May 27, 2017

Gluten-Free Foods May Not Be Healthy

This is the second time this topic has been brought to my attention. Gluten-free should not be a fad because of the dangers. This is the concern of the medical community and rightly so as this is a dangerous fad. More can be read about gluten-free here. A gluten-free diet is not a plan for weight loss and can make weight management problematic for many. Read this on WebMd as well and this article about gluten-free.

What the food industry is doing to gluten-free foods is not a good thing and is harming people more than helping them or serving peoples' best interests. As more and more people are adopting a gluten-free diet, a new study investigates the nutritional content of gluten-free products and finds them lacking.

A new study suggests that gluten-free products may not be as nutritional as their gluten-containing equivalents.

New research - presented at the 50th Annual Congress of the European Society for Paediatric Gastroenterology Hepatology and Nutrition - compares the nutritional content of gluten-free and gluten-containing foods.

Gluten is a protein found in a wide variety of wheat grains, rye, and barley, as well as in foods derived from these grains, such as pasta, bread, cereals, and baked goods.

People with celiac disease must follow a strict gluten-free diet, as this autoimmune disorder can be triggered by even the smallest intake of gluten. It is currently estimated that 1 in 100 people across the globe live with celiac disease. In Europe, approximately 1 percent of the population is thought to have the disorder, and in the United States, celiac disease affects more than three million people.

In addition to those affected by celiac disease, many people avoid gluten because they are intolerant to the protein. Gluten sensitivity has similar symptoms to celiac disease, but gluten intolerance does not damage the small intestine.

Finally, more and more people are adhering to a gluten-free diet simply because gluten-free products are perceived to be more healthful. However, new research challenges this belief.

The new study was led by Dr. Joaquim Calvo Lerma and Dr. Sandra Martínez-Barona, both of the Research Group on Celiac Disease and Digestive Immunopathology at the Instituto de Investigación Sanitaria La Fe in Valencia, Spain.

Gluten-free products are often lacking nutritional value, and consumers may be misled. The researchers evaluated the nutritional content of 654 gluten-free foods and compared them with 655 products that contained gluten.

The study found that gluten-free products had a higher energy content than gluten-containing items. Additionally, foods with gluten contained up to three times more protein than their gluten-free counterparts.

Bread, pasta, pizza, and flour all had a particularly high protein content. For children, passing up on this nutritional content may have a negative impact on their development, and the shortcomings of gluten-free products found in the study raise the risk of childhood obesity.

"As more and more people are following a gluten-free diet to effectively manage celiac disease, it is imperative that foods marketed as substitutes are reformulated to ensure that they truly do have similar nutritional values. This is especially important for children, as a well-balanced diet is essential to healthy growth and development."  Dr. Joaquim Calvo Lerma

It is currently estimated that 10 percent of children whose growth is delayed for no apparent reason may have celiac disease.

The study also found that gluten-free breads contained considerably more lipids and saturated fats. Furthermore, gluten-free pasta was found to have less sugar than pasta with gluten, and gluten-free biscuits had considerably less protein and more lipids than their gluten-containing equivalent.

In light of these findings, Dr. Martínez-Barona suggests that consumers might be misinformed on the nutritional value of gluten-free products and calls for clearer labeling on these items:

"Where nutritional values of gluten-free products do vary significantly from their gluten-containing counterparts, such as having higher levels of saturated fat, labeling needs to clearly indicate this so that patients, parents, and carers can make informed decisions. Consumers should also be provided with guidance to enhance their understanding of the nutritional compositions of products, in both gluten-free and gluten-containing products, to allow them to make more informed purchases and ensure a healthier diet is followed."



May 26, 2017

Bariatric Surgery: Reoperations Are Common

Finally some truth about bariatric surgery! Many bloggers have been critical of bariatric surgery since the beginning and declared that it was the surgeons lining the pockets with the money. I still think much of this is correct, but for some time, the remission – not a cure – for type 2 diabetes was the only headlines.

