Richard K. Bernstein, MD, FACE, FACN, FACCWS
Part 10 Chapter 22
Modifications of Preprandial or ISA Regimens to Accommodate Gastroparesis
It takes a while for your physician to select and fine-tune a program to improve stomach-emptying. In the meantime, it’s possible to reduce the frequency and severity of postprandial hypoglycemia. To do this, you must slow the action of preprandial insulin or ISA to match more closely the delay you experience in digesting your meals. Let’s suppose, for example, that you’ll be using preprandial rosiglitazone. If you have gastroparesis, your doctor may ask you to take it 10, 30, or 45 minutes before eating, instead of the usual 60–120 minutes. If you’ll be getting preprandial shots of regular insulin, your physician may want you to inject immediately before eating, instead of the usual 45 minutes. If regular still works too rapidly for your slow digestion, you may be asked to take it after your meal. Alternatively, you might substitute 1 or more units of NPH insulin for 1 or more units of regular in your syringe, to slow the action. If, for example, you are asked to inject a preprandial mixture containing 4 units of regular and 1 unit of NPH, you would draw the 4 units of regular into the syringe in the usual manner (see pages 255–256). Now insert the needle into the vial of NPH and shake the vial and syringe together vigorously a few times, as illustrated in Figure 16-6. Immediately but carefully draw 1 unit of NPH into the syringe. Now remove the needle from the vial and draw in about 5 units of air. The exact amount of air is not important. The air bubble will act a bit like the metal ball in a can of spray paint to help mix the insulins. Invert the syringe a few times to permit the air bubble to move back and forth, thereby mixing the two insulins’. (This is the only situation in which it is acceptable to mix two different insulins’in the same syringe.)
Now you can inject the contents of the syringe, including the air. The air will dissolve in your tissue fluids and cannot do any harm.
If this process confuses you, don’t worry. Your physician or diabetes educator should demonstrate it for you and check your technique.
If you use this procedure to slow down your preprandial dose of regular insulin, it’ll keep working for an unknown period of time well beyond the usual 5 hours. If you routinely correct elevated blood sugars with additional shots of lispro as described on page 301, you now have a real problem. When do you correct an elevated blood sugar?
The answer is actually simple. Under these conditions, if you add the NPH to regular before every meal, you are limited to correcting a high blood sugar only once daily—when you arise in the morning. This will be about 12 hours after your suppertime shot of the regular- NPH mixture. Twelve hours is more than enough time for the mixture to have finished acting.
If you only use the NPH mixture before dinner, then you may safely continue to correct elevated blood sugars before breakfast and lunch (after waiting the usual 5 hours or more). Do not use lispro to cover meals if you have delayed stomach emptying.
The reasoning here should be self-evident. Feel free, however, to use it to bring down an elevated blood sugar using the methods previously mentioned.
We would like to thank the publisher Little Brown and Company and Dr. Richard K. Bernstein, for allowing us to provide excerpts from The Diabetes Diet.
Copyright © 2005 by Richard K. Bernstein, M.D. All rights reserved. No part of this book may be reproduced in any form or by any electronic or mechanical means, including information storage and retrieval systems, without permission in writing from the publisher, except by a reviewer who may quote brief passages in a review.
This book is not intended as a substitute for professional medical care. The reader should regularly consult a physician for all health-related problems and routine care.
For more information on Dr. Bernstein’s and to purchase his books, CD’s or get access to his free monthly webinars, visit his website at DiabetesBook.com.