How do you know how much insulin to inject? The doctor sets the doses and the routine of the injections after a period of trial and gradual adjustment. (The aim is to use the smallest amount of insulin that will keep the blood sugar under good control.) Then the patient may make minor changes in the dose on the basis of daily blood tests and any changes in his or her schedule, or special stress, that may arise. A cold or some more serious illness will make the body require more insulin, while heavy exercise will burn up sugar and decrease the person’s insulin requirement. (In fact, he or she may need to take a snack before exercising.)

The size and timing of meals are very important for anyone taking insulin. A healthy pancreas adjusts the amount of insulin it delivers according to the body’s needs. More insulin is produced after a large meal or a high-sugar, high-fat dessert; the pancreas cuts back its secretion when a healthy person skips a meal. But someone who takes insulin shots cannot adjust the insulin flow in this way. Once the injection is given, the amount cannot be increased or decreased to meet unexpectedly changing needs.

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