Updated April 26, 2005

Insulin Therapy for Type 2 Diabetes

by Virginia Peragallo-Dittko, R.N., B.C.-A.D.M., M.A., C.D.E.

Other than hypoglycemia, serious reactions to human insulin are rare. However, injecting insulin into the same spot over and over can cause the area to become thick and hard (a condition called lipohypertrophy) or pitted and dented (a condition called lipoatrophy). When tissues become damaged in these ways, insulin injected into these sites may not be absorbed consistently, causing your blood glucose levels to fluctuate. Lipohypertrophy and lipoatrophy can be avoided by changing the site of injection within an injection area such as the abdomen each time you inject. For each shot, pick a new site a finger’s width away from your last injection.

Frequently asked questions
People who are starting insulin therapy naturally have questions. I’ve listed and answered some of them below.

Does insulin make you gain weight?

In addition to allowing glucose in the blood to enter the cells of the body, insulin also helps the body store fat. If you don’t have enough insulin, you lose weight, and if you have too much insulin, you gain weight.

If you routinely take more insulin (or sulfonlyureas) than your body needs, you will gain weight. This could happen, say, if you kept your blood glucose in the 60–70 mg/dl range and endured frequent bouts of hypoglycemia. If your blood glucose levels fall too low frequently, contact your health-care provider and talk about lowering your insulin dose.

Some people view insulin therapy as a license to eat whatever they want because they can just take more insulin to keep their blood sugar level in range. If you frequently overeat and inject extra insulin, however, you will gain weight.

If your pancreas is not secreting enough insulin and your blood glucose is elevated, your cells will use fat for energy, and you will lose weight. Once insulin therapy is initiated and your body burns glucose instead of fat, you will gain the weight back. This is a positive sign that your body is working properly again.

What is an insulin pump?

Another option for delivery of insulin, an insulin pump is a beeper-size device that contains a cartridge filled with short-acting insulin or a rapid-acting insulin analog. The pump is connected to small, flexible tubing, and the tip of the tubing is inserted into the fatty tissue under the skin. The insulin pump releases small amounts of insulin into the body every few minutes. When food is eaten, the pump can deliver a larger quantity of insulin right away. With a pump, you get closer to receiving the right amount of insulin at the right time: large amounts when you eat and small amounts between meals. The rate of insulin delivery can also be adjusted for exercise, periods of stress or illness, and other activities or occurrences that might affect blood glucose level. Insulin pumps are used most commonly by people with Type 1 diabetes, but people with Type 2 diabetes who require insulin therapy can be candidates for insulin pump therapy. Even Medicare provides reimbursement to people who meet certain criteria.

What does it mean if I have to keep taking more insulin?

Taking more insulin does not mean that you are getting sicker. Health-care providers use a formula to decide your starting dose, but they always begin with a small dose because the formula only serves as a guideline. When beginning insulin therapy, you would expect to slowly increase the dose of insulin based on your blood glucose monitoring results. The dose of insulin that works for you depends on factors such as the amount of insulin your pancreas still makes, how resistant you are to insulin, your activity level, other medicines you take that raise blood glucose, and how much you eat.

You can make a smoother transition to insulin therapy when you have help. Seek the counsel of a certified diabetes educator with whom you can share your concerns and feelings about insulin therapy. Starting insulin is a big step, but the payoff—better blood glucose control—is worth the effort.

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