What problems arise through insulin injections?

Sometimes insulin may induce mild allergic reactions.

• Insulin injection can cause an itchy small, hard red area at the injection site. There is nothing to worry about this as it goes away in a day or so.
• A generalized allergy to insulin causes rashes and itchy skin over other parts of the body. Usually, this disappears by itself. If the itching continues, consult your doctor.
• In rare cases, insulin edema or swelling may develop when you start insulin therapy. It is usually not severe. You may notice swelling in your legs, ankles, feet, hands, or face. This will go away in a few weeks.
• In the past, insulin caused formation of firm, lumpy scar tissue in an area that has been used repeatedly for injection. is the A area develops. Insulin absorption is changed in this area. This condition called as lipohypertrophy has become rare with newer and purer insulin.
• Lipoatrophy now rare resulted from loss of fat in the area due to repeated injections with impure insulins giving rise to pitted areas.

back to index

Describe when and how to increase or decrease insulin doses?

Blood sugar does not remain the same all throughout the day. This implies that dose of insulin also changes. There are many reasons for blood sugar fluctuations. Some of the reasons are:

• Changes in exercise or activity level
• Snacks added or omitted
• Delayed meals, or a change in the type of amount of food eaten
• Illness or infection
• Alcohol consumption
• Insulin injected into a lumpy area or an exercising arm or leg
• Over-treatment of an insulin reaction
• Skipped insulin injection

These conditions may require adjustment of insulin doses. Monitor your blood sugar and record the findings. Once you identify a pattern of high or low blood sugars at the same time on three successive days, determine what insulin should be working at that time. Adjust the insulin dose according to the blood sugar findings.

• Adjust your dose of insulin only by 1-2 units
• Increase insulin for high blood sugar
• Decrease insulin for low blood sugar
• Change only one type of insulin at a time.
• Check the effect of your insulin adjustment for 3 days before making another adjustment.

You can help in the process of achieving control of your diabetes by watching for high and low blood sugar patterns and keeping track of them as part of your overall blood glucose monitoring routine. A pattern occurs when your blood sugar is in a certain range at the same time of day for three consecutive days.

back to index

Explain insulin adjustments using blood sugar records.

When your blood glucose level fluctuates, try to identify the cause of the high or low blood glucose measurement. There are only three causes of fluctuations in blood sugar level: changes in diet, exercise, or insulin. Regular insulin is fast acting and usually recommended as a supplement to correct high blood sugars. The exact amount depends on how high your blood sugar is and how you usually respond to Regular insulin. A child or thin adult may be able to lower blood sugar with 1 unit of Regular insulin; a larger adult, or a person on large doses of insulin may need 2 to 4 units.

A pattern occurs when your blood sugar is in a certain range at the same time of day for three consecutive days. Look for a pattern in readings over a few days or longer. Three days of readings above the target range or two days of readings below the target range at the same time of day should make you think about the need for adjustment. Although the numbers are different each day, you can see a pattern. Morning blood sugars are all over 150 and afternoon blood sugars are all under 100. In this case, your health-care provider might recommend an increase in evening NPH (or Lente) insulin to lower your blood glucose in the morning.

Guidelines for insulin adjustment

• Identify the insulin that is acting to regulate readings at this time of day. For example, the pre–breakfast reading is mostly regulated by the previous evening's long–acting insulin.
  Adjust the appropriate insulin.
• Adjust only one insulin at a time. Adjusting more than one at a time can be confusing.
• Wait a few days to assess the effect of the insulin adjustment.
• Insulin adjustment is by cautious step–wise dose changes based on blood glucose monitoring. The amount by which the dose is changed depends on the current dose.
• Doses are adjusted by about 10 per cent of the current dose. If you are unsure‚ make smaller cautious changes‚ waiting for several days of blood glucose readings to decide on further adjustment.
• During periods of insulin adjustment more frequent monitoring of blood sugar levels are very helpful.
• Doses to be adjusted should be adjusted in parts.
  1. For 10 units or less: Adjust 1 unit. In some children on doses of less than 5units‚ 0.5 unit changes are often used
  2. For 10–20 units: Adjust 1–2 units
  3. For 20–30 units: Adjust 2 units
  4. For more than 30 units: Adjust 2–4 units

back to index

List two factors which effect blood sugars and the appropriate insulin adjustments.

Among the many factors that cause blood sugar fluctuations, diet and activity are the most important.

• Sports and activities: Exercise and activity increases glucose utilization in the body decreasing blood sugar levels. This requires insulin dose to be reduced. When children are more active‚ the first principle is to eat some extra carbohydrate to cover the extra activity. However‚ sometimes this is not enough or not suitable‚ so insulin doses can also be lowered to adjust for this. Which doses are lowered will depend on the time of the day the sport is played and which insulins are mainly acting then. For days when the activity levels will be continually high all doses may need to be lowered and this is usually a reduction by 10 to 30 per cent‚ depending on the individual. Also, in order to reduce the chances of overnight hypoglycemia, reduce the night time dose of insulin after very high energy days.
• Diet: If you know that you are to eat substantially more or less at a certain meal, insulin dose before that meal can be adjusted accordingly. For example‚ you may know that your child always eats a lot and ends up with a high blood glucose level after a party ‚ so giving some extra short–acting insulin to help cover the meal will help this. Or‚ you may know that your child eats poorly if they have to get up earlier than usual so you may give a little less short–acting insulin that morning. Remember that these are temporary adjustments only and the regular dose is usually resumed for the next dose.

back to index

What does “sliding” scales for insulin adjustments and who should use them mean?

Blood sugar changes widely during activities and so does the need for insulin. Sliding scales generally refer to giving different dosages of insulin depending on the level of blood sugar. They should not be used for the intermediate-acting or long-acting insulins but for the regular insulin and the humalogs. The blood sugar level, food intake and exercise must all be considered before each insulin dose is chosen. Insulin doses need to be adjusted after thinking about food intake, exercise, stress, illness or other factors. Some people even need a different scale for their morning compared with their evening dosage of short-acting insulin. It should always be remembered that the scale may have to be reduced if heavy exercise has just been done or is about to be done. In order to fine tune your insulin doses and normalize your blood sugar levels, your doctor may prescribe all or part of your insulin on a sliding scale basis.

Insulin sliding scale

• If Blood Glucose <180: No Insulin required
• If Blood Glucose <220: Give 4u Regular insulin
• If Blood Glucose <260: Give 6u Regular insulin
• If Blood Glucose <320: Give 8u Regular insulin
• If Blood Glucose <400: Give 10u Regular insulin
• If Blood Glucose >400: Give 10u Regular insulin

One problem with set sliding scales is that they have to be updated very regularly or they are out of date. Another problem is that they can make looking for patterns more difficult as the insulin dose is often different each day. Most people use the general principles of a sliding scale without having one written down.

back to index

Do the needs for insulin change with the seasons?

Yes. Insulin needs changes with seasons. It depends on activity level. In summer, people tend to increase their activity due to the clear weather and vacations. People on holidays also have increased activity and relaxed state of mind. With the increased activity, low blood sugars are more likely. Snacks may have to be adjusted and/or insulin doses may need to be lowered. On the contrary, during winter, people go out less and are usually confined to their work places. Also, the decreased activity tends to increase blood sugar and hence calls for increase in insulin doses.

back to index