If you have Type 2 diabetes and your blood sugar is still running high, your healthcare provider may try to convince you to take insulin.
Don’t be afraid of insulin!
There are about a million fears that people have when I start to talk to them about taking insulin.
Fear: “I won’t be able to cure my diabetes with diet and exercise!”
Insulin is not a death sentence. If your blood sugars are too high, you might need insulin for a while. However, if you clean up your diet, and start exercising every day, you might not need insulin for very long. (Caveat: On this blog I talk about Type 2 Diabetes, the kind that you got from eating crap, not Type 1 Diabetes, which is a whole different thing. With Type 1 Diabetes, you always need insulin or you will die within a few days! Just ask the guy with Type 1 who I saw today in the clinic. He landed in intensive care last week after skipping his insulin for just 3 days.)
I remember one guy who came in to the clinic because he was losing weight, always thirsty, peeing several times an hour. When I checked his blood sugar, it was about 600, and he had not had anything to eat that day. So, we started insulin right away, to keep him alive. His A1C was around 11 at first. But then, he quit drinking 4 liters of Mountain Dew and Coke every day. Within a few weeks, his blood sugars were back to normal, and when I re-checked his A1C, it was below 6! He stopped insulin, and has gone several years without his blood sugars going back up.
Fear: “Insulin will cause kidney failure.”
I deal with this question every single day. Kidney failure is caused by diabetes. Also, by taking ibuprofen and naproxen. Taking your insulin is the most important thing to do to protect your kidneys! Control your diabetes, keep the A1C below 7, and your kidneys will be happy. You also should probably take a blood pressure pill to protect your kidneys if you have diabetes, so don’t be surprised if your health care provider starts you on Lisinopril or something similar, even if your blood pressure is not too high. Insulin prevents kidney damage, and eye damage, and feet damage, and circulation damage, because insulin is the main treatment for high blood sugars.
Fear: “Insulin will put me into a diabetic coma!”
Modern day long-acting (basal) insulin almost never causes low blood sugars. If you are worried about low blood sugars, talk to your provider. Things that cause super-low blood sugars (hypoglycemia) are fast-acting, mealtime insulin, and certain medications like Glipizide (a sulfonylurea). If your blood sugar gets low, it is really easy to fix. Guess what? You just have to eat food! Most people who have really high blood sugars feel like their blood sugar is low even when it is still really high. For example, if your average blood sugar is 300 (A1C of 12), then you will feel shaky and hungry when your blood sugar gets down to 200.
Every day, I have a patient or two who says “my blood sugar got low” even though they did not check their blood sugar. So, I don’t believe them. But, you should be afraid of insulin if you do dumb things, like taking mealtime insulin without eating and then going back to bed (had a patient doing that today), or taking mealtime insulin in the middle of the night for no reason (had a patient today who used to do that until I found out about it).
Basically, if you are smart enough to be worried about a “diabetic coma” then you are probably smart enough not to take meal time insulin, or take Glipizide, without actually eating.
Diabetic coma is really a concern for people with Type 1 Diabetes, but much less of a concern for you with Type 2 Diabetes.
Fear: “It will hurt!”
I know. This is a for-real excuse in my book. However, shots in your belly with a tiny needle is nothing like poking your finger to check your blood sugar. I can think of 3 patients this month who refused insulin “because it will hurt” but obsessively check their blood sugar 5 times a day. Like, how does checking your blood sugar help anything if you won’t change your diet or take insulin? But, as a banjo player with sensitive fingers, I think that sticking a needle in your fingertip to draw blood is the worse thing EVER! Poking a needle in belly fat is really not a big deal AT ALL! It is just a reminder that you should get rid of that belly fat so you don’t have this problem in the first place. 🙂
Fear: “I will get fat!”
Yes, you might get fat if you start insulin. Before insulin was invented, people with diabetes wasted away to skeletons before they died. So it is possible that you will gain weight when you start insulin. However, you can control that by changing what you eat! If you keep eating carb-filled, processed, white fluffies (rice, pasta, wheat, bread, potato chips, tortillas, fruit juice and sugary beverages) then it is your own fault that you gain weight.
There are other medications that are way worse for weight gain. For example, several mental health medications really make you gain weight.
With Type 2 Diabetes, there are medications like Metformin, and some of the newer expensive drugs, that help you not to gain weight.
Fear: “I can’t afford it!”
True, you can’t afford insulin. However, the companies who make insulin have drug assistance programs. In my free clinic, we help everyone fill out the applications for the good quality insulin. You can also buy super-cheap insulin at Walmart, but it will still cost $20-40 a month at least.
There are other ways to get insulin, such as medication samples, or borrowing from a friend. Seriously, I know people who get plenty of insulin from family members who don’t want to take it, but who get tons of it from the VA or their health insurance plan. (I’m not saying it’s legal or anything, I just know that it happens.) There are free clinics that help with insulin, or vouchers that you can get from community groups or churches.
Fear: “It won’t work as well as pills.”
Even after I sent a patient to the ER last week because her blood sugar was 850 (and then it was 1,000 in the ER) and she spent a week in the hospital, today she said, “switch me back to pills because I think they will work better than this insulin.” I said, “NO WAY!” She will seriously die if she stops her insulin. Insulin is the most important treatment for sky-high blood sugars. Nothing else works for high blood sugars like insulin does. That patient was sent home on 4 shots of insulin a day. One basal insulin in the morning, and three shots of mealtime insulin with each meal. I hope to eventually simplify her insulin regimen, because she is relying on family members to give the shots, but for now she needs to keep do 4 shots a day.
Here is an old diagram that I found in my drawer at the clinic. I can’t figure out who orginally created it, but it is pretty neat: