Insulin “Resistance”: Breaking Down the Barriers

Over the past couple of weeks, we’ve looked at insulin: how it works[1] and the different types available[2]. If you take insulin or perhaps are about to start taking insulin, hopefully you now realize that there are options available to you. Today’s insulins and insulin regimens are quite flexible, allowing them to be closely tailored to your lifestyle.


Fears and concerns
As you’re aware, people who have Type 1 diabetes[3] must take insulin. They really have little choice in the matter, so going on insulin is generally viewed as “life-saving.” And it is. In the case of Type 2 diabetes[4], however, there may be hesitation, concern, or even downright refusal to “go on the needle.” Barriers to taking insulin often stem from personal feelings of failure, misconceptions about what insulin is and how it works, and even attitudes from health-care providers. Let’s take a closer look at some of these issues and, if you identify with any of them, explore how you might think about them differently.

My doctor wants me to start on insulin. This means I’ve failed at managing my diabetes.

It’s not uncommon for people to feel a sense of personal failure if they need to start on insulin. They may feel guilty for not making healthy food choices, for example, or not exercising regularly. Or maybe they think that if they had lost weight, things wouldn’t have come to this. Lifestyle measures are certainly an important part of diabetes management, but feeling guilty or badly about not counting carbs correctly or not walking 30 minutes every day isn’t productive. Insulin isn’t meant to be a punishment. The reality is that Type 2 diabetes is a condition that changes over time: the pancreas may start to produce less insulin, and the body’s cells may become more resistant to insulin, as well. These are factors beyond your control. Try not to take it personally!

Newer way of thinking: Insulin is another tool, along with healthy eating and physical activity, that can help me better manage my diabetes and live a healthy life.

Insulin doesn’t work that well.

Some people believe that insulin isn’t effective, or at least, isn’t going to work for them. This belief may stem from having a family member or friend who started on insulin but perhaps had complications, gained weight, or had a lot of low blood sugars. Maybe that loved one died from diabetes complications and the person attributed that to going on insulin, for example. Insulin is the most effective medication for treating diabetes. Your pancreas may not be making enough or your body isn’t using it as well as it should, but insulin is a hormone that everyone needs to regulate blood sugar. When the right insulin is prescribed, it’s an extremely effective way of controlling blood sugar levels.

Newer way of thinking: Insulin is the best medicine for me to help me better manage my diabetes.

I’m afraid of hypoglycemia.

Fear of hypoglycemia (low blood sugar) is a common concern among new insulin users. Symptoms of low blood sugar include feeling shaky or dizzy, sweating, hunger, and feeling confused or agitated. When blood sugar levels drop very low, a person may become unconscious or have seizures. Understandably, these symptoms can be frightening. No one wants to pass out! Hypoglycemia is the most common side effect of taking insulin; however, with newer insulins available, low blood sugar is less likely to occur. In addition, severe low blood sugar is less likely to occur in people who have Type 2 diabetes. Your doctor or diabetes educator can teach you how to recognize symptoms of lows and how to treat lows quickly and efficiently, before they become an issue. Better yet, checking your blood sugar regularly and aiming for consistency with your eating and exercise can help you prevent lows from happening in the first place.

Newer way of thinking: I can learn about hypoglycemia: how to prevent it, how to recognize signs and symptoms, and how to treat it, if it happens.

Insulin injections will hurt!

Very few people like getting or taking injections. Many people recall the shots that they got as a child and remember that they hurt. But those shots were given with longer, thicker needles. The good news is that insulin injections today are pretty much painless, thanks to shorter, thinner needles. In fact, many people who inject insulin will tell you that they don’t even feel the injection, and sticking their finger for a glucose check “hurts more” than the injection. True needle phobia occurs in a small segment of the population and working with your health-care provider or a behavioral health specialist can help you overcome that. But, feeling anxious or nervous about giving injections is normal. What often helps is to have your doctor or diabetes educator give you an injection with either insulin or saline so that you can get a feel for the needle. Next, you’ll learn how to give an injection, perhaps by practicing on an object, like fake skin, an orange, or even a stuffed animal. When you feel confident, you can give yourself an injection. Your doctor or diabetes educator should discuss the various injection sites that you can use: your upper arm, abdomen, or thigh and show you the proper technique so that you inject right under the skin, rather than into muscle. Don’t be surprised after you give you first injection to think, “It’s no big deal. What was I afraid of?”

Newer way of thinking: Thanks to smaller, thinner needles and knowing how to give myself an injection, taking insulin is painless.

Relatively few people will tell you that taking insulin is a walk in the park. But many of the fears and concerns surrounding insulin simply aren’t true. A lot of people will tell you that they feel so much better and have improved diabetes control after starting on insulin. Be sure to voice any concerns that you have with your doctor or a diabetes educator. Try not to view taking insulin as a punishment or as a sign that you’ve failed. Taking insulin can improve your health and the quality of your life.

Strength training is one of the best things you can do for your diabetes control. Bookmark and tune in tomorrow to learn about how to make your muscles stronger from nurse David Spero.

  1. how it works:
  2. the different types available:
  3. Type 1 diabetes:
  4. Type 2 diabetes:

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Amy Campbell: Amy Campbell is the author of Staying Healthy with Diabetes: Nutrition and Meal Planning and a frequent contributor to Diabetes Self-Management and Diabetes & You. She has co-authored several books, including the The Joslin Guide to Diabetes and the American Diabetes Association’s 16 Myths of a “Diabetic Diet,” for which she received a Will Solimene Award of Excellence in Medical Communication and a National Health Information Award in 2000. Amy also developed menus for Fit Not Fat at Forty Plus and co-authored Eat Carbs, Lose Weight with fitness expert Denise Austin. Amy earned a bachelor’s degree in nutrition from Simmons College and a master’s degree in nutrition education from Boston University. In addition to being a Registered Dietitian, she is a Certified Diabetes Educator and a member of the American Dietetic Association, the American Diabetes Association, and the American Association of Diabetes Educators. Amy was formerly a Diabetes and Nutrition Educator at Joslin Diabetes Center, where she was responsible for the development, implementation, and evaluation of disease management programs, including clinical guideline and educational material development, and the development, testing, and implementation of disease management applications. She is currently the Director of Clinical Education Content Development and Training at Good Measures. Amy has developed and conducted training sessions for various disease and case management programs and is a frequent presenter at disease management events.

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