Nearly 1 in 5 patients with a lap-band undergo multiple device-related reoperations, and complication rates vary widely between hospitals. Bariatric surgery is increasingly common in America, but care and outcomes vary greatly between centers, research finds.

Every year, nearly 200,000 Americans turn to surgeons for help with their obesity, seeking bariatric surgery to lose weight and prevent life-threatening health problems. But after more than two decades of steadily increasing numbers of operations, American bariatric surgery centers still vary greatly in the quality of care they provide.

That’s the finding of a team of researchers at the University of Michigan who used data from insurers that pay for bariatric operations, and from a statewide partnership of bariatric surgery teams, to study the issue of bariatric surgery outcomes.

Just in the past few months, the U-M team has published several papers that shed new light on the high level of variability and incidence of complications that patients still face.

“As Americans turn to bariatric and metabolic operations in higher and higher numbers, and as our county grapples with the ongoing obesity epidemic, it’s more important than ever to take a clear-eyed look at how well our surgical centers are doing, and to try to improve the care patients receive,” says Andrew M. Ibrahim, M.D., M.Sc., the Robert Wood Johnson Clinical Scholar and U-M surgical resident who led many of the new studies as part of his work at the U-M Center for Healthcare Outcomes and Policy.

Their most recent findings:
  • Nearly 1 in 5 patients with Medicare who have laparoscopic adjustable gastric band surgery will end up needing at least one more device-related operation, either to remove or replace the band around the upper portion of their stomach, or to switch to a different stomach-remodeling approach. The results were published in JAMA Surgery.

  • Additional device-related procedures for the operation were so common, in fact, that nearly half (47%) of the $470 million paid by Medicare for such procedures was for reoperations to revise or remove it. “If half the money we’re spending on a device is to revise or remove it, we ought to ask ourselves if we should still be using it,” says Ibrahim.

  • Though this form of bariatric surgery has declined sharply in popularity in recent years, and now makes up only about five percent of all operations, there are still hundreds of thousands of people who have the devices from past operations. So failure of the devices to result in weight loss, or complications from their placement, pose a potential major issue. The study finds tremendous variation between surgical centers in the rate of reoperation that their patients faced.

  • The new study looks at data from 25,042 people who had operations between 2006 and 2013, and who were covered by Medicare, which pays for about 15 percent of all bariatric operations.

Reference: JAMA Surgery, doi: 10.1001/jamasurg.2017.1093

  • Another recent paper from the U-M team finds that even accredited bariatric “centers of excellence” can vary greatly in the rate of complications their patients suffer after their operations.

  • Published in JAMA Surgery, the study looked at data from more than 145,500 patients and found a 17-fold difference between the centers with the highest and lowest rates of serious complications. It found that even within a single state, one bariatric surgery center can have nine times the complication rate of another center.

  • “While we have made significant progress improving the safety of bariatric surgery over the last two decades, the presence of 17-fold variation in complications rates across accredited centers underscores that we need to improve further,” Ibrahim notes.

May 25, 2017

Handling an Insulin Overdose

Do you use insulin and have you experienced an episode of hypoglycemia (low blood glucose)? Have you had cold sweats, trembling hands, or a sense of confusion? These are just some of the symptoms of hypoglycemia and often your doctor will not mention this when you start on insulin therapy.

Hypoglycemia happens to many people with diabetes that are using insulin or a couple of oral medication. It can be serious and even deadly.

The following are several things can put too much insulin in your system. It most often happens when you:
#1. Misread the syringes or vials: This is easy to do if you are unfamiliar with a new product.

#2. Use the wrong type of insulin: Let's say you usually take 30 units of long-acting and 10 units of short-acting insulin. It's easy to get them mixed up.

#3. Take insulin, but don't eat: Rapid-acting and short-acting insulin injections should be taken just before or with meals. Your blood sugar rises after meals. Taking rapid-acting or short-acting insulin without eating could lower your glucose to a dangerous level.

