Warming Up to Insulin

December 02, 2008

Amy Tenderich

In case you haven’t heard, there’s a movement underway among medical professionals to get Type 2 diabetics started on insulin therapy sooner. I know what you’re thinking: “Not me, no way!” But if you keep an open mind, look at the facts, and explore the reality of insulin therapy a little, you may find that your fear and loathing of insulin is quite unfounded.
Let’s break it down, myth by myth:
I just have “a little sugar problem,” so I don’t need insulin!
This is just silly. There is no such thing as “a little sugar problem.” The fact is that diabetes is a progressive illness, and many – if not most – Type 2 diabetics eventually reach a point at which the oral medications lose the ability to stimulate insulin absorption in the body (usually after a decade or so). So their doctors end up recommending injected insulin at some point in their therapy anyway.
And why wait so long? Starting earlier on insulin actually has many benefits: it more aggressively brings your blood glucose levels down, helping you more efficiently avoid the long-term damage diabetes can do. Furthermore, taking insulin, versus pills or other treatments, actually leads to better overall health and well-being. In a large-scale study of people with Type 2 diabetes in Europe (called UKPDS – United Kingdom Prospective Diabetes Study), nearly 70 percent of participants reported an “increase in well-being” following the change to insulin therapy. An average of 1% reduction in A1C levels was also associated with a nearly 30 percent drop in the risk of microvascular complications (small-vessel damage to eyes, nerves, etc.)
Insulin is only for patients at the “end of life”
This belief is an unfortunate holdover from a time when doctors indeed only tried insulin in adult diabetics as a last resort. So many people remember a Great Aunt or family friend who went on those “frightening shots” just before checking into the hospital or passing away. But these days, it’s just irrational to think of insulin as a sign of “bad” diabetes. That’s because insulin is the most effective and most natural treatment currently available for treating this illness – allowing us to live long, active and healthy lives.
The shots are painful
This is really not true. Just like pricking your finger for a glucose test, it occasionally stings a bit, but for the most part, the extremely fine needles available today have done away with the pain factor. Today, you can choose to use an injection pen that allows you to easily “dial up” your doses, and administers them with a tiny 30-guage needle. Or, if you need insulin throughout the day to cover all your food intake, you can consider wearing an insulin pump, which requires just one poke every 3 days when you change the infusion site.
Insulin is dangerous: I will go too low!
You do have to be more careful about hypoglycemia (low blood glucose) when you’re taking insulin. But two things help here: Most Type 2s start out with insulin gradually, by taking a once-a-day long-acting insulin first, and then slowly transitioning to using more short-acting insulin throughout the day. So you’ll have a chance to “learn the ropes.” Also, being on insulin forces you to be more conscientious about your diabetes. You will have to check your glucose more often in order fine tune your dosing. So you’ll find you are much more “plugged in” to where your glucose levels are and where they might be heading.
5. Life is not fun on insulin
Hey, diabetes is not fun! But don’t blame the insulin.
In fact, you might be surprised to learn that being on insulin may even be less restrictive than your current regimen. You may gain more freedom in your diet rather than less, because you can pretty much eat whatever you like (within reason) as long as you count the carbohydrates and dose accurately for the foods you choose. Of course you can’t load up on simple sugars, but you can mix and match your foods throughout the day. And you can reach for that extra piece of fruit as long as you increase your insulin dose accordingly.
So have you warmed up to the idea of taking insulin yet? Good. Now go talk it over with your doctor.
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Amy Tenderich is creator of the popular web log www.diabetesmine.com and co-author of the guidebook, “Know Your Numbers, Outlive Your Diabetes.”

From	Comment
judy makowski	October 27, 2009 3:13 AM The article has certainly given me some things to think about. o maybe rethink is a better way to put it. Thank you Amy for suggessting this it has helped. The stars were already shaded in and I couldn't change them so please don't go by them. I feel the articl has helped and I am considering insulin therapy.
morning star	October 18, 2009 7:51 PM Extremely helpful. I would like to possibly buy Amy's book.
doris	October 17, 2009 9:12 PM My endocrinolgist tried workinng with diet and exerciss until I was operated on for breast cancer. Now its insulin and oral mledicine. My medical needs have radically changed. I would prefer just diet and exercise. That wasn't working. My biggest complaint...I've gone through two doctors, Neither has told me what type I am or what my acs1 is. All I know is my blood glucose should be around 120. Let me tell you that's hard work.
Macedonio Martinez Jr.	October 17, 2009 8:16 PM where can i find your book... let me know. Mace Martinez jr.
Macedonio Martinez Jr.	October 17, 2009 8:15 PM Amy, I like to your articales very much... you are the first person that I know that makes sense. keep emailing your articals, I really enjoy reading them. Mace Martinez jr.