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Tammy Williams was no stranger to diabetes. The North Carolina
children’s librarian, now on disability, had originally been diagnosed
with Type II diabetes in her mid-20s. For years, she had been managing
her diabetes through diet modification and oral medications. But about
six years ago, she entered a new area in the world of diabetes: insulin
therapy.
“First I developed
bronchitis, and I had to go on steroids, which was going to mess up my
blood sugars,” recalls Williams, now 45. So her doctor prescribed
insulin as a temporary measure. But once she stopped taking the insulin
after her bronchitis resolved, her glucose levels kept getting worse. “I
was having more and more trouble controlling things and my diet wasn’t
working as well, so I went back on the insulin for good.”
Her first reaction: “Oh no, it’s going to hurt to give myself a
shot every day!” This is one of many common fears among people with Type
II diabetes who have to start taking insulin, says Nora Saul, RD, a
nutrition manager with the Joslin Diabetes Centers in Boston. But as
mysterious and frightening as the world of insulin therapy may seem,
with a few insights from experts, it can be much easier to manage.
Here are six tips to remember when beginning insulin treatment for diabetes:
Taking insulin doesn’t mean you’ve failed at managing your diabetes.
Once or twice a week, Saul manages an “insulin start” for a
patient who has been newly prescribed insulin. She commonly hears people
say, “I lost weight. I’m eating better and more healthfully. So why am I
being put on insulin?”
The natural progression of Type II diabetes often means that,
over time, your pancreas will produce less and less insulin. So
eventually you will need to receive it through injections. “That doesn’t
mean it’s your fault,” says Saul. “By about 10 or 15 years of living
with diabetes, most people are tending toward insulin. This is a way
that you can get your blood sugars back under control and reduce the
possibility of complications. It’ll give you more control than oral
agents can, and you will probably feel better, with more energy.”
Insulin doesn’t lead to complications.
You may have seen family members or friends start taking insulin
for their diabetes, only to experience complications, or even die. This
might worry you. You may wonder if insulin actually poses a risk to your
health.
No, says Saul. “People used to develop complications shortly
after going on insulin in the past, because in those days patients were
put on insulin as a last resort. The time to start is when your sugars
are still in reasonable control. Insulin does not cause complications, and if used appropriately and in time, it will prevent complications.”
Giving yourself insulin shots doesn’t have to hurt.
“You usually give
yourself a shot on your stomach or your thighs, and it’s not that
sensitive,” says Williams. “I actually think the finger prick when you test your blood sugar hurts much more, because your fingers are more sensitive.”
If the initial prick bothers you, Williams has learned a trick
from going to the dentist. “Jiggle your skin just a bit as you put the
needle in,” she says. “My dentist would do this when giving me Novocain,
and it made the shot much less painful.”
If you’re using a pen syringe, as many people do, Williams
advises taking it easy on the force. “Sometimes the syringes stick a
little and you have to force them a bit, and you don’t realize you’re
pushing so hard,” she says. “I used to think, ‘Hey, where’d I get that
bruise on my leg from?’ Now I hold onto the bottom of the syringe as I
press down so I don’t push too hard.”
Transporting insulin is easier than you think.
For a long time, Williams thought she had to keep all her insulin
refrigerated, even the vial she was using at that time. “I was shooting
it into my skin cold, which was uncomfortable!” she recalls.
But then she found out that only the extra vials of insulin have
to be refrigerated. “You can keep your open vial at room temperature.
Just don’t let it get excessively hot,” Williams says. “That was nice to
realize. Now when I go to the yarn store, I just stick the vial and
syringe into my pocketbook, or I keep it at the side of my desk when I’m
working on the computer so I don’t have to run to the refrigerator.”
Saul notes that even going out to dinner with your insulin is
easier these days. “With the insulin pens we have now, injecting is very
easy and can even be discreetly done at the dinner table.”
Flying with insulin is usually not a problem, Saul says. “The TSA
has become educated about this subject.” To be safe, however, she
advises carrying a “travel letter” from your doctor with you whenever
you must go through airport security with your insulin.
Practice good insulin management.