#4. Inject insulin in an arm or leg just before exercise: Physical activity can lower your blood glucose levels and change how your body absorbs insulin. Inject in an area that isn’t affected by your exercise.

Please learn the symptoms of an insulin overdose as this could save your life.
If you have low blood glucose because of an insulin overdose, you may have:
  • Anxiety
  • Confusion
  • Extreme hunger
  • Fatigue
  • Irritability
  • Sweating or clammy skin
  • Trembling hands

If your blood glucose levels continue to fall, you could have seizures or pass out.
Learn what to do if you have an insulin overdose to take care of it before you cannot. Don’t panic. Most insulin overdoses can be treated at home.
Follow these steps if you are able:

#1. Check your blood sugar. You’ll need to know where you’re starting from.

#2. Drink one-half cup of regular soda or sweetened fruit juice, and eat a hard candy or have glucose paste, tablets, or gel.

#3. If you skipped a meal, eat something now. Something with 15 to 20 grams of carbohydrates should raise your blood sugar.

#4. Rest. Get off your feet or take a break.

#5. Recheck your blood glucose after 15 or 20 minutes. If it's still low, take another 15 to 20 grams of a quick-acting sugar, and eat something if you can.

#6. Pay attention to how you feel for the next few hours. If you still have symptoms, check your glucose again an hour after eating. Keep snacking if your sugar is low.

#7. Get medical help if your sugar level stays low after 2 hours or if your symptoms don’t get better.

#8 Don't worry about pushing your sugar too high if it's only for a short time. One high level won't hurt you, but a very low level can.

#9. If you're unconscious or too confused or are having seizures, those around you will need to take control. Give your family and friends these instructions:
  • If you lose consciousness, they should call 911 immediately.
  • They may need to inject you with something called glucagon. It’s an insulin antidote. If you’re prone to low blood sugar, ask your doctor if you should have glucagon on hand at home.
  • If you're alert enough to follow instructions, they should give you sweet juice to drink.
  • If your symptoms don't steadily improve during the next hour, they should call 911.

The following are things you can do to prevent an overdose:

#1. Keep a consistent schedule. It’ll make it much easier for you to stay on track.

#2. Eat something at every mealtime. Even if you're not hungry, have some real food, a serving of carrots (cooked or raw), a glass of whole (not skim) milk, or a small serving of fruit. Never skip meals when you've taken insulin.

#3. Be prepared. Expect that you'll have insulin complications at some point. Pack hard candies in your bag and your partner's. Keep some in the car and in your travel bag, too.

#4. Make sure friends and family know the way you react to hypoglycemia. It’ll help them take action if your low blood sugar levels make you confused.

#6. Wear a medical alert bracelet. Make sure it says you use insulin. This is a most important thing to have on you if you live alone or your partner is away on business.

May 24, 2017

Hospital Protocols Still Hinder Care

Am I unhappy about my hospital experiences? In a word, yes! Plus now it involves three hospitals. The first case is in this blog and it is by far the worst. The second case involved a doctor (not a hospitalist) ordering me to take more insulin than I knew I could handle and would be more than low. I told the doctor if that then he would be required to pay for my second day in the hospital, as I would otherwise leave against medical advice when I went below 70 mg/dl. Finally, the doctor relented and my AM reading was still below 70 mg/dl, but not enough for me to be concerned. Had I taken what the doctor ordered, I would have probably been below 40 mg/dl.

The third hospital was similar to the second hospital, but this time it was a hospitalist that gave the order and he was threatening to remove my diabetes supplies and my meter. I started to get out of bed and was having trouble because of the operation and he asked me what I was doing, and I said leaving against medical advice because of an overbearing and unreasonable doctor. My wife had started gathering my supplies and putting them in my briefcase. The hospitalist told me to stay in bed and he would see what my blood glucose was and called a nurse to use the hospital meter and test my blood glucose. When the reading came out 76 mg/dl, he said he would again have me tested in the morning. I said okay and went back to sleep.

