PHYSICIAN CONTRIBUTOR

By

Dr. Patricia Juang, MD

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Mealtime insulin, also known as rapid-acting or bolus insulin, is taken before meals by people with diabetes to manage blood sugar levels after eating. Mealtime insulin can be very effective in helping diabetics maintain stable blood sugar levels, but when is the right time to start this kind of insulin? As an endocrinologist, I consider many factors before prescribing mealtime insulin to a patient, since incorporating mealtime insulin into your daily routine can be a big lifestyle change. But even though it’s a serious commitment, mealtime insulin can be the key to diabetes control for many patients.

Mealtime insulin can be beneficial for many people with type 2 diabetes. Learn what these experts want their patients to know about mealtime insulin.

Medical Reviewers: William C. Lloyd III, MD, FACS

Last Review Date: 2018 Jul 16

2018
Healthgrades Operating Company, Inc. All rights reserved. May not be reproduced
or reprinted without permission from Healthgrades Operating Company, Inc. Use
of this information is governed by the Healthgrades User Agreement.


View transcript

Dr. Page-Wilson: I’m Dr. Gabrielle Page-Wilson. The course of diabetes is different for every individual. Having said that, we know that over the course of 10 years after you’ve been diagnosed with diabetes, usually over half of patients require insulin in order to maintain good glucose control.

Dr. Messer: Caroline Messer, M.D, endocrinologist. So there’s glucose that’s swimming around in the bloodstream, and it’s banging into everything that’s in the body. So it’s banging into the nerves of vision, it’s banging into the kidneys. We called that microvascular changes, so over time there’s a risk of injury to all of those different end targets. There’s also macrovascular risks, so that’s the bigger vessels. So, blood vessels leading to the heart and the brain.

Dr. Mezitis: I’m Dr. Nicholas Mezitis, endocrinology. Mealtime dosing of insulin is very important because it gives flexibility and it also allows us to optimize the blood sugar profile.

Dr. Page-Wilson: Most people are familiar with long-acting insulin or basal insulin and usually that type of insulin lasts for 24 hours and basically controls your blood sugar and keeps it steady when you’re not eating. And then there are short-acting insulins; that’s usually used as a mealtime insulin. You take that injection about 30 to 45 minutes before a meal and it wears off after about six hours.

Maria Rodriguez: Think of mealtime insulin as standing at the bus stop before the bus passes. If you’re standing there and the bus passes, you’re not getting on that bus. So think of insulin like it has to be on board and you have to inject it before eating so that the insulin is able to regulate the blood sugar for the meal you’re going to eat.

Dr. Page-Wilson: Patients who tend to have elevated blood sugars following meals are really well suited to mealtime insulin. Mealtime insulin allows you to cover the carbohydrates in the foods that you’re eating in a very specific way. You can actually tailor your insulin dose to the quantity of carbohydrates in your food.

Jennifer Stack: My top techniques for helping people to adhere to their mealtime insulin is to start small with changes in your eating habits, because it’s so important that our mealtime insulin matches up with the amount of carbohydrate we’re having at a meal. You can start by planning three to four simple meals. Use the diabetes plate where 50% of what you’re going to consume at that meal are non-starchy vegetables. A quarter of that plate will be some kind of grain, legumes, beans, vegetables that are high in fiber. And the remaining quarter of your plate can be filled with lean proteins.

Jennifer Stack: Now, this doesn’t mean that your meals will always be this cut and dried and simple, but it makes it easier to get into a routine that you feel you can master and you feel that you can stick with.


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var $el = $(‘#psd-video-countdown’);
countdown_trigger($el, countdown_number);
} else {
$(‘#video-‘ + playerId).append(“

” + div + “

“);
}
$(“#psd-video-countdown”).fadeIn(“slow”);

};

//Lets leave it commented as it was not initialized ….????
//countdown_init();

function countdown_trigger($el, time) {

var timesRun = 0;
var interval = setInterval(function () {

timesRun += 1;
//var countdownContainer = $(‘#countdown_text’);
var countdownContainer = $el.find(‘.seconds’);
var countdown_text = parseInt(countdownContainer.text());

if (timesRun === time) {
clearInterval(interval);
//$(“#psd-video-countdown”).fadeOut(“slow”);
$el.fadeOut(“slow”);
}
countdownContainer.text(countdown_text – 1);
}, 1000);
}