“You need to understand the action time of your insulin,” Saul
explains. “For example, rapid-acting insulins start acting in about 10
to15 minutes. They peak in about two hours, and last about four hours in
the body. So it’s important not to take additional injections to
correct your blood sugar during that time.” Familiarize yourself with
when you need to take your specific type of insulin, when it will start
to work, what its peak times are, and how long one dose of insulin will
last.
As long as your insulin is refrigerated, it will last a long time.
Once you’ve taken it out of the fridge and opened it, it has a 30-day
shelf life. It’s important to note the date of first use on the vial.
Many people wonder
about discarding sharps. Saul advises her patients to use something
opaque, and thick enough that sharps won’t pierce it. “Any hard plastic
detergent bottle will work well,” she says. “Some communities will let
you dispose of sharps in the regular trash if they are in that closed
container; in other areas, you have to bring the container to a central
location. Ask your local health department if your doctor doesn’t have
the information.”
Track your blood sugar carefully.
“Keep a regular record of your blood sugar when on insulin,” says
Saul. “This can help you manage both your blood sugars and the insulin
you’re taking. You’ll see patterns and trends.”
For example, say you’re on a once-a-day dose of long-acting
insulin, and your goal is to get your morning sugar level under 130. “So
check it in the morning,” Saul says if you’re not at your goal yet and
you’re not having hypoglycemic episodes, you may need to increase your
dose. Talk with your doctor or diabetes educator; tracking and
monitoring your sugars this way gives you authority over your own care.
“It was scary when I got put on insulin, just like it was scary
when I was first diagnosed,” says Williams. “But it’s just that your
body is changing. You’re getting older, things are happening, and
sometimes it’s just a choice that your body makes at the moment. It gets
commonplace easily, and you’ll learn to manage insulin just like you
learned to manage diabetes.”
If you were buying a car, you wouldn't dream of leaving the
showroom without first asking the salesperson how safe it is, how well
it drives, and how to operate it.
If you've been prescribed insulin -- a medicine used to treat diabetes -- you shouldn't consider leaving your doctor's office without asking how to take it, what side effects it might have, and how it will affect your diabetes.
Here is a list of important questions to ask your doctor before you start taking insulin:
What type of insulin do I need?
Insulin comes in four basic forms:
Which insulin delivery method should I choose?
To inject insulin, you can use a syringe, pen, or pump. There is also a needle-free option called a jet injector. Discuss with your doctor the pros and cons of each method. Pens are easiest to use, pumps deliver insulin continuously, and syringes are the least expensive.
The decision may come down to cost, so find out which method your insurance will cover. If you don't have insurance or your plan won't pay for the type of insulin delivery method you prefer, ask your doctor about programs that can help you cover the cost.
How many times do I need to inject insulin each day?
People with type 1 diabetes may need up to three or four injections daily. Those with type 2 diabetes may need just one shot of insulin a day, possibly increasing to three or four injections.
Find out how many times a day you'll need to inject, and how much insulin to inject in each dose. If you're using an insulin pump, ask your doctor when you'll need to give yourself an extra injection (bolus).
When should I take my insulin?
How often you take insulin depends on several factors, including:
If you've been prescribed insulin -- a medicine used to treat diabetes -- you shouldn't consider leaving your doctor's office without asking how to take it, what side effects it might have, and how it will affect your diabetes.
Here is a list of important questions to ask your doctor before you start taking insulin:
What type of insulin do I need?
Insulin comes in four basic forms:
- Rapid-acting insulin starts working within a few minutes after injection, but its effects only last for a couple of hours.
- Regular- or short-acting insulin takes about 30 minutes to work fully and lasts for 3 to 6 hours.
- Intermediate-acting insulin takes 2 to 4 hours to work fully, and its effects can last for up to 18 hours.
- Long-acting insulin takes 6 to 10 hours to reach peak levels in the bloodstream, but it can keep working for an entire day.
Which insulin delivery method should I choose?
To inject insulin, you can use a syringe, pen, or pump. There is also a needle-free option called a jet injector. Discuss with your doctor the pros and cons of each method. Pens are easiest to use, pumps deliver insulin continuously, and syringes are the least expensive.
The decision may come down to cost, so find out which method your insurance will cover. If you don't have insurance or your plan won't pay for the type of insulin delivery method you prefer, ask your doctor about programs that can help you cover the cost.
