Is timing of pre meal insulin is important for controlling post meal spikes of blood sugar in diabetics who are on insulin therapy ?

[patliputra]

Many of diabetics complain that even after taking insulin before meal, their blood sugar goes very high post prandially. Why it is so? Is it related apart from other factors,with the timing of pre meal insulin ?

[Hidden]

I was advised by my physician to have insulin (novomix 50) ten minutes before BF and dinner.Working fine for me.

[patliputra in reply to Hidden]

Can there be any rationale or explanation why the time interval between insulin injection and meal is so important ?

[Hidden]

No doubt it is expensive,but in old age(73) with out any other proclivities,I am able afford it.Also,certain other oral drugs have been dropped.I think I may be able avoid the side effects of those drugs in the long run.Not only my sugar numbers but several other factors like skin condition have improved,after insulin.So,reconciled to the additional costs.Our worthy Finance Minister is himself a diabetic.Let us hope he will give some relief to his co-sufferers.

[patliputra in reply to Hidden]

The important thing is that it has helped you to control your blood sugar, at same time saved the cost of several oral hypoglycaemic drug. When cost is weighed against the effectiveness and advantage,the price becomes insignificant if one can afford.

[Hidden in reply to patliputra]

Very true.Thank you.Also,I am no longer worried about diabetic complications as I advance in age,

[patliputra in reply to Hidden]

Age is only a number. You are as young as you think. My best wishes.

[patliputra]

What I am going to write is already known to you,but still, I am repeating it. Different diabetics are prescribed different insulin ,taking into consideration, a wide variety of factors. . The choice of insulin depends on the time of bs spike,which is required to be controlled. It is reasonable to expect that after meals or snacks blood sugar will rise. But if the spike is beyond accepted level,it needs to attended. Does it remain high or come down within limits after a few hours say 2 /3 hours. Or it remains continuously high never coming down within reasonable range. Both the condition will require different type of insulin. If it spikes mainly after meals/snacks, obviously a short acting along with an intermediate acting insulin is required to prevent both post meal and pre meal rise in blood sugar,example is novo mix 50/50 or 30/70.

Glargin or Lantusis a long acting insulin, specially suited to most cases of type 1 and in type2 where it is suspected that practically very little insulin is produced.

[mapalli]

One must understand the kinetics of carbohydrate digestion,glucose liberated, absorption from intestine into blood,and insulin secretion pattren in normal individuals. Carbohyrates after digestion(digestion is enzymatic cleavage of polymeric long chain glucose to monomeric units ,glucose) the released glucose enters through glucose transporters in the intestinal cells into blood. A time course of glucose appearnce in blood can be plotted in graph sheets(Y-axis respresents glucose units and X-axis representd time in minutes, like 15,30,45,60,75,90,105,120.) It wiil be observed that glucose appearance increases gradually reaching peak around 45-60 minutes then decrease slowly to near just about 120-140mg. This is called bell shaped curve.one normally plots total Area Uder Curve for glucose(AUC )to indicate glucose area.

Since glucose itself insulin gogue, insulin secretion also increases inrelation to quantity glucose it aslo increases slowly gradualy, parelly,peaks also like glucose level and the total insulin released is AUC of insulin.

Hence the most important consideration is "coincidence "of the both peaks of glucose absorption and insulin sercetion and weaning of the insulin levels.

Imganine in diabetic condition on insulin. You are giving insulin extraneously through subcoutenous tissue(insulin never given intravenously,it is fatal and dangers unless there is medical supervision), the insulin absorbed (not secreted as in normal case) slowly, gradually and enter from fat cells to blood capilaries(this lag time) in such way the peak insulin value should "coincincodes "with glucose values to get best control of glucose. Let us imganine if insulin peak is "earlier "to glucose peak ,then drop in glucose will be drastic leading to hypoglycemia temperorarily, second situation if insulin peak is "latter "than glucose peak then glucose disappearnce from plasma is so drastick ,like person dropping from cliff, or diving from spring board of swiming pool, leading sever hypoglycemia.

Hence mangament of insulin injection consisting of slow acting &fast combination becomes very important.

Incontrast insulin secrtoroguges tablets try to secret just intune with glucose peak since they are taken along with food.Here also the peak concentration of drug in plasma, insulin secretion of insulin glucose peak should hand in hand other wise.one point remember is that the drugs continues exrert action since their pharmokinetics varies, compared to insulin. Hence excess is also excert their side effects.

Thus insulin sensitizers are preferred in the treatment.

Dr.MKJ.Sarma,

Molecular endocrinologist.

[patliputra]

Physiologically you are very correct about coincidence of peaking of both ,glucose and insulin, for maximum benefit and prevention of post prandial hyperglycaemia. So timing of insulin vis a vis meal is very very important. How to time insulin inj. In relation to meal. Of course will depend on the type of insulin,taking type of as a constant.

In practice,what time is near perfect for insulin taking ,30 min. Or 20 or 10 min. Before meal or with meal or after meal, so that glucose and insulin peak at the same time. Any thoughts?

[patliputra]

You are right. Many research papers are available on net,where it was tried to to estimate average peak time of glucose in blood after meals. It was found that on average of 72 mins. + _ few mins. So any insulin which peaks during time range,can effectively control post prandial peak.

I am emphasising on pp bs spike ,because HBA1C reading is mostly dependent on it,even when bs is near normal most of the times.

[patliputra]

Dear Indiacratus , without disagreeing with you, we are not working on imaginary lines.as a matter of fact ,always an endeavour is made to coincide insulin peak with post meal peak. The onset,duration and peak action of insulin, is only very very approximate,as it varies person to person and is dependent on many other factors. So it is always difficult to accurately predict the coincidence,tial and error method is used. So many times it is possible to prevent post prandial spike, simply by shifting time of injecting insulin ,10-30 mins.before meals.

You are right when you say that HBA1C is a measure of average glucose over a period .But when it is said that A1C mostly depends on pp spikes ,it also very correct.The explanation is very simple. During peak hyperglycaemia most glucose molecules bind with protein in haemoglobin,,more than other times when blood sugar is high. And it is the number of bound glucose that determine the HBA1C

For both of these a number of references are available on web. May be I will post it to you some time.

[patliputra]

No price do not influence decisions,it is always the concern about the welfare of the diabetic .

[Hidden]

I came across the following article relating to the topic in question.Please open the link below:

webmd.com/diabetes/guide/di...

[patliputra]

I am putting few references for your perusal

em_consulte.com/en/article/...

diabetesselfmanagement.com.... glucose management

Clinical.diabetesjournals.org/content/20/1/11

Mendosa.com/insulin_timing.htm

[Hidden]

ADA or any other website holder do not come on this site for propagating theirs theories,neither they are forcing any body to follow them,then why any body feels prejudiced to them? You are here to propagate your website and not for any wishful thinking. It is better you forget for others websites and concentrates with your one.