Diabetes Self-Management Blog

One of my nurse educator colleagues was recently featured in a teaching video on how to inject insulin. As part of the video, we asked people who have diabetes and who take insulin to answer some questions about what it’s like to have diabetes, including following a meal plan and injecting insulin. While a few of the people (two of them were young women) boldly stated that they disliked having to take insulin (or as one woman put, “poke herself”), all of them agreed that insulin was a good thing and that, if you need it, take it.

As a dietitian, I’ve dealt mostly with the “food” end of diabetes, but of course, food and insulin are so closely intertwined that you really can’t talk about one without the other (and vice versa). More and more people have diabetes, as you’re aware, and more and more people are taking insulin. Now, you know that if you have Type 1 diabetes, you have to take insulin in order to live. Right now, there are no other options for treating Type 1.

With Type 2 diabetes, things are a little murkier. Some people with Type 2 can manage just fine, at least for a while, by following a meal plan, controlling their weight, and getting regular exercise. Most people, though, are started off on a medicine (usually metformin), along with a meal plan and physical activity. After a few years, one or two more medicines (usually pills) are added. And then, after that, typically comes insulin. It’s at this stage where people beg, plead, cry, or yell to do anything to stay off of the dreaded “needle.” Why is this? Well, an obvious reason is that most of us don’t like needles. They can hurt. They’re sharp. They look long. But there are other reasons for not wanting to go on insulin, besides having to “take a needle.” I’ve listed some of the big ones, below. You may have others.

Top 5 Reasons for Not Wanting to Go on Insulin
Having to go on insulin means that you’ve failed. Why would needing to start insulin mean that you’re a failure? You may not feel this way, but plenty of people do. “If only I’d followed my meal plan/lost more weight/done more exercise…” may be the thought that races through your mind. Or maybe you’ve shaken your fist at your diabetes pills, blaming them for letting you down. The reality is that Type 2 diabetes changes over time. The beta cells in your pancreas stop making enough insulin, and as a result, blood glucose levels get too high. In some people, this progression happens more quickly than in others. Everyone’s different. But holding yourself responsible isn’t going to change much. It may help you to keep in mind that your body needs insulin, whether you make your own or you inject it.

Going on insulin means that your diabetes is getting worse. This one is closely tied to the first reason. Your diabetes isn’t really “worsening,” it’s just changing. That’s what Type 2 diabetes does. What you should try to realize is that insulin is a helper and works to keep your blood glucose levels in a safe range so that you can avoid short-term complications (like high blood glucose) and long-term complications (like eye, kidney, and heart disease).

Insulin will cause all sorts of unpleasant side effects. The insulin that you inject is practically identical to the insulin that your body makes. Insulin is a hormone, so it’s safe and natural. The major side effect of insulin is low blood glucose (hypoglycemia) and that can easily be prevented and treated. Diabetes pills, while extremely beneficial, have way more side effects than insulin. Insulin does not cause blindness, amputation, or other complications. Not taking insulin (if you need it) is what can lead to problems. Remember that your goal is to keep your blood glucose and your A1C in your target range: insulin will help you do that, big time.

Taking insulin will hurt. OK, years ago, needles were long and thick and they most likely did hurt somewhat. Today’s needles are super-thin and they come in a variety of lengths. Insulin pen needles are now available in 4-, 5-, 6-, 8-, and 12.7-millimeter (mm) lengths, while syringes come in 8- and 12.7-mm lengths (syringe needles need to be longer to penetrate the rubber stopper on the insulin bottle). If your pen or syringe needle is causing discomfort, let your doctor or educator know. You might be able to switch to a shorter and/or thinner needle, or it may be that your injection technique needs tweaking (for example, if you’re injecting into muscle rather than fatty tissue, it may cause discomfort).

Insulin will interfere with your lifestyle. Yes, you’ll need to stop and take an injection (or bolus an insulin dose with your pump), but it’s not a whole lot different than checking your blood glucose with your meter or taking your pills. Thanks to newer types of insulin, you can do everything that you’ve always done, such as go out to eat, travel, ski all day, and even skip a meal or two, depending on the type of insulin that you need to take. Yes, you’ll need to check your blood glucose more often than when you were taking pills, and yes, you’ll need to make sure you eat if you take mealtime insulin. While these may seem like inconveniences, on the flip side, you’ll very likely feel better (because your glucose levels are lower), and your diabetes control will improve.

What are your thoughts about starting on insulin? Do you agree that insulin is a good thing?

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Comments
  1. I was diagnosed in August of this year (2011). I had no prior warning or borderline blood test. I started on 500mg of metFORMIN twice a day. Seven days later at a follow up my glucose was in excess of 600 and I was hospitalized. I was then put on insulin. I use Lantus solostar Pen and there is barely any pain. Most of the time none. I was so horrible when I was diagnosed that I would try anything! My A1C was 14.4 and just 3 months later I had it down to 7.2! I feel like a different person.

    I follow a diet recommended by my diabetes doctor and nutritionist. I try to walk each day. I am now taking 2000mg and 20 units of insulin.

    My health, well-being, and mental attitude is more important to me than a little stick. If you can get a Pen it does make life much easier!

    Thanks for the article!

    Posted by Dawn R |
  2. Yes insulin is a good thing and special thoughts for type 2.

    I cannot speak for type 1 as I am not. As 20 year plus dating back to when no metformin pills I would offer the following:

    1. The glyburide/starlix pills and the early versions of these pills are dead wrong and lead to the path of adding more and more insulin.

    2. Liquid insulin is still the most adjustable and flexible dosage approach especially where type 2 may need boost and NOT the sledge hammer approach of the pills hammering the pancreas swatting flies.

