Amy Campbell is a registered dietitian and Certified Diabetes Educator who has been working in the field of diabetes for many years. She is the author of several books about diabetes, including 16 Myths of a Diabetic Diet and Staying Healthy with Diabetes: Nutrition and Meal Planning. In addition, Amy is a lecturer and frequent contributor to several diabetes-related websites.
Poor insulin—it’s much maligned and little understood. It’s a substance that some love to hate; others hate to love it. We all need it, yet it’s fraught with misunderstanding and myth. Let’s clarify some common misconceptions—and truths, while we’re at it—about a medicine whose discovery is one of the most important medical marvels of all time.
1. Insulin is a dangerous substance that can cause low blood sugar and even death
There are a couple of truths to this statement, but first, let’s clarify what insulin is. Insulin is a hormone, which means that it’s a protein. People who don’t have diabetes have no trouble making sufficient amounts of insulin to meet the body’s needs. People who have diabetes don’t make enough insulin and must obtain it elsewhere—generally by injecting it, and now in some cases by inhaling it.
One of the primary effects of insulin is to move blood sugar from the bloodstream into the cells where it’s used for energy, so yes, insulin does lower blood sugar. But if diabetes is controlled, lows are hopefully few and far between. If too much insulin is injected, it could lead to death if blood sugar levels drop too low. But these cases, thankfully, are rare, and they shouldn’t scare anyone away from taking insulin if they need it.
2. Insulin that’s injected isn’t the same as insulin made by the body
This is pretty much true. When insulin was “discovered” back in 1921, it was made from the pancreases of dogs. It wasn’t practical to gather up enough dog pancreases to meet the demand, so scientists back then manufactured insulin from pigs and then from cows. But over time, supply and demand once again became an issue. Furthermore, because animal insulin is different than human insulin, some people developed allergic reactions to pork or beef insulin, and over time it often lost some of its effectiveness.
In the early 1980s, through a process of recombinant DNA technology, synthetic human insulin was manufactured in the lab and introduced by Eli Lilly. By 2001, about 95 percent of all insulin users worldwide used a synthetic form of human insulin. Insulin analogs, by the way, such as insulin aspart and insulin glargine, are made by tweaking the amino acid sequence of the protein (insulin) to make it faster or longer-acting. Amazing!
3. People who have type 2 diabetes shouldn’t have to take insulin
Once again, this statement points to the many misunderstandings surrounding insulin. Having to take insulin isn’t a sign that you’ve “failed” at managing your diabetes. Type 2 diabetes is quite different than type 1 diabetes in that type 2 is a condition of insulin resistance. And it progresses. And it’s different from person to person. A lot of people manage their type 2 diabetes with healthy eating, weight control, and physical activity. Some need to take diabetes pills, perhaps along with newer injectable drugs. Others need insulin, sometimes sooner rather than later.
You’re not “bad” or a “failure” if you need to start insulin. Instead, you’re doing what it takes to keep your A1c and blood sugar readings in a target range and, most importantly, what it takes to lead a healthy life with diabetes.
4. Insulin comes in a pill form
Don’t we wish! Unfortunately, insulin doesn’t come in pills or capsules (yet). Remember, insulin is a protein. If you think back to high school biology, you’ll recall that all proteins that are ingested get broken down by enzymes in the digestive tract into their base units, amino acids. If you swallowed insulin, this is exactly what would happen. That insulin would break apart into single amino acids and would do nothing to lower your blood sugar. So, yes, you must inject insulin, either with a syringe, a pen, or via insulin pump. Mealtime insulin is now available in inhaled form, which is great for some folks, but longer-acting insulin must still be injected.
5. Injecting insulin hurts!
Remember when you were a kid and you had to get a shot at the doctor’s office? That was no fun. Injecting insulin isn’t exactly a day at the beach, but it shouldn’t hurt. Really. Thanks to smaller, finer needles, the “ouch factor” of insulin injections should be practically nonexistent. Why might your injections hurt?
- Your injection technique needs tweaking.
- You’re using alcohol to clean your skin before you inject.
- Your insulin is cold (keep the bottle or pen that you’re using at room temperature).
- You’ve been reusing your needle and it has become dull, which can cause some pain.
- You’re not using the right size needle for your needs.
- You’re injecting into muscle rather than right under the skin.
As the saying goes, pain is a sign that something is wrong. Talk with your doctor or diabetes educator if your injections hurt. With a few changes here or there, you can soon be injecting pain-free!
What are your insulin misconceptions? Challenge them by addressing them with your diabetes care team. You might be pleasantly surprised by what you find out.