ASK THE DOCTOR

by Wesley W. Wilson, MD

NOTE: If you have any questions for "Ask the Doctor," please send them to the VOICE editorial office. The only questions Dr. Wilson will be able to answer are the ones used in this column.

Wesley W. Wilson, MD, has retired as an Internal Medicine practitioner at the Western Montana Clinic in Missoula, Montana. Dr. Wilson was diagnosed with type 1 diabetes in 1956, during his second year of medical school. He remains interested and involved in diabetes education for patients and professionals.

Q: It seems that as I approach mealtimes, I'm almost always "low." Shouldn't I eat first, then, and take my insulin after the meal?

A: The first part of my answer is that if you are often low at mealtime, you should make some adjustment to your treatment, so as to avoid the lows. "Low blood sugars" can have dangerous consequences, and the best course is to avoid them in the first place. Frequent "lows" can cause hypoglycemic unawareness, in which you lose the ability to sense that you are heading into an insulin reaction. Serious injuries can occur during hypoglycemia.

The answer you wanted is easier to give now that we have the very fast-acting insulin called Humalog. Regular insulin (previously the fastest we had) can take 30 minutes to start having any effect. If you inject "R" insulin at mealtime, or after you finish your meal, your blood sugar might rise too high before the injection could take effect. Now, with quick-acting Humalog, it is appropriate to eat and then inject, or as manufacturer Eli Lilly and Company suggests: "Inject while looking at your food."

You can determine if it works by checking your blood sugar two hours after your meal. It should be below 180mg/dL, unless you and your doctor have selected a different postprandial sugar target. With human Regular insulins, such delay of injection very frequently leads to high sugars two hours after a meal.