INSULIN

Most people find that insulin pens are easier to use than a bottle and syringe.

Many people feel less pain (or no pain) with the smaller insulin pen needle, compared to a syringe needle.

Insulin pens may help you give yourself more accurate doses. When you draw insulin into a syringe, you must carefully measure so that you don't get too much or too little. But with a pen, you set a dial for the amount of insulin you want, and then you push the button.

Insulin pens may work better than syringes for people who don't see well or who have problems, like arthritis, that make it harder to use a syringe.

Using an insulin pen draws less attention from others. You can give yourself insulin with fewer people noticing.

You don't need to carry insulin bottles and syringes everywhere you go. An insulin pen fits into a pocket or purse.

Insulin pens give you only a limited choice of dose amounts. You may not be able to find a pen that offers the dose of insulin you need.

Pen makers offer only a limited variety of insulin mixes. So if you need mixed-dose insulin, you may need to inject yourself with two separate pens to get the right amounts of each insulin.

Your insurance may not cover insulin pens, which cost more than syringes.

After you have put the insulin cartridge in the insulin pen, screw on a new needle.

Remove the outer cap from the needle. Keep this outer cap. You will use it later to safely dispose of the needle.

Remove the inner cover from the needle. Be careful not to prick yourself. To keep the needle clean, set the insulin pen on a counter or put the outer cap back over the needle while you do the next step.

Clean the area of skin where you will give the injection. If you use alcohol to clean the skin, let it dry. If you covered the needle with the outer cap, remove it now. Check to make sure that you have the right dose. Then, using the hand not holding the insulin pen, slightly pinch a fold of skin between your fingers and thumb.

Push the needle all the way into the pinched-up area. Let go of the pinched-up area, and push the plunger of the pen all the way in. Count to five before taking the needle out. Put only the outer cap back over the needle. (The thin, inner cover is harder to put back on, and you could stick yourself.)

After covering the needle with the outer cap, unscrew the needle and throw it away in a sharps container or other solid plastic container. You can get a sharps container at your drugstore.

Don't share insulin pens with anyone else who uses insulin. Even when the needle is changed, an insulin pen can carry bacteria or blood that can make another person sick.

The pump sends insulin through a narrow plastic tube (a catheter) that ends in a tiny needle. The needle goes into your skin. The tube and needle are called an infusion set. With most infusion sets, the needle pulls out, leaving a tiny flexible tube called a cannula under your skin. You can't even feel that it's there. Some pumps attach directly to the body and do not need tubing. With this type, a remote device controls the pump. And some pumps are disposable and do not use tubing or a remote control. A pump with no tubing is sometimes called a "pump patch."

An insulin pump gives you a constant trickle of insulin throughout the day and night. This is called your basal amount. You set this up to keep your blood sugar in your target range throughout the day. You can use the pump to give yourself extra insulin when you eat a meal or a snack. You can give yourself less insulin when you are very active or exercising. You also can give yourself more insulin any time you feel you need more than your basal amount of insulin.

An insulin pump can help you control your blood sugar.

A pump may help you keep your blood sugar closer to normal. You may have fewer big swings in your blood sugar levels. A pump can deliver an exact amount of insulin and in very small amounts. The pump may help you keep your blood sugar under control without also causing low blood sugar. A pump may improve your hemoglobin A1c level. You don't have to give yourself shots several times a day.

You don't have to plan your life around your insulin shots. You don't have to stop what you're doing and give yourself a shot. Some pumps also work as a blood sugar meter or they communicate with your meter. Some pumps continuously measure glucose. And some pumps can suggest how much insulin you need based on blood sugar readings.

Diabetes control

A pump may not improve blood sugar control if you are already giving yourself insulin shots 3 or more times a day.

If you keep your blood sugar levels in a tight range, it may be harder for you to sense when your blood sugar is low.

If you are not good at counting your carbohydrate grams, the pump may not help you control your diabetes.

Some people say choosing which pump to use is harder than deciding to switch to a pump. There are a number of insulin pump companies, and each pump is slightly different.

Ask members of your diabetes team which pumps they recommend.

If you have insurance, find out which pump brands are covered. Then ask those companies to send you information or check their websites.

