As of Wednesday, December 11, 2013
DEAR DOCTOR K: I have to start taking insulin for my Type 2 diabetes. It sounds complicated. What do I need to know before I start?
DEAR READER: The first thing you need to know is that it is simple to learn and do, and the discomfort is minimal. Tens of millions of people all over the world do it every day — and probably most of them were afraid that it would be complicated and painful before they actually started taking insulin.
Insulin is a natural hormone that lowers blood sugar in all of us. In people with diabetes, the body no longer can make enough insulin to keep the blood sugar level normal. Doctors usually recommend insulin for people with Type 2 diabetes when diet, exercise and pills cannot keep blood sugar levels low enough. Insulin lowers blood sugar levels more effectively than any other available diabetes drug.
Insulin can’t be taken as a pill; it must be taken by injection or with an insulin pump. (Insulin pumps are generally reserved for people with Type 1 diabetes.) A diabetes educator will teach you how to measure, prepare and administer the injections.
The equipment available today makes injections virtually painless. The needles are very small; you barely feel them when they pierce your skin. Most people use syringes or insulin “pens.” A pen injector uses disposable needles and insulin cartridges. It’s portable and discreet, and it provides multiple accurate doses without your needing to measure and fill syringes.
There are several formulations of insulin. They vary based on how quickly they start working, how long it takes for the insulin to peak and how long it remains active. Different types of insulin can be used alone or in combination.
The type of insulin and how much and how often you use it varies from person to person. You’ll work with your doctor or diabetes educator to develop an individualized insulin program. Your goal is to maintain a blood sugar level that’s as close to normal as possible without having your blood sugar dip too low. Low blood sugar can have dangerous consequences of its own. If the sugar goes too low, you can become tired, confused and disoriented. You can even lose consciousness.
Your blood sugar level is affected both by what you eat and how much insulin you take. Most people on insulin or other diabetes medicines check their own blood sugar levels with simple home kits. The doctor may recommend adjustments in the dose of insulin based on these blood levels.
You’ll learn to manage your blood sugar by testing your blood once or twice a day to determine whether you need to adjust your insulin dose. You’ll use a glucose meter to do the testing; that’s standard equipment for most people with diabetes.
You can refrigerate insulin or store it at room temperature. But don’t freeze it. Also, discard insulin that has expired or looks cloudy or otherwise strange.
Dr. Komaroff is a physician and professor at Harvard Medical School. To send questions, go to AskDoctorK.com, or write: Ask Doctor K, 10 Shattuck St., Second Floor, Boston, MA 02115.