The discovery of insulin
Way back when, in 1921, a surgeon named Frederick Banting figured out how to extract secretions from islet cells in the pancreas as a possible treatment for diabetes, overseen by John MacLeod, the head of physiology at the University of Toronto. Banting’s assistant, Charles Best, helped to refine the process.
The first injection of insulin was given to a 14-year-old named Leonard Thompson who, at the time, weighed 65 pounds and was dying of type 1 diabetes. He had an allergic reaction to the substance, but he recovered and gained back his strength. In April of that same year, this miraculous substance was named “insulin,” from the Latin word insula, which means “island.”
In 1923, Eli Lilly (the same company that makes insulin today) began to mass-produce insulin from the pancreases of cows and pigs, and they named their insulin “Iletin.” This discovery of insulin is one of medicine’s most significant advances. A lot about insulin has changed since those initial days of discovery, and it’s all for the better. Today, there are many different types of insulin that work in different ways to try and mimic what the pancreas does in a person without type 1 diabetes.
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Why do I need insulin injections: How insulin works…and why you need it
Everyone needs insulin. It doesn’t matter who you are, how old you are, where you come from…you need it. Insulin is a hormone that is secreted by the islet cells in the pancreas in response to high blood glucose (sugar) levels. But even in the absence of high glucose, the pancreas always releases a low level of insulin.
Insulin works on blood cells, muscle cells and fat cells to signal the cells to essentially open up and let glucose in from the bloodstream. The cells then use glucose as fuel, or energy. If there’s an excess of glucose, insulin directs the liver to store the glucose (another hormone, glucagon, signals the liver to release glucose if blood glucose levels go too low). So, when things are working as they should, the body keeps a tight rein on the amount of glucose in the blood. Someone without diabetes, for example, generally have blood sugar levels between 72 and 99 mg/dl before eating, and up to 140 mg/dl two hours after eating.
Without insulin, then, blood glucose levels become too high. Complications from high blood glucose can result: in the short-term, a serious condition called diabetic ketoacidosis can occur that, if not treated promptly, can be fatal. Longer-term, high glucose levels can lead to irreversible problems with the heart and circulatory system, the nervous system, the eyes and the kidneys.
Being told that you have type 1 diabetes can be a blow; being told that you must inject insulin to stay alive can be equally as difficult. Unlike people who have type 2 diabetes, insulin is THE treatment for type 1. There is no insulin pill or patch that you can use, at least, at this time.
Understandably, people with newly diagnosed type 1 are often fearful about taking insulin for various reasons. These include:
• A fear of needles
• A fear that they’ll always have to take insulin
• A fear of being considered a failure
• A fear of insulin causing complications or even death
• A fear of gaining weight
• A fear of hypoglycemia (low blood sugar)
• Concern about the cost of insulin
• Worries that taking insulin will interfere with their lifestyle
Certainly, most people don’t look forward to having to start on insulin, and it’s natural to have some qualms about starting on a new medication that involves needles: everyone has them!
Injecting insulin: Addressing fears head on
The two main ways to take insulin are by injection and by using an insulin pump (which involves inserting a tiny cannula, or tube under the skin). There is one type of insulin that is available via an inhaler, but it’s a rapid-acting insulin that is given before meals. If you use this type of insulin, you still need to take a longer-acting insulin via injection.
One way to get over your fears and concerns about taking insulin is to tackle them head on. For starters, let your doctor, nurse practitioner and/or diabetes educator know about your concerns. Talking it out is one way to dispel fears and possible misconceptions.
Fear of needles and taking shots
Kathy Casper, RN, CDE, a diabetes educator at Newton-Wellesley Hospital in Massachusetts, encounters a lot of people who are afraid of needles and/or afraid of pain. As she puts it, “That was then, this is now — we have better treatments for type 1 diabetes, and that includes needles that are short and thin — some people barely feel them.” Casper shows her patients the needle and haves them give a “practice shot” with salt water.
Fear of being considered a failure
Type 1 diabetes isn’t something that you bring on yourself — in other words, it’s not caused by eating too much or eating the wrong foods, for example. Type 1 diabetes is caused by genetic and environmental factors.
Fear of complications
Casper mentions that, “A lot of people shy away from insulin because they had an aunt or grandmother who lost their eyesight or had their foot amputated soon after starting insulin.” The reality is that had their relative started on insulin sooner, the complication may have been delayed or even prevented. Insulin does not cause complications — high blood sugar does.
Fear of weight gain
If you are new to type 1 diabetes, weight loss may have been one of your symptoms. Weight loss occurs due to the body’s inability to use glucose as fuel — you excrete excess glucose in the urine, and the body can start to break down fat and muscle for fuel, resulting in weight loss. Once you start on insulin, your body uses food more efficiently, and you likely will regain the weight you’ve lost. If one of your goals is to lose weight, however, ask your doctor for a referral to a dietitian.
Fear of hypoglycemia
A big concern that people have, says Casper, is having low blood sugars and possibly not waking up. Casper reassures her patients that once they start on insulin, they’ll be checking their blood sugars, and they’ll also start on a lower dose of insulin that is gradually adjusted upwards to help minimize the risk of lows. Plus, you’ll likely be able to call your doctor’s or diabetes educator’s office to discuss your insulin doses, too.
Concerns about the cost of insulin
This is a very real concern. Some of the new types of insulin are very costly, and many health plans provide inadequate coverage. Be up front with your doctor about your ability to afford insulin. He or she should be able to prescribe less expensive insulin, such as Regular or NPH, for example. In addition, insulin manufacturers have patient assistance programs that you may qualify for. And Walmart sells a brand of insulin, called ReliOn that is much more affordable than other brands.
Taking insulin will interfere with your lifestyle
You might be thinking that once you start on insulin, you won’t be able to do the things you like to do. This is simply not true. You can travel, go out to eat, play sports, ride a bike, swim, go camping…there’s no reason that you can’t do everything that you used to do before you got diabetes. Sure, you’ll likely need to figure out logistics, such as taking your insulin with you and possibly adjusting insulin doses, but this is all doable. Meet with a diabetes educator to help you fit insulin — and diabetes — into your lifestyle. And remember that plenty people with type 1 diabetes do this every day!
Want to learn more about type 1 diabetes? Read “Type 1 Diabetes Questions and Answers,” “Living With Type 1 Diabetes: Four Tips to Get You Started,” “Six Type 1 Diabetes Symptoms You Need to Know” and see our type 1 diabetes videos.