In the morning, the hospitalist was there and asked the nurse to test my blood glucose again. This time it was 59 mg/dl and he was even surprised and said to use my meter, which when I used it was 58 mg/dl. Okay, he admitted, you were right and probably would have needed to stay in the hospital another day recovering from severe hypoglycemia. He said that after the operation, most people would have had a glucose reading over 140 mg/dl because of that alone. He said if he hadn't seen the results with his own eyes, he would not have believed it. He said you should be released about noon and he would be back to see me before I was released.

Breakfast arrived as he was leaving and he asked me to count the carbohydrates in the meal. I said after counting the foods I would eat and said 35 grams and pointed out the two items I would not be eating. The dietitian said I must eat them and I asked her if she wanted the whole tray thrown at her. The hospitalist told her to leave and when she wouldn't, he did escort her out of the room.

When he came back in, she was right behind him and told me she would feed me herself to see that I ate everything. I pick up the tray and told the doctor to duck. He told me to lower the tray and he would have someone take her back to the kitchen. She said he would not and she tried to get past him and I let the tray go in her direction. The food was all over her face and top and she became furious. It took two nurses to get her out of the room and the hospitalist called the administrator and he was there rather quickly. When he arrived, he asked what the problem was and when he saw me, he said what do I need to do. When the dietitian came back in, I said fire that bully. She still had food on her and said I would be brought another tray and she would force-feed me to see that I ate everything. The administrator said she would not have the chance as she could go to his office and wait for her final paycheck.

When she tried to appease him, he said told the hospitalist to call security and for them escort her from the premises and he would mail her the final check. With that, she left the room muttering to herself. Next, the administrator asked what other problems I was having. I said, because of my anger at the dietitian, I threw my breakfast at her. He asked me if the woman sitting at the foot of the bed was my wife and answered yes. He picked up my phone, dialed the kitchen, and asked them to send up two breakfasts as soon as possible. In ten minutes, we had them. The assistant dietitian and a nurse had them and the nurse asked what had happened to the head dietitian. The administrator asked the assistant if she felt up to doing the job. When she said yes, he told the nurse that the new head dietitian was standing next to her.

I was discharge at 12:30 PM and was happy to be out. My wife asked me how I had survived the problems and had everything go my way. I said because I know the administrator and you know what he asked and the hospitalist said. This was backed by the administrator and he likes his orders followed and knows that the dietitian was set on bullying me.

May 23, 2017

Herbs and Supplements for Type 2 Diabetes - P2

This is a continuation of part 1.

Milk thistle - Milk thistle is an herb that has been used since ancient times for many different ailments and is considered a tonic for the liver. The most studied extract from milk thistle is called silymarin, which is a compound that has antioxidant and anti-inflammatory properties. It is these properties that may make milk thistle a great herb for people with diabetes.

A review notes that many of the studies on silymarin are promising, but the research is not strong enough to begin recommending the herb or extract alone for diabetes care.

Many people may still find that it is an important part of a care routine, especially since the antioxidant and anti-inflammatory properties can help protect against further damage caused by diabetes. Milk thistle is most often taken as a supplement.

Fenugreek - Fenugreek is another seed with the potential to lower blood sugar levels. The seeds contain fibers and chemicals that help to slow down the digestion of carbohydrates like sugar. The seeds may also help delay or prevent the onset of type 2 diabetes.

A recent study found that people with prediabetes were less likely to be diagnosed with type 2 diabetes while taking powdered fenugreek seed. This was caused by the seed increasing the levels of insulin in the body, which also reduced the glucose in the blood.

Researchers found that the seed helped to lower cholesterol levels in patients as well. Fenugreek can be cooked into certain dishes, added to warm water, or ground into a powder. It can also be added to a capsule to be swallowed as a supplement.

Gymnema - Gymnema is a relatively new herb on the Western market. In the plant's native home of India, its name means, "sugar destroyer." A recent review noted that both type 1 and type 2 diabetes patients given gymnema have shown signs of improvement.