//Videohub advertisment top banner
var videohub_ad_seconds = 45;//player.getDuration());
var videohub_ad_total = 1;
var videohub_ad_init = function(){

var advertBannerText = “Ad 1 of “+videohub_ad_total+”: Your video will play in ” + videohub_ad_seconds + “ seconds”;
var advertBanner = “

“+ advertBannerText +”

“;
$(‘#video-player-‘+ playerId).append(advertBanner);

var $el = $(‘.videoHub-advert-banner’);
$el.fadeIn(“slow”);
countdown_trigger($el, videohub_ad_seconds);
}

//For videoHub pages…. hidin for the moment
if(isVideoHub){
//videohub_ad_init();
}

var setCookie = function(key,val) {

var surveyPath = ‘/’;
var val = ‘true’;

if (val != null && val != ”) {
val = val;
}

if (document.domain && document.domain !== ‘localhost’) {
$.cookie(key, val, {expires: cookieExpires, path: ‘/’, domain: document.domain, secure: false});
} else {
$.cookie(key, val);
}

};

// TODO: why is this prod only???
// Disabled while building
// if (isProd) {
// player.setControls(false);
// }
//
// if (skidAdOrShowLabel) {
// $playerWrapper.find(‘#video-‘ + playerId).addClass(‘adLabel’);
// }

// checking this div indicates that we have an ISI to show with ad

var $isi_video_copy = $playerWrapper.find(‘#isi-video-copy’);

$isi_video_copy.hide().removeClass(“hiding”).fadeIn(“slow”, function() {

$playerWrapper.find(“#video-copy, .playlist”).fadeOut(“fast”, function() {

if (ISIContent) {
$isi_video_copy.find(“.overview:first”).mousedown(function() {
$isi_video_copy.find(“.thumb:first”).stop();
$isi_video_copy.find(“.overview:first”).stop();

isiInteracted = true;
});
$isi_video_copy.find(“.thumb:first”).mousedown(function() {
$isi_video_copy.find(“.thumb:first”).stop();
$isi_video_copy.find(“.overview:first”).stop();

isiInteracted = true;
});
}

});

});

if (ISIContent) {
isiScroll_timeout = setTimeout(isiScroll, 5000);
}

if (hasAd && hasAdCompanionCont) {
$playerWrapper.find(“.videoData.adCompanionCont”).fadeIn(“slow”);
}

theAdTitle = event.adtitle;
theAdClient = event.client;

if (theAdTitle.toLowerCase().indexOf(“trulicity”) >= 0){
theAdClient = ‘Eli Lilly – Trulicity’;
}
else if(theAdTitle.toLowerCase().indexOf(“taltz”) >= 0){
theAdClient = ‘Eli Lilly – Taltz’;
}

var events = {};
events[‘pe’] = ‘lnk_o’;
var pev2 = s.contextData[‘hg.SubSection’];

events[‘hg.SyndicatedSite’] = s.contextData[‘hg.SyndicatedSite’];
events[‘hg.Channel’] = s.contextData[‘hg.Channel’];
events[‘hg.SubSection’] = s.contextData[‘hg.SubSection’];
events[‘hg.Server’] = s.contextData[‘hg.Server’];
events[‘hg.ContentType’] = s.contextData[‘hg.ContentType’];
events[‘prop67’] = events[‘eVar67’] = player.getPlaylistItem(this.getPlaylistIndex()).title || playerTitle;
events[‘eVar66’] = playListName;
events[‘eVar69’] = player.getPlaylistItem(this.getPlaylistIndex()).evar69 || “video”;
events[‘event57’] = ‘event57’;

events[‘eVar62’] = theAdClient;
events[‘eVar63’] = theAdTitle;

tips.omniTrackLinks.eventTracking.complexTrack(pev2, events);

})
.on(“adRequest”, function(event){

if (!isProd) { console.warn(“jwplayer’s”, event.type, “event fired”, event); }

var events = {};
events[‘pe’] = ‘lnk_o’;
var pev2 = s.contextData[‘hg.SubSection’];

events[‘hg.SyndicatedSite’] = s.contextData[‘hg.SyndicatedSite’];
events[‘hg.Channel’] = s.contextData[‘hg.Channel’];
events[‘hg.SubSection’] = s.contextData[‘hg.SubSection’];
events[‘hg.Server’] = s.contextData[‘hg.Server’];
events[‘hg.ContentType’] = s.contextData[‘hg.ContentType’];
events[‘prop67’] = events[‘eVar67’] = player.getPlaylistItem(this.getPlaylistIndex()).title || playerTitle;
events[‘eVar66’] = playListName;
events[‘eVar69’] = player.getPlaylistItem(this.getPlaylistIndex()).evar69 || “video”;
events[‘event62’] = ‘event62’;

tips.omniTrackLinks.eventTracking.complexTrack(pev2, events);

this.adsFirstQuartile = false;
this.adsSecondQuartile = false;
this.adsThirdQuartile = false;

