If you have diabetes, you know that dealing with the continuous flow of new information on insulin, blood glucose testing, and diet recommendations can be overwhelming at times.
If you’ve recently been diagnosed, or if you’re an experienced user who’s unhappy with your current insulin treatment, then perhaps it’s time to ask your doctor or endocrinologist about basal insulin.
Here are some questions you might want to consider asking during your next appointment.
“Basal” means background. This makes sense since the job of basal insulin is to work behind the scenes during fasting or sleeping hours.
Basal insulin comes in two forms: intermediate-acting and long-acting. Both are designed to keep blood glucose levels normal while fasting. But they differ according to dosage and duration of action. Basal insulin can also be delivered by pump, using quick-acting insulin.
Intermediate-acting insulin, also called NPH (Humulin and Novolin), is used once or twice daily and lasts for 8 to 12 hours.
Since every person is different, only your physician can tell you what type of insulin therapy is best suited for your needs.
Before recommending basal insulin, they’ll take into account your most recent blood glucose monitoring results, diet, activity level, most recent A1C test results, and whether or not your pancreas is still producing insulin on its own.
Your physician might consider changing your basal insulin dosage for several reasons.
If your fasting or premeal blood glucose numbers are consistently higher than your target level, then your basal insulin dose may need to be increased. If your numbers tend to be lower than your target and you experience frequent low blood sugar (hypoglycemia), especially overnight or between meals, then your dose may need to be decreased.
If there’s a substantial rise in your activity level, then you may need a reduction in your basal insulin.
If you’re chronically anxious or stressed, your blood sugars may be higher, and your physician may decide to alter your dosage. Stress can decrease insulin sensitivity, which means the insulin doesn’t work as well in your body. In this case, you may need more insulin to keep your blood sugar in check.
If you’re sick, you may need a temporary increase in basal insulin to help lower high blood glucose numbers caused by infection, although this would only be necessary for long-term illness. According to the ADA, illness creates an enormous amount of physical stress on the body.
Additionally, the Mayo Clinic cites that menstruation can impact a woman’s blood glucose levels. This is because changes in estrogen and progesterone can cause a temporary resistance to insulin. This might require an adjustment in dosage needs, and can also change from month to month depending on the menstrual cycle. Blood glucose levels should be checked more frequently during menstruation. Report any changes to your physician.
As with most types of insulin, low blood sugar or hypoglycemia is the most common side effect associated with basal insulin usage. If you begin to show too many low blood sugar incidents throughout the day, your dosage will need to be changed.
Some other possible complications of basal insulin include: weight gain (though it’s less than with other types of insulin), allergic reactions, and peripheral edema. By consulting with your physician, you can gather more information on these side effects and whether or not you may be at risk.
When it comes to basal insulin and other types of insulin therapy, your doctor, endocrinologist, and diabetes educator can help guide you toward the treatment that’s best suited for your needs and lifestyle.