Fear and Loathing of Insulin
Least favored form of treatment may prove most effective
with Amy Tenderich
Editor's Note: While this columnist is no longer writing for dLife.com and we have ceased to update the information contained herein, there is much to be read here that is still applicable to the lives of people with diabetes. If you wish to act on anything you learn here, be sure to consult your doctor first. Please enjoy the column!
March 2006 — A lot of people get all sweaty when you talk about injecting insulin. Even more so when you actually unpack your supplies and do the deed.
Now that my life depends on injecting fresh insulin, I feel differently about it. It doesn't scare me anymore, but there is this kind of subtle, almost subconscious loathing in the knowledge that I'm dependent on this stuff for the rest of my life.
And yet — ironically — my message to those of you PWDs (people with diabetes) who are not yet taking insulin is that it really isn't nearly as dreadful as you might think. It even has some major advantages.
Fighting the Fear
If you've just recently been diagnosed, or if you're controlling your diabetes via oral meds (plus diet and exercise), you likely have a looming fear of insulin as this horrendous fate that awaits you somewhere down the line. It is true that most type 2s eventually need to take insulin, as the oral medications tend to lose the ability to stimulate your insulin absorption after a decade or so.
This happened to my father back in the ‘90s, and at the time, I felt very sorry for him as he slipped into the realm of "bad" diabetes. But what I didn't get back then was how much more effective insulin is at controlling blood glucose. Had he gone on insulin therapy much earlier, perhaps he would have had a better chance at a longer, healthier life.
Insulin more aggressively brings your glucose levels down, thus helping you more efficiently avoid the long-term damage diabetes can do. More good news is that 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.)
For these reasons, medical professionals in Europe are on an aggressive campaign to treat more type 2s with insulin sooner, rather than viewing it only as a last resort.
You might be surprised to learn that being on insulin may even be less restrictive than your current regimen. You might very well find you have 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.
Plus, the fear of needles was quite unnecessary, I found, since today's injection pens take tiny 30-guage wisps that you can barely feel. Even the syringes for the night-time long-acting insulin sport miniscule needles. And my friends on the insulin pump say they often forget the stuff's even going in.
Embracing the Loathing
I'm not going to kid you, though. It is a pain having to schlep the supplies around and (if you're not on the pump) inject throughout the day. I daydream of throwing my vials and injection pens out the window and then running out to stomp on them with my hiking boots. Cruuuuunch — grind ‘em into the grass!
But having diabetes is a pain on the whole, now isn't it? I watch a number of family members and friends with type 2 diabetes fretting about their diets and exercise, while still not achieving the glucose control they want and need. Taking insulin is not the magic cure-all, God knows, but it does allow me to directly and rapidly knock down blood sugar highs.
If I change my breakfast habits, or skip my regular exercise due to a bad cold, the insulin allows me to compensate immediately. When I'm sick and my blood sugar soars, I can "correct" for this.
Being on insulin also means I can never neglect my diabetes for an extended period like my father did. Which means I will never, ever allow myself to get to the point where I'm passing out on the kitchen floor or behind the steering wheel (!), like he did. When I die I plan to be old but fit. And I know that I have insulin to thank for this chance. So what's a little loathing in exchange for a long and healthy life? I'd loath the diabetes anyway, so thank you, insulin.
Read more about Amy Tenderich.
dLife's Viewpoints columnists are not all medical experts, but everyday people living with diabetes and sharing their personal experiences, most often at a set point in time. While their method of diabetes management may work for them, everyone is different. Please consult with your diabetes care team before acting on anything you read here to find out what will work best for you.
When CGM makers create their various alerts and alarms, I’m not sure they have teenagers in mind. This was clear as I played with the settings on our new Dexcom G5. Charlie was horrified as I scrolled through and sampled the roughly fifteen sounds we could use to alert Charlie when blood sugars were too high or too low. Door bells, wind chimes, single beeps, double beeps, triple beeps, Belgian discotheque … Charlie...