In people with type 1 diabetes who were given the leaf extract over a period of 18 months, fasting blood sugar levels were lowered significantly when compared to a group that received only insulin.

Other tests using gymnema found that people with type 2 diabetes responded well to taking both the leaf and its extract over various periods of time. Using gymnema lowered blood glucose levels and increased insulin levels in the body of some patients. Using either the ground leaf or leaf extract may be beneficial for many people with diabetes.

Ginger - Ginger is another herb that science is just discovering more about. It has been used for thousands of years in traditional medicine systems. Ginger is often used to help treat digestive and inflammatory issues. However, a recent review posted to shows that it may be helpful in treating diabetes symptoms as well.

In their review, researchers found that supplementing with ginger lowered blood glucose levels, but did not lower blood insulin levels. Because of this, they suggest that ginger may reduce insulin resistance in the body for type 2 diabetes.

It is important to note that the researchers were uncertain as to how ginger does this. More research is being called for to make the claims more certain. Ginger is often added to food raw or as a powdered herb, brewed into tea, or added to capsules as an oral supplement.

Important considerations for people with diabetes - It is always best to work with a healthcare professional before taking any new herb or supplement. Doctors usually have patients start out on a lower dose and gradually increase it until a comfortable dose is found.

Some herbs can interact with other medications that do the same job, such as blood thinners and high blood pressure medications. It is very important to be aware of any interactions before starting a new supplement.

It is also important for people to get herbs from a high-quality source. Herbs are not monitored by the United States Food and Drug Administration (FDA). Products may contain different herbs and fillers, recommend an incorrect dose, or even are contaminated with pesticides.

Herbs and supplements should be seen as a complementary treatment option, and should not replace medications. Working closely with a knowledgeable healthcare professional, herbs can be a great addition to many care programs for diabetes.

End of part 2 of 2 parts.

May 22, 2017

Herbs and Supplements for Type 2 Diabetes - P1

Diabetes is a widespread disease affecting the blood glucose and insulin levels in the body. Managing the long-term consequences and complications of diabetes are as much of a challenge as the disease itself.

There are two main types of diabetes. Type 1 diabetes is where the pancreas produces little to no insulin. Type 2 diabetes is more common. With type 2, the body either does not produce enough insulin or produces insulin that the body does not use properly.  I will not be discussing gestational because doctors refuse to allow pregnant women many other medicines.

There are many treatment options for people with type 2 diabetes. Growing research suggests that some herbs and supplements may help with the condition. Useful herbs may be great to combine with more traditional methods to find relief from many type 2 diabetes symptoms.

Seven herbs and supplements: Here are seven herbs and supplements that may be of benefit to people with type 2 diabetes.

Aloe vera - Studies suggest an antidiabetic potential for aloe that may lower blood sugar levels. Aloe vera is a common plant with many different uses. Most people are aware of the plant being used to coat the skin and protect it from damage caused by too much sun exposure.

However, the plant has many lesser-known benefits as well. These range from helping digestive issues to possibly even relieving type 2 diabetes symptoms.

One review analyzed many studies using aloe vera to treat symptoms of diabetes. Their results strongly suggested an antidiabetic potential for aloe. Subjects given aloe showed lower blood sugar levels and higher insulin levels.

Further tests showed that aloe helps to increase how much insulin is produced by the pancreas. This could mean that aloe helps to restore bodies with type 2 diabetes or protect them from further damage. The researchers called for more studies to be done on aloe and its extracts to be certain of these effects.

There are many ways to take aloe. Juiced pulp is sold in many markets and added to drinks, and extracts are put into capsules to be taken as supplements.

Cinnamon - Cinnamon is a fragrant herb created from the bark of a tree and is commonly found in kitchens. It has a sweet and spicy fragrance and taste that can add sweetness without any additional sugar. It is popular with people with type 2 diabetes for this reason alone, but there is much more to cinnamon than just flavor.

