A Third of Diabetics Don’t Take Mealtime Insulin as Recommended

The UK study found that : - 1 in 5 regularly miss their insulin dose before lunch - A quarter of people feel their relationship is negatively impacted due to worries about managing their diabetes around mealtimes - Over half of people are frustrated by their diabetes management


According to the National Institute for Health and Care Excellence (NICE), a third of people with diabetes are not taking their mealtime insulin treatment as recommended.

This is the finding from a recent survey of 200 people living with type 1 or type 2 diabetes, who need mealtime insulin to control their blood glucose levels. This can lead to unpleasant mental and physical symptoms and, more worryingly, puts them at risk of serious long-term complications, such as amputation and blindness.

According to NICE guidance, people with type 1 diabetes and type 2 diabetes requiring a mealtime insulin should take it before a meal to effectively control a post-meal spike in their blood sugar levels.

Over 4 million people are living with diabetes in the UK. In 2015, the burden of NHS expenditure on diabetes was about £10 billion (or roughly 10% of total NHS resource expenditure). This rate of expenditure works out at around £192 million a week.

Ponnusamy Saravanan, Associate Clinical Professor & Honorary Consultant Physician, Warwick Medical School, University of Warwick & George Eliot Hospital commented, ‘We need to get people thinking seriously about the impact of high blood sugar after meals. In addition to immediate and sometimes dangerous symptoms such as blurred vision and extreme tiredness, regular high blood sugar levels could lead to serious long-term complications, including heart disease, blindness, nerve damage and amputation.

The survey results show a lack of education and awareness of the consequences of poorly controlled blood sugar levels around mealtimes, leaving people at real risk of developing irreversible complications. If we don’t get this message out now then we will continue to spend billions each year on treating these complications on the NHS, in addition to significant social costs to the individuals affected and their families.’

Regular symptoms of high blood sugar—known medically as hyperglycaemia— reported in the survey include tiredness, thirst, needing to urinate frequently, difficulty concentrating, reduced productivity and irritability. However, only half of those surveyed recognized these symptoms as being linked to high blood sugar levels. Only a third mentioned these symptoms to their doctor or nurse, despite 1 in 3 having to take a sick day or cancel an engagement as a result.

The social impact of managing post-meal blood sugar spikes was further brought to light by the survey, with a quarter reporting that worries about mealtime management had a negative impact on their relationship and over 40% found doing things ‘spur-of-the-moment’ difficult, as well as planning holidays.

Dr. Lalantha Leelarathna, Consultant Diabetologist and Honorary Senior Lecturer at Manchester Diabetes Centre, Manchester Royal Infirmary, added, ‘The fact that many patients don’t discuss their symptoms with their healthcare team suggests that we as clinicians need to be proactive in asking about hyperglycemia and better educate our patients on the importance of good mealtime control. In addition, we need to provide our patients with treatment strategies to achieve good post-meal glucose control. 

Missing or delayed meal time insulin will often lead to very high post-meal glucose levels increasing glucose variability and the risk of complications. Greater awareness is our best defense against diabetes-related complications and I welcome these latest survey results as an opportunity to highlight these important issues.’