and adequately treat hypoglycemia should it occur, and have these sugar sources readily available.
Remember, if you are aware of your blood sugars then you can protect against low and high sugar levels. Use the tools you have, including glucometers, fingersticks, and glucose sensors, to monitor your levels. Work with your healthcare provider to determine the right basal insulin type and dose for you. Only make small dose adjustments based on at least two to three days of glucose data to avoid both hypoglycemia and hyperglycemia. Basal insulin, if the type and dose is correct for you, is a great ally in getting your diabetes under control.
I suggest you let fingersticks, or a glucose sensor, guide you as to where the problem is. This would help you to know where and when your blood sugars are high, such as before meals or after meals. Also, you may have low blood sugars at times, which can result in high sugars later. An Hba1c level results from high fasting sugars and also high after-meal sugars. The basal insulin is targeting the fasting sugar, so you may need to amend your diet, or add or change medications. Also, not all basal insulins are created equal, so make sure to discuss which basal insulin is best for you.
Here are a few questions you should ask: Is there a treatment which has less risk for low sugars, less weight gain, and better sugar control than my present basal insulin? What other types of diabetes medications can I try besides basal insulin? What other basal insulins are there? Am I candidate for a continuous glucose monitor? How many fingersticks a day should I do and when?
Monitor your sugars more closely during any treatment change to catch high and low sugar levels before they catch you, and to determine if the treatment is helping without waiting for an Hba1c test to tell you.