Diabetes Self-Management Blog

Here at Diabetes Flashpoints, we have occasionally covered situations in which a conflict arises between saving money and following the instructions of a health-care provider. Topics in this vein include reusing lancets and syringes, sharing reusable medical devices, and abandoning drugs at the pharmacy because of cost. We’ve also mentioned how to talk to your doctor about cost-related concerns. But as the results of a survey on skipping insulin doses show, cost isn’t the only factor in whether someone with diabetes disregards certain medical advice or part of a treatment plan.

A recent article on the Web site DiabetesInControl.com highlights the results of the survey, published last year in the journal Diabetes Care. The online survey was taken by 502 adults living in the United States who took insulin injections for either Type 1 or Type 2 diabetes. Questions focused on insulin-taking habits as well as background information including age, income, education, and dietary habits.

Overall, more than half of respondents reported having intentionally skipped an insulin dose; 20% reported skipping doses regularly. Background factors associated with skipping insulin included younger age, lower income, higher education, having Type 2 diabetes (rather than Type 1), poorer dietary habits, having more injections to take each day, and reporting that injections caused pain or embarrassment or interfered with daily activities. Among people with Type 1 diabetes, skipping insulin was most strongly associated with poorer dietary habits; among those with Type 2 diabetes, the strongest associations were with lower age, higher education, lower income, and greater pain and embarrassment with injections.

As a Diabetes Self-Management article notes, the survey also probed injection-related pain and anxiety in greater detail. A Web site dedicated to the survey results, www.injectionimpact.com, notes that 33% of respondents reported dreading injections, and 29% said that injecting insulin was the hardest part of their diabetes routine. Yet just over half of respondents said they did not raise quality-of-life concerns with their health-care team; 37% thought it would be a burden on their care provider to bring up the topic. In a separate survey of 300 health-care providers, only 12% said that they tended to hear concerns from patients about the impact of injections on their lives.

Have you ever intentionally skipped an insulin dose? If so, why? Have you discussed injection-related concerns with your doctor, whether or not you skipped a dose because of them? Do you have any tips for lessening pain, embarrassment, or inconvenience associated with injections? Leave a comment below!

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Comments
  1. I suffered from bulimia and intentionally skipped insulin as means of purging to lose weight (you basically pee out all your food). It was awful, I felt sick all of the time, and my vision became worse. To be honest, I am very surprised I am here to talk about it today. But I did seek help and went through an Eating Disorders clinic. As I know insulin can make one gain weight, there are times when I still get scared to give my insulin, however I use the techniques I was taught at the clinic to help me give my insulin. I also take one look at my beautuful son and know that he needs his mom to be healthy!

    Posted by Carmen |
  2. My biggest temptation for skipping an insulin dose comes when I want to eat something I know better than to have. Paradoxically, knowing I should not eat it gives me a momentary thought of skipping the insulin dose to cover it so that it won’t cause a weight gain - never mind the rise in blood sugar and the attendant complications from that. Fortunately, I am most often able to shake that off, but using insulin dosage/high blood sugar as weight control is always a devilish little voice in the back of my head when I’m staring down a cupcake.

    Posted by Genie Long |
  3. I absolutely cannot believe that anyone would ever skip an insulin dose because they are embarrassed!! Let me see, I have a drug to take that will improve my life and help me lead a nice long, productive life but I am EMBARRASSED to take it in public - HUH? In the very few times (out of the thousands) that I have given myself an insulin shot in public and someone has made a comment; the comment was either about a relative who also has diabetes or a question about diabetes that lead to good conversation. Anyone who is embarrassed about being diabetic (or about having to take any life-sustaining drug) should just stay home and never put themselves in a situation where they might have to “embarrass” themselves by taking said drug. Better to stay home, take your meds and be healthy.