How many times do I need to inject insulin each day?
People with type 1 diabetes may need up to three or four injections daily. Those with type 2 diabetes may need just one shot of insulin a day, possibly increasing to three or four injections.
Find out how many times a day you'll need to inject, and how much insulin to inject in each dose. If you're using an insulin pump, ask your doctor when you'll need to give yourself an extra injection (bolus).
When should I take my insulin?
How often you take insulin depends on several factors, including:
- The type of insulin you use (fast-acting, premixed, etc.)
- How much and what type of food you eat
- How much exercise you get
- Other health conditions you have
- The type of insulin delivery system you use
If you were buying a car, you wouldn't dream of leaving the
showroom without first asking the salesperson how safe it is, how well
it drives, and how to operate it.
If you've been prescribed insulin -- a medicine used to treat diabetes -- you shouldn't consider leaving your doctor's office without asking how to take it, what side effects it might have, and how it will affect your diabetes.
Here is a list of important questions to ask your doctor before you start taking insulin:
What type of insulin do I need?
Insulin comes in four basic forms:
Which insulin delivery method should I choose?
To inject insulin, you can use a syringe, pen, or pump. There is also a needle-free option called a jet injector. Discuss with your doctor the pros and cons of each method. Pens are easiest to use, pumps deliver insulin continuously, and syringes are the least expensive.
The decision may come down to cost, so find out which method your insurance will cover. If you don't have insurance or your plan won't pay for the type of insulin delivery method you prefer, ask your doctor about programs that can help you cover the cost.
How many times do I need to inject insulin each day?
People with type 1 diabetes may need up to three or four injections daily. Those with type 2 diabetes may need just one shot of insulin a day, possibly increasing to three or four injections.
Find out how many times a day you'll need to inject, and how much insulin to inject in each dose. If you're using an insulin pump, ask your doctor when you'll need to give yourself an extra injection (bolus).
When should I take my insulin?
How often you take insulin depends on several factors, including:
Where should I inject the insulin?
There are some factors to consider when deciding where to inject. Most people select the abdomen since it’s an easily accessible region. Your insulin shot will work fastest if you inject it into the stomach (be sure to stay at least 2 inches from the belly button). But you can also inject insulin into your arms, thighs, or buttocks. Ask your doctor or diabetes educator to show you the right way to inject, including how to keep your needle and skin clean to prevent infections. Also learn how to rotate the injection site so you don't develop hard, fatty deposits under the skin from repeated injections.
How will insulin interact with other medicines I'm taking?
Low blood sugars caused by insulin can be intensified by some medications. Tell your doctor all of the medicines you're taking -- even drugs you bought without a prescription.
What can I eat while taking insulin?
Ask your doctor for dietary recommendations to help your insulin work most effectively. Find out how much food to eat at each meal, which types of foods are best for you to eat, whether you need to have snacks, and at what times to eat. If you drink alcohol, ask your doctor whether you can continue to drink while taking insulin, and if so, how much alcohol is safe to drink.
What is my target blood sugar level?
Ask your doctor how often you need to check your blood sugar level using your blood glucose meter. Find out your target blood sugar range before and after meals, as well as at bedtime. For most people with diabetes, the targets are:
What side effects could I have from the insulin?
Insulin can have side effects, most commonly low blood sugar and weight gain. Ask your doctor what side effects you might have, and what to do if you experience them.
How should I store my insulin?
Most insulin manufacturers recommend storing insulin in the refrigerator, but injecting cold insulin can be uncomfortable. Make sure it’s at room temperature before injecting. Ask your doctor whether to store your insulin in the fridge or at room temperature. Also find out how long your insulin will last, and how to tell if it has gone bad.
Can I reuse syringes?
Reusing syringes can lower your costs. Ask your doctor whether you can safely reuse your syringes, and how to keep them clean to prevent infection. If you throw out your syringes after each use, learn how to safely dispose of them.
If you've been prescribed insulin -- a medicine used to treat diabetes -- you shouldn't consider leaving your doctor's office without asking how to take it, what side effects it might have, and how it will affect your diabetes.