})
.on(“adStarted”, function(event){

if (!isProd) { console.warn(“jwplayer’s”, event.type, “event fired”, event); }

var events = {};
events[‘pe’] = ‘lnk_o’;
var pev2 = s.contextData[‘hg.SubSection’];

events[‘hg.SyndicatedSite’] = s.contextData[‘hg.SyndicatedSite’];
events[‘hg.Channel’] = s.contextData[‘hg.Channel’];
events[‘hg.SubSection’] = s.contextData[‘hg.SubSection’];
events[‘hg.Server’] = s.contextData[‘hg.Server’];
events[‘hg.ContentType’] = s.contextData[‘hg.ContentType’];
events[‘prop67’] = events[‘eVar67’] = player.getPlaylistItem(this.getPlaylistIndex()).title || playerTitle;
events[‘eVar66’] = playListName;
events[‘eVar69’] = player.getPlaylistItem(this.getPlaylistIndex()).evar69 || “video”;
events[‘eVar62’] = theAdClient;
events[‘eVar63’] = theAdTitle;
events[‘event56’] = ‘event56’;

tips.omniTrackLinks.eventTracking.complexTrack(pev2, events);

})
.on(“adBlock”, function(event){

if (!isProd) { console.warn(“jwplayer’s”, event.type, “event fired”, event); }

var events = {};
events[‘pe’] = ‘lnk_o’;
var pev2 = s.contextData[‘hg.SubSection’];

events[‘hg.SyndicatedSite’] = s.contextData[‘hg.SyndicatedSite’];
events[‘hg.Channel’] = s.contextData[‘hg.Channel’];
events[‘hg.SubSection’] = s.contextData[‘hg.SubSection’];
events[‘hg.Server’] = s.contextData[‘hg.Server’];
events[‘hg.ContentType’] = s.contextData[‘hg.ContentType’];
events[‘prop67’] = events[‘eVar67’] = player.getPlaylistItem(this.getPlaylistIndex()).title || playerTitle;
events[‘eVar66’] = playListName;
events[‘eVar69’] = player.getPlaylistItem(this.getPlaylistIndex()).evar69 || “video”;
events[‘eVar62’] = theAdClient;
events[‘eVar63’] = theAdTitle;
events[‘event58’] = ‘event58’;

tips.omniTrackLinks.eventTracking.complexTrack(pev2, events);

})
.on(“adError”, function(event) {

if (!isProd) { console.warn(“jwplayer’s”, event.type, “event fired”, event); }

player.setControls(true);

var events = {};
events[‘pe’] = ‘lnk_o’;
var pev2 = s.contextData[‘hg.SubSection’];

events[‘hg.SyndicatedSite’] = s.contextData[‘hg.SyndicatedSite’];
events[‘hg.Channel’] = s.contextData[‘hg.Channel’];
events[‘hg.SubSection’] = s.contextData[‘hg.SubSection’];
events[‘hg.Server’] = s.contextData[‘hg.Server’];
events[‘hg.ContentType’] = s.contextData[‘hg.ContentType’];
events[‘prop67’] = events[‘eVar67’] = player.getPlaylistItem(this.getPlaylistIndex()).title || playerTitle;
events[‘eVar66’] = playListName;
events[‘eVar69’] = player.getPlaylistItem(this.getPlaylistIndex()).evar69 || “video”;
events[‘eVar62’] = theAdClient;
events[‘eVar63’] = theAdTitle;
events[‘eVar44’] = event.message.toString();

events[‘event59’] = ‘event59’;

tips.omniTrackLinks.eventTracking.complexTrack(pev2, events);

})
.on(“adComplete”, function(event) {

if (!isProd) { console.info(“jwplayer’s”, event.type, “event fired”); }

player.setControls(true);

// update video copy
$playerWrapper.find(‘#isi-video-copy, .videoData.adCompanionCont’).hide();
$playerWrapper.find(‘#video-copy’).show();

