Type 2 Diabetes: Will I ever need to go onto Insulin?

Guest Post from Diabetes Educator, David Mapletoft

Type 2 diabetes is a progressive condition with decreasing insulin production over time.

With type 2 diabetes, your body either resists the effects of insulin — a hormone that regulates the movement of glucose into your cells — or doesn’t produce enough insulin to maintain a normal glucose level.

More common in adults, type 2 diabetes increasingly affects children as childhood obesity increases. There’s no cure for type 2 diabetes, but it is possible to manage the condition with a healthy eating plan, a daily dose of exercise and taking prescribed medication.

For most people with type 2 diabetes  a healthy meal plan and the ideal amount of exercise still aren’t enough to manage your blood glucose levels well. Medication will be prescribed for almost all people living with type 2 diabetes.

For many insulin therapy will be needed. This need for insulin use in people living with type 2 diabetes can happen quite quickly, but more often occurs in about 50% of people within 10 years of being diagnosed.

 

Pancreas Becomes Exhausted 

All of the tablets your doctor prescribes need your body to be producing enough insulin to work.

When a person with diabetes is no longer making enough of their own insulin, they will probably need insulin treatment to control their blood glucose levels. (NOTE: There are other injectable forms of medication that may be prescribed for some people which is NOT insulin)

Sometimes the tablet medication is continued example: Metformin helps insulin to work, and is often used in conjunction with insulin in people living with type 2 diabetes (and in ever increasing cases of people living with type 1 diabetes).

For people with type 2 diabetes, insulin is a tool that’s better if used sooner rather than later.

Is Insulin Safe?

Insulin is very safe – so safe that is can be used in women who are pregnant and breast-feeding.

In my practice I all too often hear of other health care professionals using insulin as a threat, an “if you” thing—if you don’t lose some weight, if you don’t do some exercise, if you don’t follow the diet, then you’re going to wind up on insulin.

That’s really not how people with type 2 diabetes should view insulin—as a punishment. Insulin is a very, very safe therapy, and people should not hesitate to use it if needed.

It is a very good medication for treating people with diabetes. When used safely and effectively insulin can prevent (or at least delay) many diabetes related health problems.

NOTE: If prescribed insulin, and you feel that there are side effects happening, talk to your doctor or pharmacist. 

Fear
If you’re picturing big syringes that you have to boil and sterilise ( I last saw these in the 1980’s), think again. Modern insulin needles are very thin and disposable—no sterilizing necessary. There are also insulin pens equipped with an insulin cartridge and disposable needles that are so simple even a child can use them. Either type of delivery system makes using insulin very easy and virtually painless—really. Most people report that giving insulin is less painful than testing your blood glucose level with a finger prick.

****If you have a genuine fear of needles in general, it might be a good strategy to talk with your professional counsellor or psychologist.****

How do I prevent hypoglycemia? 

Hypoglycaemia is a real fear for many people living with diabetes. This occurs when you have too much insulin in the body, so blood glucose drops too low.

Types of Insulin

  • Rapid-acting:  Usually taken before a meal to cover the blood glucose elevation from eating.  This type of insulin is used with longer-acting insulin.
  • Short-acting:  Usually taken about 30 minutes before a meal to cover the blood glucose elevation from eating.  This type of insulin is used with longer-acting insulin.
  • Intermediate-acting:  Covers the blood glucose elevations when rapid-acting insulins stop working. This type of insulin is often combined with rapid- or short-acting insulin and is usually taken twice a day.
  • Long-acting:  This type of insulin is often combined, when needed, with rapid- or short-acting insulin.  It lowers blood glucose levels when rapid-acting insulins stop working.  It is taken once or twice a day. from JOSLIN
Type Brand Name Onset
(length of time before
insulin reaches bloodstream)
Peak
(time period when
insulin is most effective)
Duration
(how long insulin
works for)
Rapid-acting

Humalog
Novolog
Apidra

10 – 30 minutes 30 minutes – 3 hours 3 – 5 hours
Short-acting Regular (R) 30 minutes – 1 hour 2 – 5 hours Up to 12 hours
Intermediate-
acting
NPH (N) 1.5 – 4 hours 4 – 12 hours Up to 24 hours
Long-acting Lantus
Levemir
0.8 – 4 hours Minimal peak Up to 24 hours

Some are long lasting and are given once a day; some given before each meal; some are mixed insulins which allow for least flexibility in your day.

Ideally your prescribing health care professional will know your lifestyle and prescribe an insulin that fits best for you.

Examples of things to consider when trying to fit an insulin into your day are:

  • Do you work regular hours or shift work?
  • Do you know (or want to learn) how to count our carbs?
  • How much flexibility do you want to have in when and how much to eat?
  • How prepared are you to find and implement best practice self care strategies for your entire diabetes self care plan?

Missing a Dose of Insulin

“What if I skip my insulin? Could I die?” 
It depends on how often or for how long you skip your insulin. The chances of dying from one missed dose of insulin are EXTREMELY LOW  for people living with type 2 diabetes. Talk to your doctor or diabetes educator about how you can plan for this situation. 

I tell my clients who use insulin multiple times a day that if they miss a shot, they need to:

  • Measure the blood glucose level each hour.
  • If it is a pre meal non-mixed insulin dose, it may be safe to give the insulin within an hour after the meal.
  • Call for medical assistance if the blood glucose level goes over 15 mmols (especially if you are unwell)

 

Conclusion

Insulin use for people living with type 2 diabetes is often delayed due to fear.

If you have any fears about using insulin, talk to your diabetes educator, psychologist / counsellor so you can work through this. Type 2 diabetes is like many things in life: we don’t have total control.

Our bodies and minds are very complex.

Use your team to help guide you towards the best health possible for you and your family.

David Mapletoft

Diabetes Educator

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