You should be able to try out a pump with saline solution. That way you can see how it works and feels.

Follow-up care is a key part of your treatment and safety. Be sure to make and go to all appointments, and call your doctor if you are having problems. It's also a good idea to know your test results and keep a list of the medicines you take.

If you take insulin, you need to know how many grams of carbohydrate are in a meal. This lets you know how much rapid-acting insulin to take before you eat. If you use an insulin pump, you get a constant rate of insulin during the day. So the pump must be programmed at meals to give you extra insulin to cover the rise in blood sugar after meals.

When you know how much carbohydrate you will eat, you can take the right amount of insulin. Or, if you always use the same amount of insulin, you need to make sure that you eat the same amount of carbohydrate at meals.

Learn your own insulin-to-carbohydrate ratio. You and your diabetes health professional will figure out the ratio. You can do this by testing your blood sugar after meals. For example, you may need a certain amount of insulin for every 15 grams of carbohydrate. Add up the carbohydrate grams in a meal. Then you can figure out how many units of insulin to take based on your insulin-to-carbohydrate ratio. Look at labels on packaged foods. This can tell you how much carbohydrate is in a serving. You can also use guides from the American Diabetes Association.

Be aware of portions, or serving sizes. If a package has two servings and you eat the whole package, you need to double the number of grams of carbohydrate listed for one serving. Protein, fat, and fiber do not raise blood sugar as much as carbs do. If you eat a lot of these nutrients in a meal, your blood sugar will rise more slowly than it would otherwise.

Exercise lowers blood sugar. You can use less insulin than you would if you were not doing exercise. Keep in mind that timing matters. If you exercise within 1 hour after a meal, your body may need less insulin for that meal than it would if you exercised 3 hours after the meal. Test your blood sugar to find out how exercise affects your need for insulin.

Eat at least three meals a day.

Plan meals to include food from all the food groups.Grains: 1 slice of bread (1 ounce), ½ cup of cooked cereal, and 1/3 cup of cooked pasta or rice. These have about 15 grams of carbohydrate in a serving. Choose whole grains. These include whole wheat bread or crackers, oatmeal, and brown rice. Have them more often than refined grains.

Fruit: 1 small fresh fruit, such as an apple or orange; ½ of a banana; ½ cup of chopped, cooked, or canned fruit; ½ cup of fruit juice; 1 cup of melon or raspberries; and 2 tablespoons of dried fruit. These have about 15 grams of carbohydrate in a serving.

Dairy: 1 cup of nonfat or low-fat milk and 2/3 cup of plain yogurt. These have about 15 grams of carbohydrate in a serving.

Protein foods: Beef, chicken, turkey, fish, eggs, tofu, cheese, cottage cheese, and peanut butter. A serving size of meat is 3 ounces. This is about the size of a deck of cards. Examples of meat substitute serving sizes (equal to 1 ounce of meat) are 1/4 cup of cottage cheese, 1 egg, 1 tablespoon of peanut butter, and ½ cup of tofu. These have very little or no carbohydrate per serving.

Vegetables: Starchy vegetables such as ½ cup of cooked beans, peas, potatoes, or corn have about 15 grams of carbohydrate. Nonstarchy vegetables have very little carbohydrate. These include 1 cup of raw leafy vegetables (such as spinach), ½ cup of other vegetables (cooked or chopped), and 3/4 cup of vegetable juice.

Talk to your dietitian or diabetes educator about ways to add limited amounts of sweets into your meal plan.

If you drink alcohol:Limit it to no more than 1 drink a day for women and 2 drinks a day for men. (One drink is 12 fl oz of beer, 5 fl oz of wine, or 1.5 fl oz liquor.)

Make sure to count drink mixers that have sugar in your total carbohydrate count. These include cola, tonic water, margarita mix, and fruit juice.

Eat a carbohydrate food along with your alcoholic drink.

Check your blood sugar more often. This is because alcohol can lower your blood sugar too much. This may happen even hours later while you sleep. You may want to eat and adjust your insulin dose when you drink alcohol to prevent severe low blood sugar.

Talk to your doctor. Alcohol may not be recommended when you are taking certain diabetes medicines.