Tag Archives: #Claudine Lee #dexcom #blog

How does insulin work?


There are quite a few different types of insulin on the market and a whole bunch of brand new ones arriving soon.

The basic broad classification is long vs short acting. As their name implies they are long or short acting. What does that mean? When you require insulin you have both basal needs as well as prandial (meal time) needs. Your basic and ongoing metabolism needs glucose to go into the cells (all the cells in the whole body) on a minute to minute basis and hence a basal requirement of both glucose and insulin. Insulin is the key that gets the glucose in. When you eat carbohydrates you then require insulin to get the glucose load out of the blood circulation and into the cells where it can be used as fuel.

The long acting insulins cover basal requirements and act for a long time – 6 – 24 hours and some new long actings with a duration of about 48 hours.

The short acting insulins act for a short period of time, starting within about half an hour of injecting and then lasting for around 4 hours. There are brand new ultra short acting ones that are soon to arrive.

Insulin is a dangerous substance and the most acute danger is hypoglycaemia. In other words you inject too much insulin and the sugar plummets very low. At different levels for different people but generally below 2.5 mol/l you not only feel awful but can become unconscious and potentially no longer require a bucket list.

For this reason it is imperative that if you are injecting insulin you understand how it works, when it starts working, how long it works for, the shape of the curve of the action and also imperative to know what your number is – your blood glucose. Before injecting insulin you should ideally do a glucose test and factor this number into the equation.

action of insulins

action of insulins

how do insulins work

how do insulins work

It’s in the detail


Type 1 diabetes is a diagnosis that rocks most families and patients and affects the entire family dynamic for the rest of the patient’s life. It’s affect is minute to minute and second to second and quality of life is a very key thing that gets given a good shaking up – of all affected.

Have you ever had a drop in sugar? How did it make you feel? Can you imagine going from high to low like a rollercoaster most days? That is what some patient’s face. Hard for the patient, harder still for the parent/care-taker.

For some people the term “brittle” diabetes is a swear word and does not exist, for some people it is an excuse to run their sugars all over the show. For me the truth is somewhere inbetween.

Certainly in my experience there are definitley patients who are more sensitive to insulin and in tiny alliqots than other patients, especially children, women at different times of cycle/states of hormones etc. It becomes incredibly tricky to get the “dosing” right on 4 injections a day. The more sensitive one is to insulin the easier I find it to manage patients on an insulin pump. This will enable smaller doses, a 1/3 less of a total daily dose and easier titrations in these sensitive candidates.

Life after diagnosis is tricky and quality is key. Every minute and every second counts towards that. A roller coaster is no way to live. Rather a smoothie – nice even sugars, minimal variation and mostly at target makes for a happy patient.insulin pump

A 2 % drop in A1c with just one addition – I call it a “smoothie”


Recently I have started quite a few patients on dexcom and to my and their delight with this simple intervention we have achieved a 2 % drop in A1c – WITH obliteration of hypos over a 2w to one month period. Previously unheard of!

For a type 1 diabetic who has long battled with both low sugars and high averages – neither good in long or short term it is a great joy to see the “smoothing” out of a very detailed download (c/o dexcom).

Yipee Yay!!dexdowndex sensor

all in the green, no lows no highs

all in the green, no lows no highs

Dexcom spaghetti


How does one unravel the download of dexcom spaghetti? I find continous monitoring is HUGELY beneficial to the patient on a literally minute to minute basis and in terms of the “knowing” what their sugars are and in terms of littlies the mom or dad “knowing” minute to minute “where” things are at.

For the health care professional however there is a lot of spaghetti to wade through.

My personal favourite is the graph that averages everything out and plots one average on a 24 hour day. For me I can USE this information to adjust settings and give advice. NO two days are quite the same, diabetes remains a learning game, but if you use your trends you will always win, just a little rhyme for a bit of fun.

Diabetes is a challenge, an obstacle, a learning game. I learnt recently from a very inspirational type 1 diabetic that one needs to dance with the obstacle. I am learning myself (as a health care provider) to dance with the obstacles I have in caring for diabetics.

how to unravel

how to unravel

dexcom difference


So I have 5 patients on Dexcom – continuous monitoring for diabetes. They are all type 1 patients (but type 2s could use this device too). It has made the hugest difference in terms of almost NO hypos ! Why? Because you see it dropping and you react !

Seems obvious but if you are diabetic you know how @@$$%% awful a low is. And being able to prevent is like a magic trick.

Also a lot less high excursions – you see the trend of it going up and you can exercise, run a temp basal or if really high like >15 do a correction bolus (aiming for not too aggressive otherwise you induce a see-saw pattern we are trying to avoid).

Delighted I am for them as well as all the other patients in the future that is it going to help.

The technology is simply one that works – an amazing little filament with embedded sensor that detects change that is fed into an algoryhtm. It is accurate, hard working, simply a wonderful armentarium in the diabetes tools.dexcom

Can I ask anyone out there to give feedback on their dexcom tips?

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