Higher Dose Basal Insulin in Type 2 Diabetes: Challenges and Solutions

Challenges with Higher Dose Basal Insulin Dosing

Challenges with Higher Doses of Basal Insulin

You’re prepping your insulin pen for a dose of long-acting insulin. Normally you take 65 units. You roll up your insulin pen and it gives you a hard stop at 40 units as you’re near the end of your pen. Sighhhhhhhhh. Now, you’ve got to figure out what to do. Do you take two shots— 40 units out of this pen and 25 units out of a new pen? That means two shots, more time, more hassle. Maybe you should just toss this pen, get a new one, and take the full dose out of it. Ugh, but that’s such a waste— insulin is so expensive. And you may end up running short of insulin by the end of the month. Crud. Maybe you just take the 40 units, forget about the extra 25 units, and call it a day. But then the blood sugars…..

If you inject with insulin pens, you’ve likely run across this scenario multiple times. If you have T2D, you may run across this issue every few days or weeks! The strain of making these decisions can be burdensome. And, it’s likely that this scenario is not even on your healthcare provider’s (HCP) radar. In a recent study, HCPs greatly underestimated these types of challenges for users of long-acting (otherwise known as basal) insulin. Which means it can feel isolating or frustrating to face these kinds of decisions.

Communication with Your Healthcare Provider Is Key

So, what can be done? First, HCPs need to understand what makes it hard to take insulin consistently. The BEST way they can learn is by getting your feedback. I know we’re not so great in the medical field at creating a supportive environment to discuss these things. You may feel embarrassed about struggling with insulin dosing. However, these are important issues that you’re not alone in facing. Well over half the people with T2D surveyed in the above-mentioned study were shorting their insulin doses multiple times a month. Over 40% were wasting insulin by tossing the remaining insulin in a pen. And many reported feeling stressed when faced with decisions about wasting insulin, taking more than one injection to get their full dose, and so on.

Questions to Ask Your Provider

To open the door with your HCP, try some of the options below:

“I’m not sure what to do when my pen doesn’t have enough insulin left in it for my next shot. What are my options?”

“What do some of your other people with diabetes (PWD) do when they don’t have enough insulin left in their pen for their next shot?” 

Bringing up insulin issues with your provider can also help them understand what you’re able and not able to do. For example, splitting your basal insulin dose (taking two shots a day vs one) may be a good fit for you to decrease the number of times you’re faced with a partial insulin pen dose.  (Interestingly, people with T2D were less bothered by two doses a day than their HCPs). On the other hand, having to dose twice a day has its challenges. Research has repeatedly shown that the more injections you’re prescribed, the harder it is to get all your doses in consistently. Not to mention the usual challenges of taking insulin or any medication—not getting refills in time, forgetting your medication at home, competing family and work responsibilities.

Be Open and Honest about Your Challenges with Basal Insulin

Here are some more conversation starters with your HCP:

“I’m struggling to get my evening insulin injection done, what are my options?”

“Can we try splitting my insulin doses for a few weeks? It seems like I’m short insulin doses in my pen about every 2-3 days and it’s stressing me out!” 

“We tried splitting my insulin doses, but I’m struggling to get my second dose in more than I thought I would. Should we switch back to once daily? Are there any alternatives?”

These conversations are so important. Sometimes there are things your HCP can do to help.

Your HCP Can Provide Basal Insulin Options

Concentrated insulins that can deliver higher doses (up to 160 units) at one time are game changers. Pens like the Toujeo Max SoloStar hold 900 units (compared to 300 units in standard pens) and the Tresiba FlexTouch U-200 pen holds 600 units.

Not only can they decrease how often you’d have to dose, but also how many times you’ll run into a dose shortage in a pen. Also, it means having fewer pens take up your fridge space!

For some people who need to take two injections a day, timing them back-to-back vs morning and night may make it easier to get both doses in regularly. Even off-label options could be explored — such as using a disposable insulin pump patch along with a basal dose to address your insulin needs.

Not all challenges you face with insulin dosing have a solution. For all the advances in insulin types and devices, taking large basal doses consistently can be tough. Remember you’re not alone; many others with T2D are facing similar challenges. Be bold and create space to troubleshoot with your provider. Help them understand the day-to-day reality of insulin decision-making and what you need to be successful.


Additional Resources:

The Benefits and Barriers of Insulin Pump Therapy in Type 2 Diabetes

What to Do If You Miss a Dose of Insulin

Overbasalization in Type 1 and Type 2 Diabetes: You Can Have Too Much of a Good Thing!

Type 2 Diabetes on a Budget

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