// unique to playlist but won’t fire if selector doesn’t show up
$playerWrapper.find(“.playlist”).show();

var events = {};
events[‘pe’] = ‘lnk_o’;
var pev2 = s.contextData[‘hg.SubSection’];

events[‘hg.SyndicatedSite’] = s.contextData[‘hg.SyndicatedSite’];
events[‘hg.Channel’] = s.contextData[‘hg.Channel’];
events[‘hg.SubSection’] = s.contextData[‘hg.SubSection’];
events[‘hg.Server’] = s.contextData[‘hg.Server’];
events[‘hg.ContentType’] = s.contextData[‘hg.ContentType’];
events[‘prop67’] = events[‘eVar67’] = player.getPlaylistItem(this.getPlaylistIndex()).title || playerTitle;
events[‘eVar66’] = playListName;
events[‘eVar69’] = player.getPlaylistItem(this.getPlaylistIndex()).evar69 || “video”;
events[‘eVar62’] = theAdClient;
events[‘eVar63’] = theAdTitle;

events[‘event61’] = ‘event61’;
tips.omniTrackLinks.eventTracking.complexTrack(pev2, events);

})
.on(“adSkipped”, function(event) {

if (!isProd) { console.info(“jwplayer’s”, event.type, “event fired”); }

player.setControls(true);

// update video copy
$playerWrapper.find(‘#isi-video-copy, .videoData.adCompanionCont’).hide();
$playerWrapper.find(‘#video-copy’).show();

var events = {};
events[‘pe’] = ‘lnk_o’;
var pev2 = s.contextData[‘hg.SubSection’];

events[‘hg.SyndicatedSite’] = s.contextData[‘hg.SyndicatedSite’];
events[‘hg.Channel’] = s.contextData[‘hg.Channel’];
events[‘hg.SubSection’] = s.contextData[‘hg.SubSection’];
events[‘hg.Server’] = s.contextData[‘hg.Server’];
events[‘hg.ContentType’] = s.contextData[‘hg.ContentType’];
events[‘prop67’] = events[‘eVar67’] = player.getPlaylistItem(this.getPlaylistIndex()).title || playerTitle;
events[‘eVar66’] = playListName;
events[‘eVar69’] = player.getPlaylistItem(this.getPlaylistIndex()).evar69 || “video”;
events[‘eVar62’] = theAdClient;
events[‘eVar63’] = theAdTitle;

events[‘event60’] = ‘event60’;
tips.omniTrackLinks.eventTracking.complexTrack(pev2, events);

})
.on(“adPlay”, function(event) {

if (!isProd) { console.info(“jwplayer’s”, event.type, “event fired”); }
})
.on(“adPause”, function(event) {

if (!isProd) { console.info(“jwplayer’s”, event.type, “event fired”); }

player.setControls(true);

})
.on(“adTime”, $.throttle(1000, function(event) {

var timeElapsed = Math.floor(event.position);
var totalLength = Math.floor(event.duration);
var percentageWatched = (timeElapsed / totalLength).toFixed(2);
//console.log(‘totalLength’+totalLength);
this.elapsed = Math.round(totalLength/4);

// 25% 1st quartile
if (percentageWatched >= .25 && (typeof this.adsFirstQuartile === “undefined” || !this.adsFirstQuartile)) {
this.trigger(“ads.firstQuartile”, event);
}
// 50% 2nd quartile
if (percentageWatched >= .50 && (typeof this.adsSecondQuartile === “undefined” || !this.adsSecondQuartile)) {
this.trigger(“ads.secondQuartile”,event);
}
// 75% 3rd quartile
if (percentageWatched >= .75 && (typeof this.adsThirdQuartile === “undefined” || !this.adsThirdQuartile)) {
this.trigger(“ads.thirdQuartile”,event);
}
// 100% … ad completed playback
if (timeElapsed == totalLength) {
//no needed
}

}))
.on(“tips.videoStart”, function(event) {
if (!isProd) { console.info(event.type, “event fired”); }
var events = {};
events[‘pe’] = ‘lnk_o’;
var pev2 = s.contextData[‘hg.SubSection’];