A review found that subjects with metabolic syndrome and type 2 diabetes who were given cinnamon showed positive results in many different areas such as:
  • blood glucose levels
  • insulin levels
  • insulin sensitivity
  • blood fat levels
  • antioxidant levels
  • blood pressure
  • body mass
  • time to process food

These are important markers for people with diabetes. From this research, it may be said that cinnamon is important for everyone with type 2 diabetes to take.

The researchers did note that the type of cinnamon and the amount taken does have an effect on the results, however. Only the highest quality cinnamon or cinnamon extracts in capsule form should be used as a complementary treatment method. An experienced healthcare practitioner should always be consulted before starting to use cinnamon heavily as a supplement.

Bitter melon - Bitter melon is a traditional Chinese and Indian medicinal fruit. Research suggests that the seeds may help to reduce blood sugar levels.

Momordica charantia, also known as bitter melon, is a medicinal fruit. It has been used for centuries in the traditional medicine of China and India. The bitter fruit itself is cooked into many dishes, and the plant's medicinal properties are still being discovered.

One discovery being backed by science is that bitter melon may help with symptoms of diabetes. One review noted that many parts of the plant have been used to help treat diabetes patients.

Bitter melon seeds were given to both people with type 1 and type 2 diabetes to reduce their blood sugar levels. Blended vegetable pulp mixed with water also lowered blood sugar levels in 86 percent of the type 2 diabetes patients tested. The fruit juice of the bitter melon also helped to improved blood sugar tolerance in many cases. Eating or drinking the bitter melon can be an acquired taste. Luckily, similar effects were noted with extracts of the fruit taken as supplements as well.

There is not enough evidence to suggest that bitter melon could be used instead of insulin or medication for diabetes. However, it may help patients to rely less on those medications or lower their dosages.

Part 1 of 2 parts.

May 21, 2017

Erythritol a Marker for Weight Gain

I have long suspected that many of the sugar substitutes were overrated. Now the word is out on one of them, sugar alcohol erythritol. This commonly used sugar replacement used in low-calorie foods that people eat to lose weight may actually have the opposite effect.

The sugar alcohol erythritol occurs naturally in foods like pears and watermelons but has been used as a sugar replacement in low-calorie foods. It is found in the sugar replacement products Zsweet, Zero and Sweet Simplicity. Truvia is a mix of erythritol and stevia.

The study was a collaboration of researchers at Cornell, Braunschweig University of Technology in Germany and the University of Luxembourg, on a discovery-based analysis to identify metabolomic markers linked to weight gain and increased fat mass in students transitioning to college life.

"About 75 percent of this population experiences weight gain during the transition," Patricia Cassano, professor in the Division of Nutritional Sciences at Cornell, said in a press release. "With this in mind, it is important to identify biomarkers of risk that could guide its understanding and prevention."

Researchers found that people who gained weight and abdominal fat over the course of a year had 15 times higher blood erythritol at the beginning of the year compared to those who were stable or had lost weight and fat mass.

The study was part of Cornell's ENHANCE project by the Division of Nutritional Sciences to understand how the transition to college affects changes in diet, weight and metabolism in students.

"With the finding of a previously unrecognized metabolism of glucose to erythritol and given the erythritol-weight gain association, further research is needed to understand whether and how this pathway contributes to weight-gain risk," Cassano said.

May 20, 2017

Basal-Bolus Insulin Therapy

Diabetes is a disease that affects the way the body produces and uses insulin. Basal-bolus insulin therapy is a way of managing this condition. In type 2 diabetes, both the production and use of insulin are affected.

In people without diabetes, insulin is produced by the pancreas to keep the body's blood glucose levels under control throughout the day.

The pancreas produces enough insulin, whether the body is active, resting, eating, sick, or sleeping. This allows people without diabetes to eat food at any time of the day, without their blood sugar levels changing dramatically. For people with diabetes, this doesn't happen. However, a similar level of blood sugar control can be achieved by injecting insulin.

