Not Tracking Your Insulin Doses? This Doctor Shares Why You Should
Do you ever forget how much insulin you took with a meal you’ve had? Or do you forget if you’ve taken your insulin, at all? One of the challenges to developing a consistent, effective routine for taking insulin is remembering to track your dosages. While it’s easy to believe that we can keep our “numbers in our head”—tracking your insulin dosages can help make managing type 2 diabetes easier, as well as get more out of your appointments with your providers. In the interview below, Tejawsi Kompala, MD, an adult endocrinologist, shares some strategies for logging your insulin, the benefits of doing so and how smartpen technology can help.
When other medications aren’t working and it’s time to start insulin, what responses do you receive from your patients? What concerns do they have?
It’s a big spectrum. I think when someone needs to start insulin, there can be a whole range of emotions. I think common ones are fear, guilt, shame, feeling like a personal failure, or just a lot of unknowns. Unfortunately, a lot of misconceptions are out there related to insulin. So I really think it’s important to help people understand that, this is not a personal failure. Type 2 diabetes is a progressive disease. This is just a sign that you may need additional assistance from the outside world and insulin that your body can’t make.
So I try and normalize it, but address some of the emotions. I do think, I would say, that if people have any specific thoughts or fears or questions about it, get those out in the open. Talk with your health care provider, because it’s way better to just get it addressed up front than have a lingering thought in the back of your mind. There are lots of tools in the toolbox for type 2 diabetes, and insulin is one of the really good tools out there.
Do you often have patients on insulin who overestimate or underestimate their insulin dosages?
Yeah, this is a really common issue. I think it’s true for both basal insulin and then absolutely true for bolus/mealtime insulin. I think, off the bat, one thing I’d always say is that when you first start insulin, there are a lot of ways for your healthcare provider to make a really good educated guess based on what they think is going to be the right dose. But it will almost never be perfect right away, and we should expect that there’s going to be some trial and error, a couple of tweaks to the dose. So I like to just set people up for the expectation that, hey, it’s going to take us a couple of tries to get to the right place, and that’s okay. It doesn’t mean that it’s not working. It doesn’t mean that anything’s going wrong. It’s just going to take a little bit of time for us to get there. So, that’s one thing I’d say.
Then on the patient’s end of things, people are wanting to make sure they’re taking the right amount, but you need a lot of data and a lot of understanding of what’s going on in your life to really know, was that the right amount for me? Was that too much too? Too little? So I know we’re going to talk about it, but really common, I think the answer is there does have to be some emphasis on making sure you know what you’re doing in terms of food, insulin, what’s going on in your life and to communicate that with your provider. It helps so both people together can make sure that you’re at the right dose.
What are some tips that you give people about logging it? Why is it important, why is it challenging for some patients, and does logging insulin make doctor’s appointments more productive?
Focusing specifically on mealtime insulin. We already know that living with diabetes is hard, right? So it’s like a second job, you’re already thinking about a lot of things all day, every day. And so I think my main mantra is, do things that are going to help you, but sustainably, and let’s try and make it the easiest way possible. So, specifically related to logging, I think the main reason why I think that it’s important is that it’s hard to remember to take your insulin. This is a classic and common problem. When you’ve got a thousand things going on, to remember, “Did I take my breakfast insulin or my lunchtime insulin?”—can actually be hard. So I think sometimes logging it helps yourself or another person reflect a little bit on, did I mindfully take my insulin or just a little bit of accountability there to keep a record of what’s been going on.
So I think the first goal of logging is, did it happen or did it not happen? Because you need to really know if you took the insulin, yes or no, to then evaluate if that dose is working out for you or not. The second aspect I’d say is really to then figure out, well, was that the right dose for me? I think that’s really where that’s a conversation, a data-informed conversation, between a patient and between their provider needs to happen. And you need some information to really understand, is that the right dose? So the specifics and the things that I think are most helpful are blood glucose lagging, you’re paying attention to what was my blood glucose at the time. Paying attention to how much insulin did I take, was it two units? Was it 10 units? Having that information in a way that you can record it really easily and keep up with it, but also that it can be interpreted and shared and looked at by others is going to make it the most successful.
