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The thought of sticking yourself with a needle is not something most people look forward to, but for some type 2 diabetes patients, taking insulin becomes a necessity. Taking insulin does require a great deal of self-direction—although your doctor and diabetes educator will be there to answer your questions, you will be responsible for adhering to the plan on a daily basis. A recent study found insulin to be one of the top medications to cause serious adverse adverse effects if taken incorrectly, and the rate of such medication mistakes are climbing.
With practice, though, you can get into a routine and using insulin to manage your type 2 diabetes will become second nature. Here’s what an endocrinologist, diabetes educator, and pharmacist told us you should know to get there.
Insulin syringes and “pens” are the most common ways to get insulin into your body, but you may have the option to use an insulin pump or continuous subcutaneous insulin infusion (CSII). “Using a vial and insulin syringe is the least costly method of injecting insulin, but has a greater incidence of injection site discomfort, less accuracy, less convenience, less ‘user-friendliness’ and increased psychosocial issues,” says pharmacist Dave Walker, RPh, a member of the Medshadow Medical Advisory Board.
Insulin pens, which already have the medication inside so you don’t have to draw it up from a vial yourself, are more convenient, have greater accuracy, and are more user friendly, Walker says. “The trade-offs are increased cost and the inability to mix two types of insulin together,” he says.
Insulin pumps, which are continuously attached to your body, might seem more convenient—but they’re not right for everyone. “Pumps have a greater patient acceptance and can control insulin levels more precisely, thereby having greater glycemic [blood sugar] control,” Walker says. “But this is offset by the increased cost and increased risk of injection site infection and pump failure.”
You and your doctor can together decide which type of insulin delivery is right for you.
The first time you inject yourself with a needle could be a scary experience. But rest assured: It’s probably not as bad as you think. “The needles used these days are so thin and are treated to be friction-free, making them almost painless,” says endocrinologist Donald McClain, MD, PhD, a professor of endocrinology and metabolism at Wake Forest Baptist Medical Center.
However, “diabetes distress” is a real thing, says the American Diabetes Association, and may be influenced by the difficulties of dealing with injections. If you’re experiencing stress or anxiety over taking your insulin, speak with your diabetes educator or doctor for strategies on how to cope.
You can inject insulin in a variety of places on the body, but check with your doctor first. "Insulin can be injected in the abdomen, which is usually the preferred injection site," Walker says. That's where it's absorbed the fastest. "Insulin can also be injected in the thigh or arm, but always inject insulin in the site recommended by your healthcare provider," he says. Wherever your insulin injection site, stick to the same general location with each shot so the medication gets distributed at the same rate. But, make sure you rotate the particular spot so you’re not injecting into the same location. For example, move around on your belly from shot to shot.
Sticking yourself in the same exact place every time can create lumps under the skin that could make the medication not as effective.
Insulin can get a little confusing. There’s fast-acting insulin, which works right away with meals, and others that act more slowly. “A diabetic’s need for insulin should be individualized and depends on a number of things including body weight, percentage of body fat, activity, diet, and other medications taken,” Walker says. “Some patients with diabetes need a combination of a short, rapid-acting insulin and an intermediate or long-acting insulin product.”
Make sure you know which insulin medication should be taken when.
“If you are using more than one insulin, it is prudent to label which is your long-acting insulin and which is your short-acting insulin, and place them apart from each other,” says Agnes Weaver, RN, CDE, a diabetes educator at Piedmont Fayette Hospital. “For instance, a pre-meal, short-acting insulin pen can be left near the dining room table and a basal, or long-acting, insulin pen can be left by the nightstand if you are taking it at night.”
As you get more comfortable with taking insulin, you’ll be able to better understand how it affects your glucose levels. “The most common mistake is taking insulin without knowing what the blood sugar is,” Dr. McClain says. Unfortunately, blood sugar checks do require more sticks—this time in the form of a finger prick. You’ll need a blood glucose meter, and Weaver says to check with your insurance to make sure you’re using a “preferred” brand for cost effectiveness.
Test by applying blood to strips that the meter will read. “Not applying enough blood onto the glucose strip can result in an ‘error’ message on the meter or an erroneous reading,” Weaver says. “Adjust your lancing device to get a deeper stick to draw more blood.” Be sure to consistently record your results to report to your doctor later.
