Understanding Your Medicine Dosage

Chapter 20 · Vihang Rahul Vasa

“What you consume decides how tomorrow evolves.”

Vihang Rahul VASA

Once you start diabetes medicine, it will take time to find the correct medicine, the correct dosage, and the correct timing: all customised for you and your body’s sensitivity. These medications do not work like painkillers. Different diabetes medicines have different onset times and mechanisms of action, some act within hours, others take days or weeks to show their full effect, and they need to be adjusted step by step, individually, only for you, for that given condition. Be patient with this process. Also, this dosage may or may not be adjusted over time, depending upon how you manage your lifestyle and how your body reacts to the medication. Trust the process, and trust your doctor. Never change or stop any medicine abruptly on your own.

If you are ever prescribed insulin, remember that it must be stored properly: refrigerated but never frozen, never left in a hot car or in direct sunlight, and always checked for expiry. Improperly stored insulin may lose its effectiveness without any visible change, and you may not realise it until your readings start misbehaving. Use an insulated medical pouch, with a cold pack if the journey is long or hot, kept so that the ice never touches the insulin, when carrying insulin outside.

Tablets need care too. They come in sealed strips for a reason: once a tablet is taken out, it is exposed to air, light and moisture, and studies have found that in Indian heat and humidity some tablets kept in a pill organiser can absorb moisture and change within weeks. I do not keep tablets loose in an organiser; I open a fresh tablet from the strip at each dose. To keep track of what I have taken, I use a pill chart with a tick for every dose: a medicine-reminder app on the phone does the same job.

If Your Doctor Prescribes Insulin: Learn Before You Inject (Important)

Illustration: An insulin syringe and vial, the traditional method

Illustration: A modern insulin delivery pen with cap

Then and now: the traditional syringe and vial (left), and the modern insulin delivery pen (right). Images: iStock by Getty Images (licensed).

Before taking insulin for the first time, these are the things you must settle with your doctor:

• Learn from your doctor, not from a video. Take your first injection at the clinic, under their eyes. At home, keep someone with you for the first few times.

• Be 100% sure of your dose. Insulin types and pens are not interchangeable: your dose, timing, and technique are set for you alone. Never adjust on your own, and never change the brand or type of insulin without consulting your doctor.

• Use a fresh needle every time. Never share a pen, not even within family.

• Prime the pen before every injection. Priming is a small “air shot” fired into the air, done exactly as your pen’s leaflet shows, until a drop of insulin appears at the needle tip. It removes air and confirms the pen is working. Skip it, and part of your dose may never reach your body: you will think you took it all, but you did not. Priming the medicine pen protects every dose.

Your doctor’s instruction comes first: this list exists so you ask for it, and settle for nothing less.

Read more on correct insulin injection technique: FITTER expert recommendations, Mayo Clinic Proceedings 2016;91(9):1231–1255 (mayoclinicproceedings.org/article/s0025-6196(16)30321-4/fulltext ), and the American Diabetes Association’s insulin guidance ( diabetes.org/health-wellness/medication/insulin-routines). On keeping tablets in their sealed strips: Albert V, Lanz M, Imanidis G, Hersberger KE, Arnet I, “Stability of medicines after repackaging into multicompartment compliance aids,” Drugs & Therapy Perspectives 2017;33:487–96. Full citation in the Appendix.

Illustration: An insulin pen being used at the abdomen

An insulin pen in use: always learn the technique from your doctor before your first injection. Image: iStock by Getty Images (licensed).

Licensed stock images, for educational illustration only; they depict no one connected with this book and endorse no brand, device, or manufacturer. Insulin technique must be learned from your treating doctor and your device’s official instructions.

Illustration: Chapter 20 illustrated summary. An individual medicine plan considers choice, timing, dose, response and time to settle.

Chapter 20 An individual medicine plan considers choice, timing, dose, response and time to settle. It includes doctor-led adjustments, technique learned in clinic, and safe storage and transport of medicines and insulin.

Chapter at a glance: an AI-generated illustration to be read with the chapter, not instead of it. The people shown are not real.