Because your body uses glucose as energy throughout the day, you need a long-acting insulin in the bloodstream to help your body release glucose into your cells and produce energy.
Long-acting insulin or ultralente, and the newer ultra long-acting insulins such as Lantus and Levemir remain in your system for up to or more than 24 hours. These types of insulins, often referred to as “background” insulin, are used to control blood sugar levels when you are not eating.
There are times, however, when your background insulin might not be as effective as it once was and you need to make some adjustments, either to the amount or frequency of doses. Some of these circumstances include:
- You experience frequent highs or lows in your blood sugar level
- Your level of physical activity changes
- You gain or lose weight
- You become sick
- You experience emotional stress
- You start taking medications that can affect your blood sugars
You experience frequent highs or lows in your blood sugar level
If you experience frequent highs or lows in your blood glucose, your background insulin may not be set up appropriately. Frequent low blood sugars may be a sign that your long-acting insulin is too high. Conversely, your background insulin may be too low if you frequently have high blood sugars.
Your level of physical activity changes
The more physically active you are, the more sensitive to insulin you are. That means you need less insulin than someone who is not physically active on a regular basis. If you increase the intensity or length of your exercise routine, you will likely need to decrease your dose of long-acting insulin. And if you decrease your activity level, you may need to increase your dose of background insulin.
You gain or lose weight
Your long-acting insulin needs are also impacted by how much you weigh. The heavier you are, the higher the dose of background insulin you need. But if you lose weight, you become more sensitive to insulin and need less of it.
You become sick
If you become sick, you may need to change both your short-acting and long-acting insulin doses. This depends on the type (bacterial or viral), severity and duration of the illness. During bacterial infections, you may need to increase the frequency or amount of your short-acting insulin. Long-lasting viral illnesses may require a change in your long-acting insulin, whereas shorter viral illnesses may respond best to changes in short-acting insulin.
You experience emotional stress
Stress can cause blood sugar levels to increase. If the stress is temporary or lasts only a short period of time, you can counteract the rise in blood glucose with an extra dose of short-acting insulin. But if you are experiencing a prolonged period of stress, you may need to increase your background insulin dose.
You start taking medications that can affect your blood sugars
Steroid medications, such as prednisone and cortisone, increase blood sugar levels, so much so that you may even need to triple your insulin intake. You will likely need to adjust both short-acting and long-acting insulin doses for as long as the drug is taken or effective. Whenever you are prescribed a medication, contact your primary Diabetes doctor to find out if and how you should adjust your insulin doses.
Of course, any time you suspect you might need to change your background insulin, you should first discuss it with your Diabetes care provider. When you make changes to your long-acting insulin, check your blood sugar levels frequently to see how the action times of your short-acting insulin responds. You might need to tweak and test changes to your background insulin more than once until you find the dose that helps you gain better control of your blood glucose.
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