The body naturally produces a surge of insulin when we eat. This insulin “dose” breaks down carbohydrates into sugar, or glucose, for the body to use as energy. When you have diabetes, this natural insulin process doesn’t work properly. Mealtime insulin replaces the natural dose your body would give you at mealtime. Since your body can’t regulate the dose itself, you help by timing your meals with mealtime insulin injections. Examples of mealtime insulin include insulin aspart (NovoLog), insulin lispro (Humalog), and insulin glulisine (Apidra). If you skip a meal, you will most likely need to skip your mealtime insulin dose. If your blood sugar is low, your doctor may recommend a high-sugar snack such as half a cup of fruit juice or sugary soda. Every person is different, however, so it’s important to talk with your doctor about what to do if you miss a meal before you start taking mealtime insulin, especially if your eating habits tend to be irregular. It’s also a good idea to have a plan for what to do if you get sick and can’t eat for an extended period. When’s Mealtime for Mealtime Insulin? The American Diabetes Association recommends spacing meals evenly, not skipping meals, and avoiding eating too much at one time. Good rules of thumb are: Eat three meals a day Allow four to five hours between meals Eat around the same time each day An example schedule is: Breakfast at 7:00 a.m. Lunch at 12:00 noon Dinner at 5:00 p.m. If the early bird special doesn’t work for you, don’t worry. The important thing is to find a consistent schedule you can commit to. Make Breakfast a Priority With Mealtime Insulin Skipping breakfast has been shown to elevate blood sugar levels for the rest of the day. Don’t set yourself up for this battle with your blood sugar. If it gets too high, you’re at risk of hyperglycemia, and if it gets too low, you’re at risk of hypoglycemia. Both conditions can become serious enough to send you to the hospital. If you’re simply not a breakfast person, ask your doctor about working with a registered dietitian on breakfast options you can stomach. Plan ahead and have the right foods on hand to make the routine easier. Avoid Common Pitfalls at Dinner While skipping breakfast can un-do your efforts at blood sugar control all day, skipping dinner can disturb your levels overnight. Eating too much at dinner can throw you off, too. Dinnertime is a key time to keep an eye on your portions, as well as the number of carbohydrates in your meal, especially if you’re dining out. Keep in mind that alcohol contains carbohydrates to account for, as do mixers, like fruit juices that are high in sugar. Drinking alcohol in general makes blood sugar levels harder to maintain, and the effects of alcohol can fuzz the symptoms of low blood sugar. If you think you may have trouble controlling how much you drink, be honest with your doctor and ask for help. Mealtime Insulin & the Importance of Close Monitoring You can’t rely on symptoms to know if your blood sugar is too high or too low. Hyperglycemia and hypoglycemia share some of the same symptoms, such as fatigue and confusion. You may not have symptoms at all, especially if you’ve been living with diabetes for several years or if your diabetes has not been well controlled in the past. If you miss a meal, keep a close eye on your blood sugar levels and follow the next steps recommended by your doctor. Seek medical attention if your blood glucose levels: stay at 70 mg/dL or lower stay above 250 mg/dL or higher Seek emergency medical attention if your blood glucose levels stay above 300 mg/dL. This could be a sign of diabetic ketoacidosis (DKA), which happens when your body starts using fat for energy because it doesn’t have enough glucose. DKA can cause coma and even be fatal. Mealtime insulin isn’t the easiest treatment to master, but every diabetes treatment comes with pros and cons—and mealtime insulin may be the tool you need to control your diabetes. Be patient with yourself, give it a chance, and take pride in your daily wins. Don’t forget to consistently refill your mealtime insulin prescription, and reach out to your doctor with any doubts or concerns so the appropriate changes in treatment can be made if you need them.