Here is a list of important questions to ask your doctor before you start taking insulin:
What type of insulin do I need?
Insulin comes in four basic forms:
- Rapid-acting insulin starts working within a few minutes after injection, but its effects only last for a couple of hours.
- Regular- or short-acting insulin takes about 30 minutes to work fully and lasts for 3 to 6 hours.
- Intermediate-acting insulin takes 2 to 4 hours to work fully, and its effects can last for up to 18 hours.
- Long-acting insulin takes 6 to 10 hours to reach peak levels in the bloodstream, but it can keep working for an entire day.
Which insulin delivery method should I choose?
To inject insulin, you can use a syringe, pen, or pump. There is also a needle-free option called a jet injector. Discuss with your doctor the pros and cons of each method. Pens are easiest to use, pumps deliver insulin continuously, and syringes are the least expensive.
The decision may come down to cost, so find out which method your insurance will cover. If you don't have insurance or your plan won't pay for the type of insulin delivery method you prefer, ask your doctor about programs that can help you cover the cost.
How many times do I need to inject insulin each day?
People with type 1 diabetes may need up to three or four injections daily. Those with type 2 diabetes may need just one shot of insulin a day, possibly increasing to three or four injections.
Find out how many times a day you'll need to inject, and how much insulin to inject in each dose. If you're using an insulin pump, ask your doctor when you'll need to give yourself an extra injection (bolus).
When should I take my insulin?
How often you take insulin depends on several factors, including:
- The type of insulin you use (fast-acting, premixed, etc.)
- How much and what type of food you eat
- How much exercise you get
- Other health conditions you have
- The type of insulin delivery system you use
Where should I inject the insulin?
There are some factors to consider when deciding where to inject. Most people select the abdomen since it’s an easily accessible region. Your insulin shot will work fastest if you inject it into the stomach (be sure to stay at least 2 inches from the belly button). But you can also inject insulin into your arms, thighs, or buttocks. Ask your doctor or diabetes educator to show you the right way to inject, including how to keep your needle and skin clean to prevent infections. Also learn how to rotate the injection site so you don't develop hard, fatty deposits under the skin from repeated injections.
How will insulin interact with other medicines I'm taking?
Low blood sugars caused by insulin can be intensified by some medications. Tell your doctor all of the medicines you're taking -- even drugs you bought without a prescription.
What can I eat while taking insulin?
Ask your doctor for dietary recommendations to help your insulin work most effectively. Find out how much food to eat at each meal, which types of foods are best for you to eat, whether you need to have snacks, and at what times to eat. If you drink alcohol, ask your doctor whether you can continue to drink while taking insulin, and if so, how much alcohol is safe to drink.
What is my target blood sugar level?
Ask your doctor how often you need to check your blood sugar level using your blood glucose meter. Find out your target blood sugar range before and after meals, as well as at bedtime. For most people with diabetes, the targets are:
- 70 to 130 mg/dL before meals
- Less than 180 mg/dL 1 to 2 hours after the start of a meal
What side effects could I have from the insulin?
Insulin can have side effects, most commonly low blood sugar and weight gain. Ask your doctor what side effects you might have, and what to do if you experience them.
How should I store my insulin?
Most insulin manufacturers recommend storing insulin in the refrigerator, but injecting cold insulin can be uncomfortable. Make sure it’s at room temperature before injecting. Ask your doctor whether to store your insulin in the fridge or at room temperature. Also find out how long your insulin will last, and how to tell if it has gone bad.
Can I reuse syringes?
Reusing syringes can lower your costs. Ask your doctor whether you can safely reuse your syringes, and how to keep them clean to prevent infection. If you throw out your syringes after each use, learn how to safely dispose of them.
Questions Your Doctor May Ask You
You won't be the only one asking questions at your visit. Your doctor may also ask a few questions of you, including:
You won't be the only one asking questions at your visit. Your doctor may also ask a few questions of you, including:
- How are you feeling while taking your insulin?
- Are you having any side effects?
- How are you responding to your insulin dose? Are you having any problems with high or low blood sugar?
- Have you had any trouble using your insulin syringe, pen, or pump?
- Do you know how to store and dispose of your used syringes/needles?
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