events[‘hg.PageName’] = s.contextData[‘hg.PageName’];
events[‘hg.Server’] = s.contextData[‘hg.Server’];
events[‘hg.Channel’] = s.contextData[‘hg.Channel’];
events[‘hg.ContentType’] = s.contextData[‘hg.ContentType’];
events[‘hg.SyndicatedSite’] = s.contextData[‘hg.SyndicatedSite’];
events[‘hg.SubSection’] = s.contextData[‘hg.SubSection’];
events[‘hg.ContentName’] = s.contextData[‘hg.ContentName’];
events[‘hg.HourOfDay’] = s.contextData[‘hg.HourOfDay’];
events[‘prop67’] = events[‘eVar67’] = player.getPlaylistItem(this.getPlaylistIndex()).title || playerTitle;
events[‘eVar66’] = playListName;
events[‘eVar68’] = ‘1:M:0-25’;
events[‘eVar69’] = player.getPlaylistItem(this.getPlaylistIndex()).evar69 || “video”;

events[‘event64’] = ‘event64’;

tips.omniTrackLinks.eventTracking.complexTrack(pev2, events);

this.firstQuartile = false;
this.secondQuartile = false;
this.thirdQuartile = false;

})
.on(“tips.firstQuartile”, function(event) {

// we’re only going to fire these 1 time … first time thru this.someQuartile won’t exist
// after that it will exist & be true so we’ll for it to exist & not be true
if (typeof this.firstQuartile === “undefined” || !this.firstQuartile) {
if (!isProd) { console.info(event.type, “event fired”); }
this.firstQuartile = true;

var events = {};
events[‘pe’] = ‘lnk_o’;
var pev2 = s.contextData[‘hg.SubSection’];
events[‘hg.PageName’] = s.contextData[‘hg.PageName’];
events[‘hg.Server’] = s.contextData[‘hg.Server’];
events[‘hg.Channel’] = s.contextData[‘hg.Channel’];
events[‘hg.ContentType’] = s.contextData[‘hg.ContentType’];
events[‘hg.SyndicatedSite’] = s.contextData[‘hg.SyndicatedSite’];
events[‘hg.SubSection’] = s.contextData[‘hg.SubSection’];
events[‘hg.ContentName’] = s.contextData[‘hg.ContentName’];
events[‘hg.HourOfDay’] = s.contextData[‘hg.HourOfDay’];
events[‘prop67’] = events[‘eVar67’] = player.getPlaylistItem(this.getPlaylistIndex()).title || playerTitle;
events[‘eVar66’] = playListName;
events[‘eVar68’] = ‘1:M:0-25’;
events[‘eVar69’] = player.getPlaylistItem(this.getPlaylistIndex()).evar69 || “video”;
var eventsString = ‘event63=’ + this.elapsed + ‘,event66, event67’;
events[eventsString] = eventsString;

tips.omniTrackLinks.eventTracking.complexTrack(pev2, events);

}

})
.on(“tips.secondQuartile”, function(event) {

// we’re only going to fire these 1 time … first time thru this.someQuartile won’t exist
// after that it will exist & be true so we’ll for it to exist & not be true
if (typeof this.secondQuartile === “undefined” || !this.secondQuartile) {
if (!isProd) { console.info(event.type, “event fired”); }
this.secondQuartile = true;

var events = {};
events[‘pe’] = ‘lnk_o’;
var pev2 = s.contextData[‘hg.SubSection’];

events[‘hg.PageName’] = s.contextData[‘hg.PageName’];
events[‘hg.Server’] = s.contextData[‘hg.Server’];
events[‘hg.Channel’] = s.contextData[‘hg.Channel’];
events[‘hg.ContentType’] = s.contextData[‘hg.ContentType’];
events[‘hg.SyndicatedSite’] = s.contextData[‘hg.SyndicatedSite’];
events[‘hg.SubSection’] = s.contextData[‘hg.SubSection’];
events[‘hg.ContentName’] = s.contextData[‘hg.ContentName’];
events[‘hg.HourOfDay’] = s.contextData[‘hg.HourOfDay’];
events[‘prop67’] = events[‘eVar67’] = player.getPlaylistItem(this.getPlaylistIndex()).title || playerTitle;
events[‘eVar66’] = playListName;
events[‘eVar68’] = ‘2:M:25-50’;
events[‘eVar69’] = player.getPlaylistItem(this.getPlaylistIndex()).evar69 || “video”;
var eventsString = ‘event63=’ + this.elapsed + ‘,event66, event68’;
events[eventsString] = eventsString;

tips.omniTrackLinks.eventTracking.complexTrack(pev2, events);

