5 Tips for Adding Insulin to Your Type 2 Diabetes Treatment
There may come a time when insulin will help you better manage your type 2 diabetes. With a little insight, some training, and preparation, you can master injections—and improve your diabetes management.
1. Give Yourself a Break.
Type 2 diabetes is a chronic disease, and it can progress even if you’re following all of your health care team’s recommendations. To best manage your blood glucose, you may need to start using insulin or another injectable medication. (Go here for more on how type 2 progresses.) Going on insulin doesn’t mean you’ve failed, though. “Insulin is a tool, just like anything else: like my meter, like exercise, like eating lower-carb meals,” says Corinna Cornejo, 57, of Oahu, Hawaii, who manages her type 2 diabetes with regular and NPH insulin. “If that tool is going to help keep my blood sugar better managed, why wouldn’t I want to use it?” Her doctor explained the potential complications that come with prolonged high blood glucose to help her understand why insulin is an essential part of her arsenal to manage her diabetes.
2. Learn to Inject.
Once you are prescribed insulin, a nurse or diabetes educator will teach you how to properly use it. People with type 2 starting the medication usually begin with a daily dose of long-acting or ultra-long-acting insulin. Insulin can be dosed and injected using a vial and syringe or a pen and needle. You’ll practice measuring the correct dose, and you’ll learn the best places to give an injection: abdomen, tops of thighs, and backs of arms, where there is more fatty tissue. Your nurse or educator will show you how to select new patches of skin to inject into, which keeps your tissue healthy and helps you avoid building up scar tissue. Rotating your injection sites also helps your body reliably absorb the medication so it acts as expected, says Carolé Mensing, RN, MA, CDE, FAADE, chair of the National Certification Board for Diabetes Educators. Unlike vaccinations, which use long needles that reach muscle tissue, insulin is injected with thin, short needles into the fatty layer just under the skin, a process that is usually painless.
3. Prepare for Lows.
Low blood glucose, or hypoglycemia, may happen when taking insulin. When blood glucose drops to 70 mg/dl or lower, you may have symptoms such as hunger, nervousness, shakiness, perspiration, dizziness or light-headedness, sleepiness, and confusion. “It’s crucially important for patients to be familiar with what hypoglycemia symptoms are and what the protocol should be to treat,” says Jonathan Leffert, MD, FACP, FACE, ECNU, president of the American Association of Clinical Endocrinologists. Without treatment, hypoglycemia can lead to confusion, abnormal behavior, or even unconsciousness because the brain needs glucose to function properly. Treat lows with the 15-15 rule: Eat 15 grams of rapidly absorbed carbohydrate (glucose tablets and gels make for more-precise dosing than candy), wait 15 minutes, then check your blood glucose again. If your blood glucose is still low, eat another 15 grams of carb, wait 15 minutes, and re-check. It’s a smart idea to stash sources of fast-acting glucose in several places—such as your purse or computer bag, bedside table, desk, and car—in case of lows.
4. Plan Your Budget.
Insulin is covered to various degrees by insurance. Plan to ensure ongoing insurance coverage because the retail price of most insulin products is high. Your pharmacist can help you bring costs down by suggesting coupons and discounts. They can also look up what your insurance might cover. Drug manufacturer websites may offer discount codes, which Wes Lyons, 35, of Huntsville, Alabama, uses when he picks up his Novolog and Levemir to manage his type 2 diabetes. “You’re still paying a lot more than you would for an oral medication, but you’re getting a discount,” Lyons says. “The control factor, not having these weird slumps and highs, is worth it.” Talk to your health care team about finding the most affordable options. Older types of insulin may be cheaper and just as effective for your needs, says Leffert.
5. Keep a Log.
Checking blood glucose and logging the results are vital for insulin users, says Leffert. “People tend to look at blood sugar testing as a static ‘here’s what’s happening right now, and that’s what I need to do to react.’ But … we can teach them pattern recognition,” he says. Looking at patterns will help you and your doctor see whether you are consistently off target at certain times of the day or in response to, say, eating at a restaurant. This information can help you and your health care provider adjust your food, exercise, or insulin dose as needed. Many meters allow you to add information to the glucose reading (such as “after meal” or “sick day”) and can download results to a computer and let you create reports. The data can help you become your own diabetes investigator, Mensing says, and help you find a regimen that works best for you. Of course, it’s also OK to keep a log using a pen and paper. Record the date, time, blood glucose result, and any notes that can help explain the result, such as eating an unusually large meal or sitting for a long time during a cross-country car trip.
Calling the Shots
Your doctor may recommend an injectable drug from the GLP-1 receptor agonist class (such as Byetta or Victoza) instead of or in addition to insulin. Such medications are effective, have less risk of low blood glucose (hypoglycemia) than insulin does, and won’t cause weight gain—some people even lose a few pounds after starting one of these medications.