Insulin is a hormone produced by the pancreas that helps keep blood sugar levels balanced when you eat. With type 2 diabetes, the body doesn’t produce enough insulin on its own. Most of the time, we’ll start treating type 2 diabetes with a combination of lifestyle changes, oral medications, and non-insulin injectable medications. However, over time, most diabetics will eventually need to take insulin to keep blood sugar levels balanced. There are a number of different types of insulin, from long-acting insulin that lasts all day, to rapid-acting insulin that works only for a short period of time. This rapid-acting insulin is also known as mealtime insulin, because patients take it right before a meal. Examples of mealtime insulin include insulin aspart (NovoLog), insulin lispro (Humalog), and insulin glulisine (Apidra). Mealtime insulin provides your body with enough insulin to cover the carbohydrates you’ll eat and brings your blood sugar levels back down after a meal. Mealtime insulin can be a really effective tool in keeping diabetes controlled, but it can also be a big lifestyle change to make. Here are some of the tips I share with my patients to help them stay on top of their mealtime insulin. 1. Be honest with your doctor. When patients are first starting out on mealtime insulin, it’s crucial they’re honest with their physician about their capabilities. If you know you’ll struggle to keep a regular meal schedule, or are likely to forget to take your insulin often, let your doctor know. Telling your doctor you can do it, but then not doing it, is not going to help you. If taking mealtime insulin three times a day with meals is not working for you, that’s okay. Your doctor can find a different solution. When my patients have this problem, I tell them to start out with just one mealtime insulin dose with their biggest meal of the day. Then, slowly, we’ll work our way up to three injections a day if we can. 2. Enlist your support system for help. Whether it’s one, two, or three injections a day, ask your family members or friends to help you remember your mealtime insulin. Most of the time, we don’t eat alone—you might eat breakfast with your spouse, lunch with your coworkers, and dinner with family or friends. Let your loved ones know you’ve started on mealtime insulin so they can help remind you to take your dose before meals. This can also make you more comfortable giving yourself the injection in front of others—if your friends and family are on your team supporting you, you won’t feel embarrassed to take out your insulin pen or syringe. The more comfortable you feel about your injections, the more likely you are to take them. 3. Understand carbohydrates. Each time you give yourself mealtime insulin, you’ll need to estimate your dosage based on how many carbohydrates you plan to eat. It’s common for my patients to not really understand what carbs are and accurately assess their portions. Carbs are found in dairy, fruits, grains, beans, starchy veggies like potatoes, and sugary sweets. Often, patients think they’re making healthy choices when they eat fruit, but all fruits are carbohydrates that can raise blood sugars. I tell my patients they need to always look at the “total carbohydrates” number on nutrition labels. For example, food items labeled “sugar-free” often have carbohydrates. While there may not be refined sugar in sugar-free cookies, the flour is a carbohydrate you need to account for. Sugar-free candies tend to use sugar alcohols, which still count as carbohydrates. And watch out for sauces and creams—anything creamy is typically made with half-and-half or milk, which are carbohydrates. Even salad dressings can have a high number of carbs if you’re not careful. I ask my patients to limit their meals to four carb servings per meal, or 60 grams of total carbs per meal, and avoid all sugary beverages like juice and regular soda. Snack foods are especially high in carbohydrates, and I tend to recommend my patients stay away from carbohydrates between meals. Pay attention to ingredients and nutrition labels, and watch your carbohydrate portions. Accurately assessing the number of carbs you’re taking in will help you use your mealtime insulin correctly and control your diabetes effectively. 4. Think long-term. It’s easy to get overwhelmed with your busy day—you’re working hard and have barely enough time to grab lunch, much less take your dose of mealtime insulin. But I always try to motivate my patients by thinking long-term. It’s important to know why you’re prescribed mealtime insulin and why you need to treat your diabetes. Often, people don’t experience immediate symptoms when their blood sugar levels are high, so they don’t feel compelled to act. But when you think about yourself 20 or 30 years down the line, it becomes clearer why committing to your diabetes treatment is so important. If you don’t start controlling blood sugar now, you might lose your eyesight, need kidney dialysis, and even live with an amputated foot in the future. Those are all very scary things we don’t want to happen. But it’s key to understand the risks so you understand your decisions now will really impact you decades later. 5. Use an insulin pen if you can. I tell my patients to find out if their insurance will cover insulin pens, rather than vials and syringes. Insulin pens are much easier to use and carry with you—you can keep it in your pocket or purse so you’ll always have it. I find my patients who use pens are more likely to commit to taking their mealtime insulin as prescribed, since they always have it with them and can inject themselves more easily. 6. Turn to technology. If you tend to eat alone, or don’t feel comfortable asking others for help, I recommend taking advantage of your smartphone. Set daily reminders when you typically eat meals so you always know it’s time to take your insulin and eat. You can also download various apps on your phone to help you estimate how many carbohydrate servings are in your meal, whether you’re eating out at a restaurant or enjoying a homecooked meal. It can be tricky to commit to your mealtime insulin every day, but it’s worth it. Use the resources available to you—your physician, friends, family, smartphone, and more—to stick to this important regimen so you’re able to live free of complications for many years to come.