Order of Insulin for Type 1 (before or after a meal)

I wouldn’t dispute the insulin instructions a doctor has prescribed anyone. I can only state what I have been told over the years. (I’ll also add that if type 1 normally one takes a long acting insulin that’s slow acting and works as background insulin to lower BG overall. So 2 insulins are working together.). The reason taking the fast acting before the meal is recommended is to provide sufficient time for the insulin to do it’s job. If you wait, it runs behind and may not catch up to lower the BG for a longer time, so you get higher spikes. There are super fast acting insulins you can inhale. I’ve never tried those though.

I sometimes do wait and bolus after I eat when I’m not sure what I’m going to eat in advance. Sometimes it works out ok, other times it doesn’t. All my doctors and CDEs tell me to bolus 15-30 minutes before eating. I try to.

I have done both as a Type 2. When I take Novolog (fast acting) before a meal, my high value isn't as high or long, as when I go out to eat and don't have my kit with me. The high is higher and lasts longer. Also if you can vary your dosage, will cause lows if you wait until after eating and you base the dose on your high value. My body has some recovery for eating since I am Type 2.

I take both long acting acting. I take short acting based upon the meal I'm getting ready to eat. If it is a Thanksgiving meal, I would take 12 to 15 units and if it is a light diabetic meal, I'd take 6 to 8. I always take
it before I eat. The long acting is a different regiment, if my Dexcom meter shows an A1C of 6.9, I'd take 24 units a day. If I'm facing Christmas week with family, I raise it to 28 units. If I'm exersing a lot & eating diabetic meals, I'd go with 20 units. For the short acting, if I'm exercising & eating diabetic lifestyle, I may only use it once a day. You get a feel for it overtime. The Dexcom sensors/system have really helped me cope with Diabetes.

@davidyapp thank you for sharing your "system" of managing it. i know this is not a one size fits all, and i'm sure it takes some time to figure out how your body responds to your lifestyle, while figuring out the insulin accordingly. good luck with continued success!

you are right ... it is definitely the same for all patients ... I've had diabetes for 35 years. & I've mentioned the things that have been most useful of this timeframe. No need for patients to wade through their own trail and tribulations if someone with experience can help lead the pathway. Diabetes is a tough disease ... the longer we can stay away from dialysis the better. I watched fafter who ended his life on dialysis & know the ends and outs of his life as well. We need to try to make all of the right choices ... when I was young, was a little bit of a rebel ... and today, I'm a lot more reflective on these decisions and =try to correct where possible.e

@mizzdeb48,

It is definitely an astute observation to recognize that medications are almost never a 'one size fits all' blanket of success or side effects. Have you had a chance to ask this question with your provider as well as it is certainly a good question. How are you currently doing with your insulin and eating currently? Are you experiencing issues the way you have been currently doing it?

@JustinMcClanahan it's actually my sister (newly diagnosed Type 1) who i'm advocating for and helping to navigate this. unfortunately, she's dealing with other major health issues and everything has collided at once for her. yes, she is discussing this with the appropriate medical people, and a diabetic dietician as well. this will sadly continue to be an issue for her until she figures it out, or at least gets to a more "routine" place with it. thankfully, she has good support from her husband and other family (sibs, etc) as well, along with the wonderful caring, responsive people on this support group. she just signed on to Mayo Clinic Connect, so hopefully, she can ask her own questions and take advantage of the outside support! thank you again for your response!

@davidyapp You’ve got me worried about you! Here’s why:
This discussion is about when to take fast acting insulin at meal time (eg before or after the meal). Members (including you) responded that lots of people take a combination of long acting and fast acting insulin. This is typical and a commonly prescribed treatment method.
What concerns me is your reference to “Dexcom meter” that you later refer to as “sensor/system” and that “if it shows an A1C of 6.9…..” I use a 15 day Dexcom G7. The Dexcom doesn’t show A1C. The data shows the glucose in your interstitial fluid and compares pretty well to what your blood sugar is, allowing you to keep an eye on things 24/7.
You mention basing your fast acting insulin dose on the Dexcom data and sited examples of 6-8 units, 12-15 units, 20 units, 24 units, 28units. Are you talking about per meal or per day? Could you please clarify? I hope you mean per day because the range of units you mention (6 - 28) seems like an awful lot per meal IMHO! Please let me know. Thinking about you! (The discussion is about when to take fast acting insulin at MEAL time.)

@cehunt57
I read Davidyapp’s comment & I’m seeing he was referring to long acting insulin when talking about 20-28 units PER DAY. He stated he takes 6-8 units of fast acting when exercising or is eating less per meal & more , 12-15 for bigger meals. That’s what I do too.
I use the Dexcom G7 15 day sensor too & on the app under the Trends tab, it shows a percentage called GMI, glucose management indicator, telling you what your blood sugar is over a longer period of time. They state that this number will likely differ from your A1C.
Maybe this is what he’s referring to??
Hope this helps so you don’t have to worry about him!😊

Thanks for the feedback; I haven't transitioned yet to the 15 day meter ... still on the 10 day meter. I like seeing where my 90 day A1C is trending. I guess I'll have to watch another metric sounds like "GMI" going forward. I will transition to the 15 day meter in 4 weeks. I had a pretty large stockpile of the 10 day sensors.

Let me clarify a few things ... I've using Novsep for my short acting insulin ... I eat one large me a day usually dinner with my wife ... I try to exercise twice a day for 45 minutes each. I don't eat breakfast & eat roughly 700 calories for lunch and 1000 calories for dinner. Depending how my blood sugars are trending, I might use 6 to 8 units in the afternoon and 8 to 10 units for dinner. I'm taking 1000 mg metformin twice a day. If my blood sugars are below 200 at night, I usually don't take the short acting insulin ... the metformin will begin my blood
sugars to 80 to 100. I'm guarding against low blood sugars. I'm not sharing this data as prescriptive ... it just shows the balancing act that I need to follow on a daily basis.

For long-term insulin (Treseba), if my 90 day A1C is below, 7.2, I use 24 units; if my A1C is below 7.0, I use 20 units, and if my blood sugars are above 7.4, I used 28 (rarely use this dosage ... sometimes during the holidays); sorry for all of the confusion between quick acting and long-term insulin. I take long-term insulin at night & it doesn't impact blood sugar levels until one or two days out.

I don't mean to be prescriptive just want to show my experience. All of our experiences will be difference. Thanks for he response to my email/tex.