}

})
.on(“tips.thirdQuartile”, function(event) {

// we’re only going to fire these 1 time … first time thru this.someQuartile won’t exist
// after that it will exist & be true so we’ll for it to exist & not be true
if (typeof this.thirdQuartile === “undefined” || !this.thirdQuartile) {
if (!isProd) { console.info(event.type, “event fired”); }
this.thirdQuartile = true;

var events = {};
events[‘pe’] = ‘lnk_o’;
var pev2 = s.contextData[‘hg.SubSection’];

events[‘hg.PageName’] = s.contextData[‘hg.PageName’];
events[‘hg.Server’] = s.contextData[‘hg.Server’];
events[‘hg.Channel’] = s.contextData[‘hg.Channel’];
events[‘hg.ContentType’] = s.contextData[‘hg.ContentType’];
events[‘hg.SyndicatedSite’] = s.contextData[‘hg.SyndicatedSite’];
events[‘hg.SubSection’] = s.contextData[‘hg.SubSection’];
events[‘hg.ContentName’] = s.contextData[‘hg.ContentName’];
events[‘hg.HourOfDay’] = s.contextData[‘hg.HourOfDay’];
events[‘prop67’] = events[‘eVar67’] = player.getPlaylistItem(this.getPlaylistIndex()).title || playerTitle;
events[‘eVar66’] = playListName;
events[‘eVar68’] = ‘3:M:50-75’;
events[‘eVar69’] = player.getPlaylistItem(this.getPlaylistIndex()).evar69 || “video”;
var eventsString = ‘event63=’ + this.elapsed + ‘,event66, event69’;
events[eventsString] = eventsString;

tips.omniTrackLinks.eventTracking.complexTrack(pev2, events);

// Set the values used in Q4
//sometimes on Video centers when accesed from a mobile with “/?vid=a-video-id ” parameter, it triggers the Q4 from the first video-hub video,
//so we set readyForLastQuartile on Q3 for later check to verify it has passed by.
//
// As sometimes the 2 seconds debouncing delay take the incorrect title on Q4, we need to be sure we get the correct title
readyForLastQuartile = true;
currentPlayerTitle = player.getPlaylistItem(this.getPlaylistIndex()).title || playerTitle;

}

})
.on(“tips.showEndCard”, function(event) {

if (!isProd) { console.info(event.type, “event fired”); }

if ($playerWrapper.find(“.video-player-endCard”).length > 0) {
var $vpWrapper = $playerWrapper.find(“.video-player-wrapper”);

playerHeight = $vpWrapper.height();
$playerWrapper.find(“.video-player-endCard”).css({
“min-height”:playerHeight
});
$playerWrapper.find(“.video-player-endCard”).show();
$vpWrapper.css({
“width”:0,”height”:0,”overflow”:”hidden”
});
$playerWrapper.find(“.video-player-endCard-dismiss”).on(“click”, function(event) {
event.preventDefault();
player.trigger(“tips.hideEndCard”);
//player.trigger(“play”);
});

// add endCard (omniture) code here

}

})
.on(“tips.hideEndCard”, function(event) {

if (!isProd) { console.info(event.type, “event fired”); }

$playerWrapper.find(“.video-player-wrapper”).css({
“width”:”auto”,”height”:”auto”
});
$playerWrapper.find(“.video-player-endCard”).hide();

})
.on(“tips.createPlaylist”, function(event) {

if (!isProd) { console.info(event.type, “event fired”); }

// the playlist data (Array):
var playlistArray = player.getPlaylist();
var playlistArray_length = playlistArray.length;

// bail if there’s no data
if (playlistArray_length “;
listItemsHtml += ” “;
listItemsHtml += ”

“;
listItemsHtml += ”

“+title+”

“;
listItemsHtml += ”

“+description+”

“;
listItemsHtml += ”

“;
listItemsHtml += “”;

}

// just in case the list is empty, we won’t show the label, until
// we actually render the list
if(!isVideoHub){
$(“#upNext”).show();
}

// if the playlist existed lets wipe it out,
// this will make it possible to re-create or reset
// for ex. if you loaded a new playlist with Ajax
$playerWrapper.find(“.playlist”).remove();

return ‘

    ‘+listItemsHtml+’

‘;

});

if(isVideoHub){

$playerWrapper.find(“.videoHub-playlist”).append(function() {

// we’re building one big string to insert, to reduce DOM manipulation
var carouseListItemsHtml = “”;
carouseListItemsHtml += ‘

“;
carouseListItemsHtml += “

“;
return carouseListItemsHtml;

});
}

$(document).on(“click”, “.playlist li”, function() {
var thisVideoPlayer = $(this).closest(‘.video-player-wrapper’).find(‘.jwplayer’).attr(‘id’);
jwplayer(thisVideoPlayer).playlistItem($(this).index());
});