Injections can be used throughout the day to mimic the two types of insulin: basal and bolus. People without diabetes produce these throughout the day and at mealtimes, respectively

What is a basal-bolus insulin regimen? A basal-bolus insulin regimen involves a person with diabetes taking both basal and bolus insulin throughout the day. It offers them a way to control their blood sugar levels. It helps achieve levels similar to a person without diabetes.

There are several advantages to using a basal-bolus insulin regimen. These include:
  • flexibility as to when to have meals
  • control of blood sugar levels overnight
  • they are helpful for people who do shift work
  • they are helpful if traveling across different time zones

The downsides to a basal-bolus regimen are that:
  • people may need to take up to 4 injections a day
  • adapting to this routine can be challenging
  • it can be hard to remember to take the injections
  • it can be hard to time the injections
  • it's necessary to keep a supply of insulin with you

These things can make it harder to manage diabetes well. To make it easier, some experts suggest introducing the regimen gradually. When this happens, bolus insulin is taken, beginning with just one meal at a time.

What is basal insulin? Basal insulin is also sometimes known as "background insulin." It is usually taken once or twice a day to keep blood sugar levels consistent. This is important when the body is releasing glucose to supply cells with energy, during fasting.

By keeping sugar levels steady during fasting, basal insulin allows the cells to change sugar into energy more easily. Basal insulin makes up about half of the total amount of daily insulin. It is sometimes called "long-acting insulin" because it needs to be effective for a long time.

Examples of long-acting basal insulin for people with diabetes include:
  • glargine (Lantus)
  • detemir (Levemir)

These insulins reach the bloodstream several hours after injection and are effective for up to 24 hours. However, people using these treatments will also need to use rapid-acting insulin when they eat. This applies for people with type 2 diabetes.

As well as using long-acting basal insulin, some people with type 2 diabetes may need to take oral medication. In addition, they may need a weekly injection of a medicine called a "GLP-1 agonist".

What is bolus insulin? People with diabetes take bolus insulin at meal times, to keep blood sugar levels under control after eating.

Bolus insulin needs to act quickly, and so is known as "short-acting" or "rapid-acting" insulin. It works in about 15 minutes, peaks in about 1 hour, and continues to work for 2 to 4 hours.

Brands of rapid-acting bolus insulins include:
  • NovoRapid
  • Humalog
  • Apidra

Bolus insulin needs to reflect the amount of food eaten during a meal. So, carbohydrate counting and insulin-to-carbohydrate ratios are important tools for people with diabetes who use. However, some people find it easier to use an "insulin scale" instead.

An insulin scale is a list of how much insulin should be given before a meal. It takes into account both the pre-meal blood sugar level and the amount of carbohydrate that would usually be eaten at that meal.

However, it is still important for people using insulin scales to think about the dose of insulin they will take. They should compare it to the amount of food they are eating and what activities they have planned for after they eat.

This is because if they are going to eat more than usual then they may need more insulin than is listed on the scale. Or, they may need less insulin than is listed on the scale if they are planning on being more active than usual that day.

Insulin for people with diabetes is usually injected. However, in recent years, some alternatives to syringe injections have become available.

One alternative to injections is insertion aids, which are spring-loaded devices with a shielded needle. Insertion aids release insulin at the simple touch of a button.

Infusers are another option. An infuser is a device containing a needle or catheter (a flexible plastic tube) that remains under the skin for up to 72 hours.

When a person needs to administer insulin, they inject the insulin directly into the infuser, rather than into the skin. This method reduces the number of times they would need to insert a needle into their skin.

Yet, another method is the use of jet injectors. This does not use needles. Instead, a thin, high-pressure stream of insulin is forced through the skin.

Although jet injectors do not involve needles, the pressure can cause bruising.

Insulin can also be delivered using insulin pumps, if you can afford them. These are small, computerized devices that provide a steady, measured, and continuous dose of basal insulin, or a surge of bolus insulin at mealtimes. The insulin is delivered through a catheter that is taped in place on the skin.