Ask the Doctor

Ask the Doctor

ASK THE DOCTOR

by Wesley W. Wilson, MD

NOTE: If you have any questions for "Ask the Doctor,"
please send them to the VOICE editorial office. The only questions Dr. Wilson
will be able to answer are the ones used in this column.
Wesley W. Wilson, MD, has retired as an Internal Medicine practitioner
at the Western Montana Clinic in Missoula, Montana. Dr. Wilson was diagnosed
with type 1 diabetes in 1956, during his second year of medical school. He remains
interested and involved in diabetes education for patients and professionals.
Q: It seems that as I approach mealtimes, I'm almost always
"low." Shouldn't I eat first, then, and take my insulin after the
meal?
A: The first part of my answer is that if you are often low
at mealtime, you should make some adjustment to your treatment, so as to avoid
the lows. "Low blood sugars" can have dangerous consequences, and
the best course is to avoid them in the first place. Frequent "lows"
can cause hypoglycemic unawareness, in which you lose the ability to sense that
you are heading into an insulin reaction. Serious injuries can occur during
hypoglycemia.
The answer you wanted is easier to give now that we have the
very fast-acting insulin called Humalog. Regular insulin (previously the fastest
we had) can take 30 minutes to start having any effect. If you inject "R"
insulin at mealtime, or after you finish your meal, your blood sugar might rise
too high before the injection could take effect. Now, with quick-acting Humalog,
it is appropriate to eat and then inject, or as manufacturer Eli Lilly
and Company suggests: "Inject while looking at your food."
You can determine if it works by checking your blood sugar two
hours after your meal. It should be below 180mg/dL, unless you and your doctor
have selected a different postprandial sugar target. With human Regular insulins,
such delay of injection very frequently leads to high sugars two hours after
a meal.