Most people diagnosed with type 2 diabetes are told to manage their condition with diet, exercise, and drugs such as metformin. As the disease progresses, however, blood sugar levels tend to rise. Your doctor will likely respond by prescribing more medication.
Eventually, perhaps after many years, you may be asked to turn to insulin injections. Insulin is the most powerful glucose-lowering drug available, but it has some serious side effects that users need to be aware of.
What can you expect? This article will describe what will and what won’t happen when you add insulin to your treatment regimen.
There Is No Need to Panic
Insulin therapy sounds scary. Injections are uncomfortable. And the truth is, insulin does increase the level of difficulty involved with managing your health. But it shouldn’t mean that your lifestyle needs to change in any significant way.
It’s also important to remember that you haven’t done anything wrong if you get to a point where you need insulin therapy. Since type 2 diabetes is often a progressive disease, many with the condition will require insulin at some point. You didn’t fail at diabetes management, and insulin is no punishment. Adding insulin therapy to your management toolkit is just another way to better meet A1C goals, enjoy better blood sugars, improve your quality of life, and even extend your life. Embrace it!
You Will Experience Low Blood Sugars, and They Can Be Dangerous
The most important side effect of insulin therapy is hypoglycemia, or low blood sugar. It’s possible that you’ve never experienced this symptom before. Most diabetes medications, including metformin, are not known to cause blood sugar lows (sulfonylureas are an exception). Insulin is a whole different story.
Hypoglycemia means your body does not have enough sugar in the blood to fuel all of your body’s cells, especially those in the brain. Low blood sugar is typically defined as a blood glucose level below 70 mg/dL (3.8 mmol). Insulin can lower your blood sugar so effectively that you can easily end up in this unhealthy range. If your blood sugar gets too low, it can actually be dangerous.
Luckily, all mild cases of hypoglycemia can be treated very easily and quickly, with carbohydrates, ideally simple refined sugars.
If you’re taking insulin, you need to be prepared to treat hypoglycemia at any time. This means bringing rescue snacks, such juice, candy, or glucose tabs, everywhere you go. It might be smart to set up stashes at work, by your bed, and in your car.
Symptoms of low blood sugar include:
You’ll also want to measure your blood sugar more frequently than you’re accustomed to now. Low blood sugar can usually be sensed, but that isn’t foolproof. Hypoglycemia is especially likely after you’ve skipped a meal or exercised.
Severe hypoglycemia occurs when the symptoms are strong enough that you cannot treat yourself. Severe hypoglycemia always requires immediate emergency medical attention. Ask your doctor about a prescription for glucagon, an emergency medicine that can be used to bring blood glucose levels up quickly. You’ll want to train your coworkers, friends, and family on how to recognize very low blood sugar and how to administer your glucagon rescue medication.
You will need to work with your doctor to fine-tune your management, so you are able to take enough insulin to manage high blood sugars, while not taking too much where you will drop too low. Finding the right dosage takes a learning process, and it will take time.
Basal vs Rapid Insulin
Most people with type 2 diabetes will start with a prescription for “basal” insulin. This insulin is typically injected only once or twice per day. Basal insulin is meant to respond to the continuous release of glucose from the liver around the clock; it supplements the baseline amount of insulin that your body requires to live.
Rapid insulin is also variously called fast-acting, meal-time, or bolus insulin. Many patients will only progress to rapid insulin long after beginning basal insulin. This insulin works much more quickly and powerfully and is typically taken before meals. The use of rapid insulin requires a considerably more complicated dosage strategy, with a higher risk of hypoglycemia.
Your Medical Bills Will Probably Go Up
Insulin is one of the most expensive chronic disease medications on the market in the United States. If you have good insurance, Medicaid, or Medicare, your insulin may cost about $35 per month, or even less. But not everyone is so lucky — for some people, insulin costs hundreds of dollars per vial.
You May Need Additional Support
Adding insulin therapy to your diabetes management will mean some big adjustments. You may need extra emotional, mental, and even physical support during this time. Insulin therapy can be expensive, and the threat of low blood sugars can be very stressful. If you’re using rapid insulin, it makes every meal a little bit more complicated.
Getting support from family and friends, joining a diabetes support group, or simply becoming more engaged in the diabetes community can really help during this time. Make sure to enlist friends and family to help you, and be open and honest with them about your worries and struggles. Adding insulin therapy to your management is meant to help, not hurt, but it’s easier when you’re not doing it alone.
Insulin and Weight Gain
Insulin has a reputation for causing weight gain.
Both clinical trials and the diabetes community’s anecdotal reports suggest that it’s true. Insulin is a growth factor, and helps the body to store energy as fat. Experts have also theorized that subcutaneous insulin injections have “‘unphysiological’ pharmacokinetic and metabolic profiles” that introduce some metabolic dysfunction that could cause extra weight gain.
But there is no reason to assume that insulin-associated weight gain is inevitable, especially if you make an effort to boost your insulin sensitivity.
We have an entire article on the subject: Does Insulin Make You Fat?
Insulin Can Improve the Quality of Your Life
When taking insulin, it is crucial that you work with your doctor and follow your treatment plan to better meet your health goals. The transition from managing with diet and exercise and non-insulin medications to insulin therapy can be challenging, but with a growth mindset and preparation for what lies ahead, you can thrive on insulin therapy, with significant benefits for your long-term health.