Finding the Right Mealtime Insulin


Amy Rushlow

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If your doctor has suggested you take insulin before meals, you now have more treatment options for your diabetes than ever before. So how do you decide? Your lifestyle, diabetes type, age, and how your body reacts to treatment will determine the right type of insulin for you.

Which Mealtime Insulin Is Best?

There are two main categories of mealtime insulin. Some people take background insulin once or twice a day and rapid-acting insulin at one or more mealtimes. Other people use premixed insulin, which combines rapid-acting insulin and a longer-lasting insulin into one medication.

Background plus mealtime insulin may be best for you if:

  • You are able and willing to give yourself shots before meals. With mealtime insulin, you may have to inject yourself two to five times a day.

  • You’re OK with carrying insulin with you and checking your blood sugar several times a day

  • You have an irregular schedule or diet. Mealtime insulin allows you to adjust your dose depending on how many carbohydrates you eat.

  • You eat only one major meal each day

Premixed insulin may be a better fit for you if:

  • You have a low risk of hypoglycemia (low blood sugar). Premixed insulin can make blood sugar drop too low in some people.

  • You find it hard to give yourself multiple shots during the day. Some people find it difficult to give injections at work or school.

  • You regularly eat three daily meals, usually at the same times each day. If you don’t eat regular meals while taking premixed insulin, your blood sugar may get too low.

  • You’re looking to save money on your medications. You pay only one copay with premixed insulin, compared to two copays with background plus mealtime insulin.

Injection-Free Options

About 20% of people prescribed insulin injections regularly miss doses, according to a study in  Diabetes Care. It can be difficult to fit injections into your daily life. Fortunately, you have alternatives.

An insulin pump delivers insulin through a small tube connected to a needle that is taped in place. The computer in the device controls the dose of insulin you receive. A pump can deliver a steady dose of background insulin. You can also give yourself mealtime insulin using an insulin pump.

Some insulin pumps help you calculate the amount of insulin you need before a meal. One study found that this method is more accurate than calculating a dose on your own.

The FDA also recently approved an inhalable fast-acting mealtime insulin, called insulin human (Afrezza). Studies show that it improves long-term blood sugar control. You shouldn’t take it if you smoke or have a chronic lung disease, such as asthma.

Work with your doctor to determine which type of insulin is right for you. Be open about your lifestyle and how likely you are to follow the treatment regimen he or she suggests.

Key Takeaways

  • Background plus mealtime insulin may be best if you’re willing to give yourself shots before meals, can check your blood sugar several times a day, and have an irregular schedule or diet.

  • Premixed insulin may be a better fit if you have a low risk of hypoglycemia, you find it hard to give yourself multiple shots during the day, and you regularly eat three daily meals, usually at the same times each day.

  • It can be difficult to fit injections into your daily life, but there are alternatives, such as insulin pumps and inhalable insulin.

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Medical Reviewers: William C. Lloyd III, MD, FACS Last Review Date: Dec 22, 2016

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View Sources

Medical References

  1. Is the mealtime insulin approach working? Endocrine Society. (
  2. Is mealtime insulin right for me? Endocrine Society. (
  3. Insulin & other injectables. American Diabetes Association.
  4. Fact sheet: diabetes and insulin, Endocrine Society. (
  5. Sussman A, Taylor EJ, Patel M, et al. Performance of a glucose meter with built-in automated bolus calculator versus manual bolus calculation in insulin-using subjects. Journal of Diabetes Science and Technology. 2012;6(2):339-44.
  6. Peyrot M, Rubin RR, Kruger DF, et al. Correlates of insulin injection omission. Diabetes Care. 2010;33(2):240-5. (

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