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Managing Diabetes Magazine - diabetes

Benefits of insulin
Regain control of your diabetes

Often, people with type 2 diabetes postpone taking insulin as long as possible. Instead, they use oral medication, hoping to get their blood glucose levels under control. Starting on insulin is a step that many want to avoid at all costs.
Why does insulin have such a bad reputation? Without argument, it is the most effective medication for controlling blood glucose. This hormone is made naturally by the body to regulate the level of glucose in the blood. People with type 1 diabetes must take insulin to live. Without it, their bodies cannot use the sugar that cells require to function.

For those with type 2 diabetes, insulin also has benefits and a place in treatment. Type 2 diabetes is a chronic, progressive disease. As time goes on, the pancreas becomes less able to make insulin. The body may also resist the action of any insulin that is made. As diabetes changes over time, so must the tools used to control blood glucose. Keeping blood glucose low can prevent or delay issues related to diabetes. Complications include kidney problems, numbness and tingling in the arms, hands, legs and feet, eye disease, and problems with erections in men.

Advantages of insulin

Throughout your journey with type 2 diabetes, treatment goals remain the same. You want to maintain your blood glucose within normal range. Living a healthy and active lifestyle helps reduce the risk of complications. Healthy living lowers fasting and after-meal blood glucose, while improving glucose tolerance. Insulin is another primary tool your body uses to control blood glucose. Either your pancreas is able to make enough insulin, or it can be injected.

Insulin is easy to give, acts quickly and is safe when used properly. The dose can be increased as needed, and there is no maximum. Using insulin does mean that you will test your blood glucose more often. However, it also gives you greater control over your blood glucose. At any given moment, you will have the power to change your dose based on your diet, health and activity level.

Studies show that using insulin at certain points in your treatment may bring considerable benefits. For instance, you might use insulin for a short time when first diagnosed with type 2 diabetes. New research suggests that using insulin immediately after diagnosis may actually put diabetes into remission – something previously thought to be nearly impossible. More research is needed in this area before this therapy becomes mainstay, but using insulin early after being diagnosed is becoming more common. According to the Canadian Diabetes Guidelines, if your A1C is over 8.5 per cent when you are diagnosed, insulin is an appropriate choice for your initial treatment. If your blood glucose is too high, your pancreas and other organs could be damaged. Insulin quickly lowers your blood glucose, restoring some function to your pancreas and giving it a break from producing its own insulin.

Using insulin temporarily may also help if certain health conditions arise. For instance, your doctor might prescribe the steroid medication prednisone to treat your asthma attacks. Steroids, and illness in general, can make blood glucose rise. Your oral medications might take too long to become effective or already be at maximum dosage. In this case, insulin can help meet your targets and goals while you are using the steroids.

After living with type 2 diabetes for years, you may find it difficult to maintain your goals. At a certain point, lifestyle changes and pills are no longer enough to control blood glucose well. This doesn’t necessarily happen because you are doing things wrong, although unhealthy choices may mean that you reach this point sooner. Diabetes is progressive. Eventually, your body may not respond to medication the way it once did.
If this is true for you, adding insulin to your treatment may be helpful. Depending on which medications you take, you may find some can be reduced or eliminated altogether. This simplifies your routine and lowers the cost of managing your diabetes. Better blood glucose control can lessen complications, leading to a better quality of life.

Expect to continue using metformin even after you start insulin. It is one of the first tools recommended by the Canadian Diabetes Association to treat type 2 diabetes. Metformin can help reduce weight gain that sometimes occurs with insulin use. As well, it lowers the amount of glucose released by the liver, which is especially useful overnight. The new class of medications called SGLT2 inhibitors (empagliflozin, dapagliflozin and canagliflozin) may also help counter the weight-gain potential of insulin. A second class of medications called GLP-1 agonists (Victoza, Byetta, Trulicity and Ozempic) have also been shown to cause weight loss and can enhance your sugar control. The GLP-1 medications are injectable and while they are not traditionally used at the same time as insulin, there are occasions where exceptions will be made. You can talk to your local CDE or endocrinologist if you would like to learn more about these classes of medications.

Insulin may not only lower the number and cost of pills you take. You may also have greater flexibility in when and how much you can eat.