$(document).on(“click”, “.videoHub-playlist .video-carousel-card”, function () {
$(‘.video-carousel-card’).removeClass(‘playing’);
$(this).addClass(‘playing’);

var thisIndex = $(this).attr(‘data-index’);
var lastIndex = $(‘.videoHub-playlist .video-carousel-card’).length -1;

setTimeout(function () {
if ( lastIndex == thisIndex) {//when is the last index, go to the previous otherwise slick doesnt slide to the last slide
thisIndex = thisIndex – 1;
}
$(‘.slick-carousel’).slick(‘slickGoTo’, thisIndex);
}, 500);

var thisVideoPlayer = $(this).closest(‘.video-player’).find(‘.video-player-wrapper .jwplayer’).attr(‘id’);
jwplayer(thisVideoPlayer).playlistItem($(this).attr(‘data-index’));
});

})
.on(“ads.firstQuartile”, function(event){

// we’re only going to fire these 1 time … first time thru this.someQuartile won’t exist
// after that it will exist & be true so we’ll for it to exist & not be true
if (typeof this.adsFirstQuartile === “undefined” || !this.adsFirstQuartile) {
if (!isProd) { console.info(event.type, “event fired”); }
this.adsFirstQuartile = true;

var events = {};
events[‘pe’] = ‘lnk_o’;
var pev2 = s.contextData[‘hg.SubSection’];

events[‘hg.SyndicatedSite’] = s.contextData[‘hg.SyndicatedSite’];
events[‘hg.Channel’] = s.contextData[‘hg.Channel’];
events[‘hg.SubSection’] = s.contextData[‘hg.SubSection’];
events[‘hg.Server’] = s.contextData[‘hg.Server’];
events[‘hg.ContentType’] = s.contextData[‘hg.ContentType’];
events[‘prop67’] = events[‘eVar67’] = player.getPlaylistItem(this.getPlaylistIndex()).title || playerTitle;
events[‘eVar66’] = playListName;
events[‘eVar69’] = player.getPlaylistItem(this.getPlaylistIndex()).evar69 || “video”;
events[‘eVar75’] = Math.floor(event.duration);
events[‘eVar62’] = theAdClient;
events[‘eVar63’] = theAdTitle;
events[‘event70’] = ‘event70’;

tips.omniTrackLinks.eventTracking.complexTrack(pev2, events);

}

})
.on(“ads.secondQuartile”, function(event){
// we’re only going to fire these 1 time … first time thru this.someQuartile won’t exist
// after that it will exist & be true so we’ll for it to exist & not be true
if (typeof this.adsSecondQuartile === “undefined” || !this.adsSecondQuartile) {
if (!isProd) { console.info(event.type, “event fired”); }
this.adsSecondQuartile = true;

var events = {};
events[‘pe’] = ‘lnk_o’;
var pev2 = s.contextData[‘hg.SubSection’];

events[‘hg.SyndicatedSite’] = s.contextData[‘hg.SyndicatedSite’];
events[‘hg.Channel’] = s.contextData[‘hg.Channel’];
events[‘hg.SubSection’] = s.contextData[‘hg.SubSection’];
events[‘hg.Server’] = s.contextData[‘hg.Server’];
events[‘hg.ContentType’] = s.contextData[‘hg.ContentType’];
events[‘prop67’] = events[‘eVar67’] = player.getPlaylistItem(this.getPlaylistIndex()).title || playerTitle;
events[‘eVar66’] = playListName;
events[‘eVar69’] = player.getPlaylistItem(this.getPlaylistIndex()).evar69 || “video”;
events[‘eVar75’] = Math.floor(event.duration);
events[‘eVar62’] = theAdClient;
events[‘eVar63’] = theAdTitle;
events[‘event71’] = ‘event71’;

tips.omniTrackLinks.eventTracking.complexTrack(pev2, events);