You asked, is this an important component of having an effective or productive doctor’s visit, and 100 percent I think the answer is yes. So there are a lot of studies out there that when we don’t have all the data that we need between patient and provider, oftentimes, we just kick the can down the road. We say, okay, well we’ll figure it out next time, keep doing what you’re doing. But I think if you can have all the data right then and there, it can lead to a lot more of an informed conversation and adjustments can be made, conversations can be had, and questions can be answered.
Do you think there’s probably an emotional component to logging our insulin dosages, as well?
Absolutely. I think most people are aiming to really have blood sugar numbers that are really in control and do the right thing, but it’s hard and it’s day-to-day, every day is different and life is challenging. I think as much as possible to not put so much judgment on yourself or on the numbers and just realize, that we’re really just collecting pieces of the puzzle here to figure out what works, and what doesn’t work, and it’s a step by step process.
What are some easy ways to start logging and keeping track of insulin dosages? Are there any apps or log books that you recommend?
I think importantly, do the one that feels right to you. If you are a pen and paper person, pen and paper are perfectly okay. But if you are a person who likes to use apps or other kinds of technologies out there, there are plenty of good ones. So the clinic that I work in, we actually have a physical little book that we give to a lot of people. And a lot of people actually like to use that. For some of my folks who like to use apps, there’s a bunch I’ll recommend, just some popular or common ones. Glooko, Tidepool, mySugr. I know these come up a lot, but there are a lot, so I think that you’re welcome to look around and see what interfaces you like the most.
Also, let’s remember, let’s try and decrease the work as much as possible, right? Like the daily work of living with diabetes. If you have a glucometer or if you have a continuous glucose monitor (CGM), a lot of times the device itself is going to have its own software so that without doing any additional work, it’s just the record is right there. And so I definitely encourage anyone for the devices that you use, to look into them and see what software is already there so you don’t have to reinvent the wheel.
Smartpens are revolutionizing multiple daily injections (MDI) therapy, especially for people with type 2 diabetes. How do you think smart pens help improve insulin management, and do you have patients who use them and have seen improvements in their diabetes care?
I think about smart pens as kind of bringing the power of pumps to pen therapy. A lot of my patients really like most is one, even just the memory features. So a lot of the smart pens out there have the ability to track when did you take your last dose, you can set up reminders. For me personally, I think for myself and for a lot of the patients that I work with, I think smart pens that have bolus calculator support are incredible. Specifically, I’m talking about a lot of mental math sometimes is required for figuring out, well, how much insulin should I be taking at this particular meal based on how much food I’m eating and where am I right now with my blood glucose? What I love is that a lot of smart pens have bolus calculator functionality kind of built-in with them, which can then help remove part of your brain’s burden in terms of having to figure that out yourself.
I think a lot of insurances are increasingly covering them, and they can be a lot more affordable and accessible than getting into pump therapy. So, I have been recommending smart pens to a lot of my folks who are using pen therapy. Even if they don’t use all the kind of bells and whistles features about it, from the provider perspective, sometimes even just the tracking and the logging of insulin data that happens automatically without any additional effort from the user can be really helpful for the visit. At least that can help me understand you took five units then and what happened after. It can really help bring the data to the conversation like we were talking about.
Do you have any other tips about logging insulin that you wanted to share with the type 2 diabetes community?
What I’d say is that a little bit of data can go a long way. So even if it’s not every single day that you’re logging data, I think especially sometimes before you’re about to have a visit or if there are questions or concerns on your mind, those are especially good times to really focus on logging. Because I think then your effort really pays off in terms of making sure that you can see what the next steps are.
Educational content related to insulin use is made possible with support from Lilly, an active partner of Beyond Type 2 at the time of publication. Editorial control rests solely on Beyond Type 2.