    Posted by Thom |
  4. The only time I ever intentionally skip an injection is with my Novalog - if I have a low fasting glucose reading in the morning and I know I’m going to be doing significant exercise, such as a 5K walk, I don’t take the shot with breakfast as it would take my blood suger too low.

    Other than that, I never miss either my mealtime or long-acting injections. I used to give myself allergy shots, so doing the insulin is no big deal. For me, the most painful and disagreeable part of my diabetes regimen is pricking my finger for the blood drop.

    I don’t enjoy the 24/7/365 aspect of my Type 2, but I am able to deal with it by making a game out of it - I win when I beat the blood sugar monster back into it’s stable - lol.

    Depending on the season, my A1c ranges between 6.4 and 7.0 - seldom above 6.7, once as low as 6.1.

    Posted by Steve |
  5. IFFOLLOWED MY INSULIN REGIME FOR A LONG TIME. THEN MY BS SPIRALED OUT OF CONTROL AGAIN AND SOON I WAS UP TO TAKIIBNG MULTIPLE INJECTIONS A DAY. I GOT DEPRESSED AND STARTED SKIPPING A DOSE HERE AND A DOSE THERE AND SOON I WAS RUNNING BS IN THE 400 TO 500 RANGE. AFTER MULTIPLE HOSPITALIZATIONS AND AN ENDOCRINOLOGIST THAT I FELT LISTENED TO ME MY NEW DR PUT ME ON AN INSULIN PUMP AND AS MY BS SUGARS GOT UNDER BETTER CONTROL AND I STARTED TO FEEL BETTER I DECIDED TO TAKE MY CONTROL BACK.

    Posted by pamela dietz |
  6. your doctor say to lose weight but you are on insulin how are you going to lose weight if you are on insulin the insulin feed the fat that is why i don’t like it if you already have a weight problem and you are on insulin your hopeless do you think there is another way

    Posted by Phyllis |
  7. Insulin doesn’t cause you to gain weight. Overeating does. Alot of people think that if you use more insulin, you’d gain weight. It’s the other way around. If you eat more, you’d need to use more insulin hence you’d gain weight. I’m on insulin now and I’m losing weight steadily. I eat within my calories range. I’m also on low carb - complex carbs meal plan. Taking insulin has been the best thing for me. I prefer that over oral meds. I skipped insulin once because I was lazy and sleep so I took oral med instead. The next morning the bg was high and out of control. I have not skipped the insulin ever since.

    Posted by Kim |
  8. I disagree with this comment.

    If the to live time exceeds the output of time gut; then you need to est more to cover or drive to a low.

    I know. I was pushing 1200 cal diet and found that the 12 hour to live on 75/25 was enforcing eating or crashing.

    I am now on 5 hour to live stbndard humolog and can organize so that not issue. I have to keep meal dose down to 1.5 to 3 units.

    I am looking into 1-2 hour to live insulin strictly for peaks and closer tracks the gut output.

    On pill side 10.5 hour to live glyburide same dumb issue. Starlix has 4 to 5 hour. I am off that crap now and on to small amounts of insulin.

    Choice is simple either one controls diet or on wrong pill/insulin to live time - it does.

    Put me down as tired of the fork/knife plate get set ready eat for 10 or 12 hours.

    Posted by jim snell |
  9. I was taking Metformin before I got pregnant, but my OB said insulin was better for baby. So now at the end of my pregnancy (and lots of insulin tweaks here and there), my BG’s are finally in the 120’s after a meal and 80-90’s Fasting. So, at times I do skip my Novolog @ lunch. I am currently using NPH & Novolog at pregnancy. I am praying that I won’t need to inject myself anymore after giving birth, as it is VERY painful and nerve wrecking to keep track of scarred skin (injection sites already used recently) and the bruising left on my skin.
    By the way, my child is a healthy baby boy and NOT over weight and I have only gained 6 pounds during my whole pregnancy. I personally do not believe insulin makes you over weight.

    Posted by Elizabeth G. |

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