The hormone insulin helps a cell absorb glucose from the blood. For a long time, insulin was extracted from the pancreas of cattle or pigs, purified and administered to humans. Today, genetically modified bacteria or yeast is used to produce a perfect copy of human insulin. Insulin cannot be taken as a pill as it will then be broken down during digestion. It must be injected into the fat under the skin.
There are many types of insulin available. These differ in how they are made, how they work in the body, and price. However, each person responds to insulin in his or her own way. That is why the type or dose of insulin prescribed to each individual may vary. Reluctance to use insulin is a well-established problem among patients with Type 2 diabetes mellitus. Here are some common myths about insulin and the actual facts.
Myth: Insulin cures diabetes.
Fact: Currently there is no cure for diabetes. Insulin is a method of controlling diabetes. Insulin supplements what the beta cells of the pancreas cannot make.
Myth: Taking insulin means failure at managing diabetes.
Fact: Using insulin is not a sign of failure to control diabetes. Nor is it an indication of severe health problems or proof that risk of diabetes complications has increased. All people with type 1 diabetes must take insulin. After years of successful management, it is common for people with type 2 diabetes to reach a point where improved glucose control can be obtained only by using insulin. It is a natural progression of type 2 diabetes.
Myth: Insulin causes complications.
Fact: The complications are due to poor control of diabetes and not due to insulin or tablets. It is more likely that insulin might have delayed or even prevented these complications if started earlier.
Myth: Insulin injections are painful.
Fact: Today's insulin syringes and pens are virtually painless. Most people are surprised by how little an insulin injection hurts. Insulin does not “sting” going in, and the needles are very small and thin. It is important to learn the right technique and bring the insulin to room temperature before taking insulin.
Myth: Insulin causes hypoglycaemia (low sugar).
Fact: Most often hypoglycaemia is due to negligence in timing between insulin shots and meals or too much time between meals. Hypoglycaemia need not occur with insulin alone. Low sugar can occur with oral medication too. Reduction in dosage may be necessary during diarrhoea, vomiting and poor food intake to prevent low sugar. Learn to prevent, recognise, and treat hypoglycaemia irrespective of whether insulin or tablets are used.
Myth: Insulin is too expensive.
Fact: Diabetes is expensive. Generally, however, insulin is usually less expensive than different types of oral medication. Keeping blood sugar under control is the best way to minimise expenses.
Myth: Insulin injections disrupt one's life
Fact: Many people believe that, once they start insulin, they can no longer be independent, live alone, travel, or eat away from home. None of these is true. Your doctor can design a schedule that will fit your lifestyle and various types of insulin are available for different needs. Devices like insulin pens and pumps may provide even more flexibility in your daily life.
Myth: Insulin is addictive.
Fact: You cannot get addicted to insulin. Insulin is a natural hormone that your body needs.
Myth: If insulin dose is increased, I must be getting worse.
Fact: Each person needs a different amount of insulin along with a nutrition plan and exercise. Also there may be periods where the dose is temporarily increased due to concurrent infection, stress, surgery etc. The dose and type of insulin has to be adjusted periodically depending on individual blood reports.
Myth: Once you start insulin you cannot stop.
Fact: People with Type 1 diabetes require insulin lifelong as their beta cells produce very little or no insulin at all. In Type 2 diabetes there are many situations where insulin is used temporarily. In such cases insulin is stopped after a few weeks or months and oral medications are resumed. The need to take insulin lifelong in Type 2 diabetes depends on the individual's pancreatic reserve.
Ask your doctor
If you are considering insulin or if your doctor has suggested it to you, the following questions can help you get ready for your next visit.
How satisfied are you with your current level of blood glucose control?
How interested are you in changing your therapy?
What is your biggest fear?
What problems do you think you will face?
What do you see as the most positive thing about insulin therapy for you?
Clinicians can alleviate many concerns by being aware of the personal and social dimensions of insulin therapy. Numerous strategies are available for successful counselling and implementation of insulin therapy in patients with type 2 DM. It will be possible to help patients make an informed decision when the time comes to start insulin therapy.
The writers are Chennai-based diabetologists. Website: www.drvseshiah.org and www.drbalaji.org
