Amy Tenderich was diagnosed with type 1 diabetes in May of 2003. She is the founder and editor-in-chief of Diabetes Mine and co-authored the book Know Your Numbers, Outlive Your Diabetes. You will frequently find her speaking at diabetes, health, and social media events across the country.
People without diabetes have a great, fully automatic system controlling their insulin output, while we people with diabetes might be said to be operating on “manual transmission.” We need to constantly think about what gear we’re in, and make adjustments.
The bodies of non-diabetic people constantly secrete low levels of “background” insulin to cover their basic metabolic needs. Their bodies also secrete short bursts of insulin during meals to help absorb the food-induced increases in glucose. Their healthy pancreases simply know, automatically, how much insulin is required to cover any given food they might eat.
In people with diabetes, this system is “broken.” Type 1 diabetics generally don’t produce any insulin at all, and the bodies of people with type 2 can’t process the insulin that is present. So we use insulin shots to do our best to mimic these two types of insulin secretion.
The background, or “basal” insulin is given to diabetics in the form of a long-acting insulin such as Lantus, NPH, or Levemir insulin. This allows glucose—the common fuel for your body’s cells—to leave your blood and enter the cells.
The other type of insulin secretion, in response to a meal, is called a “bolus” dose, and is given to diabetics in the form of a fast-acting insulin such as Humalog, Novolog, Apidra, or regular insulin. It is necessary to calculate the amount of“bolus” (mealtime) insulin needed to cover the carbohydrates you will eat at any given meal.
Again, the constant challenge is to administer insulin via a needle, insulin pen or pump, or other device, in a way that most closely replicates the body’s basal and bolus needs.
Note that many type 2 diabetics take basal insulin only, often in the form of once- daily Lantus shot. This is usually sufficient to cover their insulin needs for many years.