Adjusting Your Insulin for Time Changes

The body's sensitivity to insulin varies throughout the day and night. You are most insulin sensitive early in the night and most resistant early in the morning. These changes in insulin sensitivity are due to the daily fluctuations in the levels of hormones, particularly cortisol. The internal body clock that regulates these hormones gets cues from environmental light and temperature. When you go to a different time zone, the body clock and the hormones reset to the new light-dark cycle. This resetting process takes time and explains why you feel "jet-lagged." The challenge for people who are on insulin is to figure out how to adjust basal insulin levels while the body is getting used to being in the new time zone. The solution is to make sure that you have a safe basal rate and to use bolus insulin doses to cover any high blood glucose levels:

• If the time zone adjustment is only one to three hours, ignore it and just give the basal insulin at your usual time in the new time zone. For example, if you give your insulin glargine at 10 p.m., then do so at 10 p.m. in the new time zone.

• If you travel east (shorter day) and the time zone change is long, give bolus insulin every four hours and delay giving the basal insulin until at least twenty-four hours have passed since the last basal insulin injection.

• If you are traveling west (longer day), inject bolus insulin every four hours until you inject your basal insulin at your usual time in the new time zone.

• If you are on a pump, you can change the pump clock to the new time. If the time zone change is long, you may go on the lowest basal rate until the jet lag has resolved and then you can set up new basal doses.

Since activity and diet may be different when you are traveling, you may have to adjust your basal insulin even if the time difference is negligible.

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