Follow your doctor’s instructions for how often to check your blood sugar to make sure the insulin is bringing it into an OK range. “Everybody is different when it comes to checking blood sugar levels,” Walker says. “Many diabetics can get by with checking their blood sugar once daily if they have a history of good glycemic control. Other patients need to check multiple times a day—sometimes four or five times a day—to determine their insulin needs and adjust according to a sliding insulin dose scale provided by their health care provider."
Your insulin may need to be adjusted depending on what you eat. “The best ways to deal with this problem is to come up with a dose of insulin that is tailored to the grams of carbohydrate in the meal,” he says. “With ‘counting carbs’ and knowing their ‘carb ratio,’ you can calculate a good dose for that meal.” Your particular carb ratio is best determined by your doctor or diabetes nurse. Follow these tips for counting carbs.
Counting carbs and monitoring blood glucose can help assure you’re getting the right amount of insulin. “In the ideal world, each dose with meals ought to be tailored to the carbohydrate content of the meal, and to the blood glucose level going into the meal, so a correction can be made if the pre-meal glucose is low—take less insulin—or high—take more, for a ‘correction factor,’” Dr. McClain says. Checking blood sugar again two hours after meals lets you know if you hit the calculated dose correctly.
Just as eating affects the amount of energy coming in, physical activity affects the amount of energy going out. So when you exercise, you’ll have to take care to avoid hypoglycemia, or low blood sugar, when taking insulin. “Exercise increases the rate that the glucose is taken up into tissues, so people will need less insulin with exercise,” Dr. McClain says. “If they know they will exercise within an hour or two of a meal, they can take a little less of the usual dose with that meal. If they have already taken insulin, they may need a snack to keep their glucose up.”
The more you exercise, the less insulin, or bigger snack, you will need, but see your doctor to get specific guidance for your situation. In addition, if you’re starting a new exercise regime, be sure to talk with your doctor first to work out a new plan for monitoring and taking insulin. “The most important thing is that there is no substitute for checking the glucose before and during or after the exercise,” Dr. McClain says.
It can seem like everything in life affects your insulin dose—and in some ways it does. Even getting sick can alter how much you need, because as your body goes on high alert to fight off your illness, the resulting stress hormones can affect how your body uses insulin. (Not surprisingly, plain old stress can do this to you, too.) Plus, being sick might affect how much you’re able to eat.
Come up with a “sick day plan” with your diabetes educator or doctor to head off any problems that may arise in advance. In addition, call your doctor if you’re not getting better, have had a fever for several days, are having a lot of vomiting or diarrhea, or are simply concerned about how the illness is affecting your insulin needs.
Yes, you might gain weight when you start taking insulin. But it’s not a side effect of the medication—it’s actually happening because you’re body is starting to work properly again. Insulin lowers blood sugar by allowing cells to absorb glucose, instead of it building up in the bloodstream. Before you were on medication, this lack of glucose absorption may have actually made you lose weight, so once the insulin starts working, you’ll gain it back.
Plus, your hunger cues might have been off when your body wasn’t able to process glucose, which it needs for energy, so it told you to eat more. But now that you’re body’s working again, if you eat the same amount of food you’ll gain weight. Talk to your doctor about how you can balance any weight gain with physical activity and portion control. Whatever you do, don’t adjust your medication dose as a way to lose weight.
Make sure you get rid of your needles properly—you can’t just throw them in the trash. “There are safety syringes available that help prevent inadvertent needle sticks after injecting insulin products, but insulin syringes and needles should [still] be placed into a sharps container immediately after use,” Walker says. “A sharps container is a hard plastic container that is used to safely dispose of hypodermic needles.” When it’s full, dispose of the sharps container according to your state and local regulations. Some hospitals offer free needle disposal programs as well.
You may be tempted to reuse needles in order to save money, but you may risk getting an infection by doing so. “Reusing insulin syringes may help reduce costs and waste, but do not routinely reuse syringes without consulting your health care provider or nurse,” Walker says.
You may feel like taking insulin is going to get in the way of your everyday activities, social life or travel, but living with insulin doesn’t have to be inconvenient. “Most insulin products do not need to be refrigerated; however, you should carry your insulin products in some sort of insulated travel bag or kit to prevent temperatures exceeding 80 degrees or so,” Walker says. “Likewise, those traveling in very cold temperatures need to protect their insulin from freezing.” Because of this, you shouldn’t leave your insulin in the car, Weaver says. In addition, your levels of activity may change during your travels, so remember to check your blood sugar levels frequently while traveling and make adjustments in insulin doses as required, Walker says.