In my position as a pharmacist and certified diabetes educator, physicians often assign me the task of starting their patients with Type 2 diabetes on insulin therapy. Unfortunately, in most situations, insulin has been presented to these patients as a last-ditch treatment option, after target glucose goals have not been achieved or maintained with lifestyle modifications and other therapies.
Not surprisingly, I encounter people who are upset at the news that insulin is now necessary. Others feel anxious or overwhelmed by the prospect of fitting insulin into their lifestyles. Many people believe that insulin causes the complications of diabetes. Here is some information to dispel some of these myths about insulin therapy:
Myth 1: “It’s my fault I am being put on insulin because I didn’t do what I was supposed to do.”
People with diabetes often view the switch to insulin therapy as sign of personal failure in managing their diabetes. Insulin may be perceived as a punishment for failing to exercise, eat properly, or take their medicines. However, due to the progressive nature of Type 2 diabetes, people should expect to eventually require insulin therapy — this is due to the diabetes running its natural course, not to failure on their part.
It is inevitable that the insulin-producing beta cells of the pancreas will deteriorate over time, resulting in insulin deficiency. In other words, the pancreas cannot keep up with the body’s need for insulin no matter what you’ve done to manage your diabetes. Accordingly, insulin treatment is a normal and effective way of replacing the body’s insulin. Think of it as a form of “hormone replacement therapy.” The goal of all diabetes treatment is to find the right combination of treatments to provide the best blood glucose control while minimizing side effects — insulin is merely one of those options.
Myth 2: “Insulin injections hurt.”
Most people are surprised by how little an insulin injection hurts. With the small, fine needles available today, insulin injections are virtually painless. Insulin is injected into the layer of fat below the skin where there are no pain receptors. In fact, most people tell me that the finger pricks used to measure their blood glucose levels hurt much more than their insulin injections.
Myth 3: “Now that I am on insulin therapy, I will have more episodes of low blood glucose.”
Although some degree of hypoglycemia, or low blood glucose (typically defined as a level below 70 mg/dl) may occur in people using insulin, severe hypoglycemia is rare and has been shown to affect only about 0.5% of people with Type 2 diabetes. You can learn how to prevent, recognize, and treat hypoglycemia, therefore avoiding severe episodes.
Early symptoms of hypoglycemia include shakiness, nervousness, sweating, and confusion. People with diabetes should always carry a source of carbohydrate with them, along with a blood glucose meter to check glucose levels when any of these symptoms occur. Treatment is usually 15 grams of carbohydrate, examples of which include 3 or 4 glucose tablets, 4 ounces (1/2 cup) of fruit juice or regular (non-diet) cola, or 5 or 6 pieces of hard candy. Blood glucose levels should be checked again in 15 minutes and, if levels are still low, the steps above should be repeated until the glucose level is 70 mg/dl or higher. Strong evidence has demonstrated that the benefits of achieving good blood glucose control outweigh minor episodes of hypoglycemia as long as these episodes are not too severe or too frequent.
Myth 4: “If I am placed on insulin therapy, I will gain weight.”
Some people with Type 2 diabetes may gain weight after starting insulin therapy. However, often this weight gain occurs due to improved blood sugar control. Uncontrolled diabetes causes people to lose weight because glucose cannot get to the cells in the body. When insulin is introduced, glucose can be absorbed from the calories eaten, leading to some of the weight that was previously lost being regained.
To minimize weight gain following the initiation of insulin therapy, people with diabetes should make healthful food choices and get regular exercise. The good news is that weight gain tends to level out as insulin therapy continues, and the weight gain may be temporary. Ultimately, the benefits of good blood glucose control will reduce the risk of complications and should take priority over the concerns about weight gain.
Myth 5: “Insulin causes complications like blindness and kidney failure.”
Part of the reason behind the “negative image” of insulin is that physicians have historically used it as a warning to keep their patients motivated and focused on other therapies. It’s no wonder that people who try their best, but inevitably need insulin therapy, often feel guilty.
Physicians commonly delay starting insulin due to their own hesitations about the treatment. Some of these include a fear of causing low blood glucose or a concern that their patients will not adhere to an insulin regimen. The result is that insulin is often added to therapy too late in the course of diabetes. The reality is that people do not develop complications from being started on insulin, but rather, they develop complications from being started on insulin too late. Insulin actually reduces your risk of getting complications. Adding insulin to your treatment can improve your control and result in fewer complications than you would have had otherwise.
Hopefully, these myths about insulin will go away as doctors begin insulin therapy sooner rather than later and people with diabetes become more educated about insulin treatment. So if your physician tells you its time to add insulin to your regimen, just remember, diabetes is a chronic, progressive illness. The longer you’ve had Type 2 diabetes, the more likely you are to need insulin. Insulin can provide improved blood glucose control and slow or prevent the development of complications.