    3. The real story inmy opinion for type 2 is to get the insulin resistance shut down first. This requires medical help on leaky livers and any other medical misfire, then fix carb/diet control and sufficient hearty exercise to stop overfilling all the storage sites of liver, fatcells, skeletal muscle cells. Than adjust insulin to boost that which is not sufficient. See Cell physiology and data about insulin resistance as well as data on metformin and not just the “official” bible story on metformin.

    4. Research papers, lap band, bariatric surgery and tight extreme diets are all showing that if you get the glucose pressure stopped back, the pancreas can and does ( but not for all) recover its operation.

    5. These are not cures but simply running the old hunter gatherer gut/digestion/gene set in ways that keep body from rotting out and glucose levels down. This is not “cure” but simply and safely operating an old 10,000 year old digestion system in the way it was optimized to work in days of poor and irratic sources of food.

    6. If you do not get the glucose pressure/level cut back, the insulin resistance gets trapped on and one is forced to use more and more of the injected analog of insulin that your body cells do not initially recognize genetically and the skeletal muscle cells are forced to take on more glucose. In the meantime, ones body sets about to turn off and defeat the foreign insulin resulting in one having to use more and more over time and body and sells getting sicker. That is my guess.

    So liquid insulin is critical, easier to and more flexible to dose and really can help in conjunction with getting insulin resistance shut down and properly addressing the conditions that are causitive of type 2 diabetes. Yes liquid insulin is great but not the sole answer for type 2 diabetes which needs a full complement of actions to stop the rot.

    In crisis management, job 1 should be to stop the rot and second identify practible and working cures if they exiest.

    Posted by jim snell |
  3. I also meant to add that when one gets into a fight with the insulin resistance turned on - ie the fat cells, liver, skeletal muscle cells are full and will not take any more glucose, one is in war with the body cells fighting to turn insulin off and pancreas and injected insulin is attempting to force more storage of glucose.

    My read of that is a dragout fight to the grave yard - no prisoners. Body cells do not want to die and become a marachino cherry.

    Posted by jim snell |
  4. Thanks for sharing your story, Dawn!

    Posted by acampbell |
  5. I was diagnosed with Type 2 in 1999. I controlled it with diet and exercise for a while, then went on Metformin, followed by glypizide, Byetta and Symlin. I finally decided to go on insulin 2 and a half years ago and 2 years ago got an insulin pump. I was AMAZED at how awful I had been feeling, once I stopped feelin so terrible. I’m glad I’m on insulin, even if I don’t “really” need it yet. My body says otherwise.

    Posted by Michelle Evans |
  6. Is insulin a good thing? What might be the effect?

    I had an opportunity to talk with a friend’s son who was a graduate student and was working with a researcher at a North Carolina University working with diabetes. He said the mitochondria is like a battery. It needs to be discharged as well as charged, i.e. exercised. Remember the ni-cad batteries that needed to be discharged fully or they lost capacity to retain their full charge. That is a chemical analogy.

    His opinion was that if the pancreas was not exercised because injecting insulin negated the need of the pancreas to work, it would eventually lead to the pancreas not being able to produce insulin.

    Now I am an engineer, not a medical professional, so I don’t quite understand the relationship between mitochondria and pancreatic islets.

    Has anyone else noticed this effect? For a while, I could have a hamburger and FF at lunch, not too often, which is about twice my carb allotment. It would seem to kick the system into gear and at bedtime my reading would be a little lower than normal and the next morning would also be lower.

    Anybody have any thoughts?

    Posted by Bill Dallin |
  7. Even with short needles on Humalog pen, the injection can still hurt due(per my physician)to not being always able to avoid nerve endings in th skin. On occasion the insulin will “burn” upon injection in fatty tissue.

    Posted by Peter Hey |
  8. What is Jim Snell’s area of expertise? I found all that very confusing and not very understanding.

    Posted by Ferne |
  9. The only downside is that is is a make fat drug for some diabetics.

    Posted by calgarydiabetic |
  10. Ferne:

    I am electronics engineer now retired who spent 40 years debugging complex digital computer systems, broken hardware and incomplete and idadequate designs and resolving them.

    I am not medical person but apologies for confusion. 30 years doing it wrong now stopped, pancreas back working almost correctly, liver over release now controlled and on 1200 calorie diet per day and 2 miles working. Insulin resistance is shut down and weight dropped from 330 lbs to under 250 lbs. No lap band or bariatric surgery. Use of glyburide/starlix all dropped. Stooped lantus ( was at 10 units - dropped to 5 to 0); had been on 26 units of humalog 75/25 once a day; dropped that to humalog lispro 3 units breakfast, linch and dinner. That now reduced to one shot 3 units in am to counter large dawn effect. Still on metformin. A1c had been 13.3 and now 6.4.

    Confused - I am too.

    Posted by jim snell |
  11. To answer Bill Dallin

    No the total opposite actually occurs when some diabetics are put on insulin ASAP their pancreas actually recover so much so that they can go off it.

    It is true if you take a normal person and feed them no carbs they may loose the ability to pass the glucose uptake test. This is a short term loss.

    Posted by calgarydiabetic |
  12. Amy - Thanks for a great article on Insulin, is it a good thing really.

    However I find that most articles written.including this one, does not indicate that the main thrust of the article is to assist Type 2. I wish that some how the TYPE of diabetes could be in the title of the article or a sub title at the beginning of the article.

    Thanks. Always appreciate your column
    Type 1 for 54 years.

    Posted by joan |
  13. Hi Joan,

    That’s a great suggestion and I’ll try to be more aware of that for future postings. Thanks for your thoughts.

    Posted by acampbell |

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