Our experts demystify insulin injection therapy for diabetes and show you how to avoid weight gain, hypoglycemia and needle pain.
When your doctor tells you she wants to start you on insulin therapy, it's normal to have some questions:
- Will it be painful?
- Will I be at risk for low blood sugar?
- Will I gain weight?
These are valid questions. Unfortunately, insulin has been so shrouded in mystery and misinformation, it's easy sometimes to forget all the good it can do—allowing you to keep tight control of your blood glucose.
In fact, insulin was regarded as a miracle drug less than a century ago, when Canadian researchers first isolated the hormone, in 1921. Now, injectable insulin allows anyone whose pancreas no longer manufactures insulin to live a full, healthy life.
Though once considered a last resort for treating type 2 diabetes, insulin injection is now increasingly recommended earlier. Some doctors will prescribe it if your hemoglobin A1c is above 10 percent, and recent research suggests starting insulin injections earlier can keep complications such as heart and kidney disease at bay.
If you're approaching insulin with confusion and fears about injecting yourself or handling the potential side effects of insulin, here's some expert advice and a few strategies that will help you make this powerful therapy as effective as possible.
Make insulin injections practically painless.
Many people assume insulin injections will hurt. Often this is just a fear of needles dating back to childhood. But sometimes the fear goes much deeper: Some are concerned that injecting insulin means their disease is getting worse. But that notion is outdated. The important thing is not to avoid needles but to do everything that's in your power to control your diabetes and prevent damage to your nerves, eyes and other organs.
Since insulin can't be swallowed—digestive enzymes break it down before it can reach the bloodstream—it must be injected, whether you’re afraid of needles or not. But advances in insulin-delivery devices have made injections practically painless. The needles used today are extremely thin and coated with silicone, so they slide in more easily. Also, insulin is injected into the fatty tissue of the abdomen, upper arm or hips, where there are few nerve endings. "Sticking your finger to check blood sugar levels is actually more painful than self-administering insulin," advises Melissa Li-Ng, M.D., an endocrinologist at the Cleveland Clinic.
Prevent low blood sugar
Hypoglycemia occurs when blood glucose drops below normal, about 60 mg/dL, which can be triggered by administering too much insulin (the most common cause), delaying or missing a meal or exercising on an empty stomach.
Most FDA-approved insulin formulations are carefully calibrated so as not to cause hypoglycemia, says Naheed Ali, M.D., author of Diabetes and You: A Comprehensive, Holistic Approach. But when blood sugar does drop, there are many strategies for managing it. Learning the early signs—such as sweating, heart palpitations, hunger and feeling weak or faint—allows you to stop hypoglycemia in its tracks. Treat early signs with four ounces of orange juice, six ounces of nondiet soda, up to seven hard candies or up to five glucose tablets—and call your doctor.
If you've been on insulin therapy for many years and stop experiencing the early warning signs, you may be in danger of serious hypoglycemia (which can cause loss of consciousness). Keeping glucose tablets and pre-filled glucagon syringes on hand—if your doctor agrees—will ensure you're prepared to keep your blood sugar at a healthy level.
Avoid insulin-related weight gain.
Perhaps you've heard that insulin can cause you to pack on pounds? While it does have the potential to cause weight gain, it poses no more of a weight risk than oral blood-glucose-lowering meds. A recent study in Diabetes Care compared insulin-based treatment with oral therapy in people with newly diagnosed type 2 diabetes and found that patients on insulin gained less weight than those on oral therapy and after about a year and a half the weight gain among the insulin-taking group stopped.
If you eat the same amount of food as you did before you started taking insulin, you will likely gain weight. The best way to prevent it is to modify your diet and increase physical activity once you start insulin, in order to help you achieve a healthy weight, says Dr. Li-Ng. She recommends working closely with your doctor and a nutritionist to take the steps necessary to prevent weight gain. Some doctors will add the injectable medication pramlintide, which makes insulin more effective by blocking glucose release by the liver and slowing the emptying of the stomach, which, in turn, produces a feeling of fullness.
Try These Easy-to-Use Insulin Products
Ask your doctor about these breakthroughs in comfort and convenience. They can make insulin therapy easier and more effective than ever before.
Silicone-coated needles This new breed of smaller, thinner insulin needle coated with silicone can make injections virtually painless.
Pens Pre-filled disposable insulin pens have tiny needles and are easy to use and more discreet than a syringe.
Rapid-acting insulin By beginning to work just five minutes after it is injected, and lasting approximately two to four hours, rapid-acting insulin allows some patients more flexibility when timing meals.
Room-temperature insulin This insulin can be safely stored at room temperature and doesn't require refrigeration, providing patients a greater degree of freedom and convenience.
Insulin pumps Delivering rapid-acting insulin throughout the day, insulin pumps require catheter insertion (by a needle) once every few days.
From our sister publication, Diabetes Focus, Spring 2011