Could a Shorter Insulin Needle Help you?

Shorter insulin needles are now available for both syringes and pen needles. Many people report that they make injections more comfortable.

What advantage does the shorter insulin needle offer?

For insulin to be absorbed properly, it should be injected into the subcutaneous tissue - the fatty layer above the muscle. This region is typically anywhere from several millimetres to one centimeter thick. Using a shorter needle may help prevent intramuscular injections, when insulin is injected into the muscle by mistake.

Children, thin adults, and people who do not pinch up or fold the skin when injecting are more likely to have this happen. Using a shorter needle may also reduce pain during an injection, since there is less needle to enter the skin.

Who might want to try shorter needles?

Almost anyone who injects insulin may benefit from using shorter needles. One Canadian study suggested people who are overweight (with a body mass index of more than 27) might have more difficulty using a shorter needle. However, the issue could be related to technique as similar studies found little difference.

If you want to try a shorter needle, you can always work with your health care provider to ensure your technique is good. Then, watch carefully for any signs of change in blood glucose control.

What needle lengths are available?

Subcutaneous pen needles come in a variety of lengths. ‘Short’ needles are 4 millimetres (mm) long and are now very much the standard. Needles are also available in 5, 6 and 8 millimetres.

Using insulin

Commonly, treatment starts with a long-acting insulin, typically taken at bedtime. The dose provides the background or basal insulin that your pancreas would normally make around the clock to control your blood glucose level. (Basal insulins include Lantus, Toujeo, Levemir, Tresiba and Basaglar.)

With this insulin in place, your body will have the energy it needs for basic functions. When you take basal insulin, your pancreas is relieved of this task. It can reserve the insulin-making ability it has left for a time when your blood glucose needs more control. This means that you may be able to eat regular-sized meals without worrying so much about blood glucose spikes afterward.

In addition, basal insulin brings down your fasting or morning blood glucose levels. When you start the day with blood glucose within target range, it is easier to maintain and achieve your desired numbers. Symptoms of high blood glucose may be reduced or eliminated. For instance, constant thirst and associated trips to the bathroom often come along with diabetes. Consider the luxury of a good night’s sleep without all the interruptions to get up and go! If your blood glucose is lower, you may find that you have more daytime energy as well.

Basal insulin is often paired with fast-acting (bolus) insulin such as the rapid-acting forms (NovoRapid, Fiasp, Apidra and Humalog) and short-acting forms (Humulin R and Novolin ge Toronto). This insulin acts and breaks down quickly so that its effects do not linger for too long. It is injected around mealtime to help counter the rise in glucose that happens after you eat. The dose of short-acting insulin may be adjusted depending on what you are eating. This allows you to target your after-meal glucose to the goals set by you and your diabetes educator.
There is a third category of insulin called premixed insulins (Humulin 30/70, Humalog Mix 25/Mix50, Novolin GE 30/70, 40/60 or 50/50). These insulins contain a mix of bolus and basal insulin. They allow for fewer injections but less flexibility in dosing, as they come in pre-set ratios and cannot be customized like separate basal/bolus regimens.

Finally, there is a fourth class of intermediate-acting insulins (Humulin N and Novolin NPH). These insulins usually last for 12-18 hours and are sometimes used as basal insulins.

One of the biggest benefits of insulin is that you regain control of your diabetes. No longer will you find that no matter what you do, your numbers are always high. You have the power to change your blood glucose in a very short time. You can achieve the blood glucose results that you have always wanted.

Say yes to insulin and all of its benefits. Begin by talking with your doctor or certified diabetes educator about your insulin options.

FAMILY HEALTH is written with the assistance of
Alberta College of Family Physicians
FAMILY HEALTH is written with the assistance of
Alberta College of Family Physicians
While effort is made to reflect accepted medical knowledge and practice, articles in Family Health Online should not be relied upon for the treatment or management of any specified medical problem or concern and Family Health accepts no liability for reliance on the articles. For proper diagnosis and care, you should always consult your family physician promptly. © Copyright 2018, Family Health Magazine, a special publication of the Edmonton Journal, a division of Postmedia Network Inc., 10006 - 101 Street, Edmonton, AB T5J 0S1 [DI_MDab18]
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