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?