}

})
.on(“ads.thirdQuartile”, function(event){
// we’re only going to fire these 1 time … first time thru this.someQuartile won’t exist
// after that it will exist & be true so we’ll for it to exist & not be true
if (typeof this.adsThirdQuartile === “undefined” || !this.adsThirdQuartile) {
if (!isProd) { console.info(event.type, “event fired”); }
this.adsThirdQuartile = true;

var events = {};
events[‘pe’] = ‘lnk_o’;
var pev2 = s.contextData[‘hg.SubSection’];

events[‘hg.SyndicatedSite’] = s.contextData[‘hg.SyndicatedSite’];
events[‘hg.Channel’] = s.contextData[‘hg.Channel’];
events[‘hg.SubSection’] = s.contextData[‘hg.SubSection’];
events[‘hg.Server’] = s.contextData[‘hg.Server’];
events[‘hg.ContentType’] = s.contextData[‘hg.ContentType’];
events[‘prop67’] = events[‘eVar67’] = player.getPlaylistItem(this.getPlaylistIndex()).title || playerTitle;
events[‘eVar66’] = playListName;
events[‘eVar69’] = player.getPlaylistItem(this.getPlaylistIndex()).evar69 || “video”;
events[‘eVar75’] = Math.floor(event.duration);
events[‘eVar62’] = theAdClient;
events[‘eVar63’] = theAdTitle;
events[‘event72’] = ‘event72’;

tips.omniTrackLinks.eventTracking.complexTrack(pev2, events);

}

})

;

}

Type 2 diabetes occurs when your body doesn’t make enough insulin to control your blood sugar levels. Insulin is a hormone made by the pancreas that helps your body use sugar as energy. When you eat, the carbohydrates in your food are broken down into sugar. That sugar needs to be absorbed to be used as energy. During a meal, insulin signals to your muscles, fat, and liver that they need to absorb incoming sugar to use or store. Without insulin, the sugar doesn’t know where to go, so it stays in your blood. These high blood sugar levels can cause increased thirst and increased urination in the short-term; long-term, uncontrolled blood sugar levels can cause serious damage to your kidneys, eyes, and feet, as well as raise your risk of heart attack and stroke.

In people with type 2 diabetes, the body becomes very insulin resistant, which means you need a lot more insulin than normal to control blood sugar levels. Eventually, your pancreas can’t keep up and isn’t able to make the large amount of insulin you need. That’s where diabetes medications come in.

After you receive a diagnosis of type 2 diabetes, your doctor will likely advise you to make some lifestyle changes, like adjusting your diet and adding more exercise into your daily life. Additionally, you’ll be prescribed medications to treat your diabetes, usually starting with oral medications. We will try these to help your body produce more insulin and respond better to the insulin you already make. If oral medications aren’t enough to control blood sugar levels, then we add either non-insulin injectable or insulin therapies. Eventually, most people with type 2 diabetes will require insulin injections to continue controlling their blood sugar levels. There are several different types of insulin to choose from, and often patients take a combination of insulin and non-insulin medications.

When non-insulin therapies alone aren’t doing enough to keep your blood sugar levels stable, you’ll probably start initially on a long-acting insulin. Examples of long-acting insulin, also known as background or basal insulin, include insulin glargine (Lantus, Toujeo), insulin detemir (Levemir), and insulin degludec (Tresiba). At first, you may take non-insulin oral or injectable medications along with long-acting insulin; the insulin keeps blood sugar steady when you’re not eating, and the non-insulin medications prevent your blood sugar from spiking after you eat. However, as time passes, the non-insulin drugs might not be enough to cover the rise in blood sugar post-meal. When I see patients who say they’re taking all their medication, avoiding sugary beverages, and limiting their carbs, but their blood sugar levels are still elevated and they’re not reaching their goals, then we start talking about the next step: moving to mealtime insulin.

Typically, patients will continue to take their long-acting insulin and then add mealtime insulin on top of it. Examples of mealtime insulin include insulin aspart (NovoLog), insulin lispro (Humalog), and insulin glulisine (Apidra). If patients are hesitant to make the commitment of taking mealtime insulin before every single meal, we can start slowly. They can take mealtime insulin before their largest meal of the day and see how they do. Usually, if patients see their sugars have really improved on just one mealtime insulin dose a day, they’re willing to expand that to two and then three doses a day. It’s definitely hard at first to incorporate mealtime insulin into your daily life, but it gets more doable with time. I tell patients once it becomes a habit, you’ll realize it’s not really that big of a deal. It just becomes part of your lifestyle. Initially, when you’re adding something new to your already-busy lifestyle, it can seem overwhelming and difficult. But once people get the hang of it, it becomes much easier.

THIS CONTENT DOES NOT PROVIDE MEDICAL ADVICE. This content is
provided for informational purposes and reflects the opinions of the
author. It is not a substitute for professional medical advice,
diagnosis or treatment. Always seek the advice of a qualified healthcare
professional regarding your health. If you think you may have a medical
emergency, contact your doctor immediately or call 911.