5 Insulin Mistakes You Need to Avoid

If you use insulin to keep your blood sugar in check, these five common mistakes could lead to dangerous lows or highs. What you need to know:

insulin injections1. Wrong dose, wrong insulin. There are four basic types of insulin: Rapid- and short-acting insulins are injected before a meal to cover the rise in blood sugar from the food you’re about to eat; intermediate- and long-acting insulins control blood sugar for up to 24 hours, covering periods of time when shorter-acting types have stopped working.  People with type 1 diabetes often take a combination of shorter-and longer-acting insulins – and that’s where mix-ups can happen. Among the most common: Taking a too-high dose of a rapid-acting insulin because you’ve mistaken it for a longer-acting type, according to a report in the journal Clinical Diabetes. The danger: Low blood sugar.

The fix: If this happens to you, eat enough carbohydrates to cover the extra insulin, keep monitoring your blood sugar, watch for signs of hypoglycemia (such as shaking, sweating or a headache ) and call your doctor right away if you have any concerns. To prevent it from happening again, make sure you know which insulin is which and what the right dose is. In a 2014 report in the journal Prescrire International, experts note that sometimes, doctors and pharmacies abbreviate the word “units” to “U”, which can look like an extra zero, leading people to take insulin doses ten times higher than prescribed. Ask your doctor or pharmacist if you’re unsure of the right dose.

2. Sharing an insulin pen. Insulin pens are a convenient way to get a just-right dose without filling and injecting yourself with a conventional syringe. They can be used multiple times, with a new needle each time. But a fresh needle doesn’t mean sharing’s OK. The Centers for Disease Control and Prevention warns that blood and skin cells can be sucked into the insulin cartridge during a shot. Sharing a pen is the same as sharing the same syringe and could expose you to infectious diseases. Earlier this year, the FDA told insulin pen makers to add a warning label about sharing to packages.

The fix: If you and other people in your household use insulin, make sure everyone has their own pen.   

3. Skipping or not taking enough insulin when you’re sick. If you’re so sick you can’t eat or are vomiting or have diarrhea, you may think you don’t need insulin because there’s little to no food in your digestive system. But don’t make the mistake of skipping your insulin; blood sugar levels may actually rise higher than usual because your body’s under stress.  

The fix: Work out a ‘sick day plan’ in advance with your healthcare professional so you know how much insulin to use. And be sure to call your doctor if you’ve had vomiting or diarrhea for more than six hours, if your blood sugar stays over 240 despite following your sick-day plan, if you have symptoms of dehydration or ketoacidosis (high levels of dangerous compounds called ketones in the bloodstream) such as chest pain, trouble breathing, fruity-smelling breath or dry lips and mouth; or if you’re not sure what to do.  

4. Storing insulin incorrectly. Potency—insulin’s ability to control blood sugar—drops when insulin is exposed to heat or extreme cold. The longer the exposure, the less effective it becomes. The ideal conditions? Unopened insulin stored in the refrigerator (set between 36°F and 46°F) should stay potent until the expiration date. An opened vial can be stored at room temperature or in the refrigerator for up to 28 days, according to the U.S. Food and Drug Administration. (Insulin that’s been diluted or taken out of the vial should be thrown away after two weeks.) 

The fix: To protect potency, never store insulin in the freezer, in direct sunlight or in the glove compartment of a car, the American Diabetes Association recommends. If you’re traveling with insulin in a cooler pack, make sure it doesn’t freeze. Don’t use insulin that’s been frozen, is past the expiration date or that’s been stored at room temperature for longer than recommended. And make sure the insulin looks ‘normal’ before each use—no clumps, particles, discoloration or frosting on the inside of the bottle.   

5. Exercising when insulin’s peaking. Hitting the gym or your local walking trail at the same time a dose of insulin is reaching peak effectiveness in your body could lead to low blood sugar. Exercise uses up blood sugar as well as glucose stored in the liver; as insulin “pulls” more blood sugar into cells, levels could drop dangerously.

The fix: Check your blood sugar before, during and after exercise; if it’s low, have a snack that you know will raise it. Carry glucose tablets or a carbohydrate-rich snack with you in case your blood sugar drops while you’re working out. Skip hot tubs, saunas and steam rooms afterwards; by keeping your heart rate up, these can decrease blood sugar levels even further. If problems persist, talk with your healthcare professional and work with them to create a plan in order to adjust your doses surrounding activity.

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