The correctional environment poses challenges for coordinating insulin administration with food intake, particularly for inmates on short-acting (regular) insulin. The consequences of insulin/food mismatch are, at best, suboptimal control of hyperglycemia; at worst, the result is frequent and potentially severe hypoglycemic episodes. Because of the many factors in a correctional environment that can interfere with the optimal timing of insulin and food, the insulin regimen should be as “forgiving” as possible. The shorter the onset and peak of the insulin, the more critical it is to coordinate food intake with insulin administration. For this reason, rapid-acting insulin is generally not utilized within the BOP. Short-acting (regular) insulin is typically administered two-to-three times per day; ideally, it should be administered prior to a meal to allow some absorption of insulin prior to the rise in blood glucose that occurs during a meal. However, if the timing of meals is uncertain, regular insulin can be administered immediately after eating (rather than before). Although the inmate will have a short period of postprandial hyperglycemia, this approach causes fewer long-term consequences and good diabetic control can still be achieved. Below are questions to consider when planning for optimal insulin/food coordination in BOP facilities:
• Depending on the size of the dining hall, the size of the inmate population, and the type of meal being served, it may take anywhere from one-to-three hours to serve a meal. Is the pill line open during this entire meal period to administer insulin?
• Do inmates have free movement to go to the pill line before they go to the dining hall?
• If insulin is given prior to a meal, and then an institution recall occurs (a lockdown, an emergency count, a fog line, a severe weather incident, etc.), which of these situations would prevent inmates from eating?
• Are there contingency plans to provide food to prevent hypoglycemia?
• Are correctional staff trained to appropriately identify and respond to hypoglycemic episodes in insulin-dependent inmates?
• How quickly could a sack lunch or a snack be provided to inmates who had received their insulin, but were then prevented from eating their usual meal?