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Managing Diabetes Magazine - diabetes

No need for Insulin
Do your excuses hold water?

The discovery of insulin in 1921 was, and still is, considered one of the greatest medical discoveries of our time. Insulin saves lives and is still the most powerful tool for controlling blood glucose. However, 90 years later, many people are not taking advantage of it to help manage their type 2 diabetes. Why not?

Where does this reluctance come from? Avoiding or delaying the use of insulin can allow high blood glucose to damage your blood vessels and nerves. Many excuses are often given for rejecting insulin. Before you say no, consider whether emotion, fear or misinformation is behind your excuse.

“ I’m afraid of needles.”
“ I don’t like the idea of sticking a needle in my body.”
“ It will hurt.”

Under the surface:Although a fear of needles is possible, more often this excuse masks another fear or emotion.

The truth: Very few people have a true fear of needles. Many who refuse or delay insulin still go for flu shots and travel immunizations, and would not object to B12 or iron injections. Refusing insulin may have little to do with the needle itself. Instead, it is about associated feelings and emotions. Dig deeper to discover the true underlying cause.

For instance, do you fear the pain associated with injections? It is important to know that modern insulin injections are virtually painless. Today’s needles are as short as four millimeters, slim, and barely visible to the naked eye. If pain occurs, it may come from an improper injection technique. This can easily be corrected with the guidance of a health care professional.

Perhaps your fear is linked to embarrassment and the social stigma of needle use. Have an open discussion with your family, friends, and health care provider. Reassurance can help you realize that there is no need to be ashamed about diabetes and how it is managed. If you do have a true phobia of needles, overcome it by sitting down with a health care professional with expertise in diabetes. Having somebody walk you through the process can help you gain confidence over time.

“ Using insulin is inconvenient.”
“ It is too difficult to carry my insulin and supplies with me when I leave the house.”

Under the surface:You may not be aware of advances in ways to deliver insulin. Many people have mistaken or outdated ideas about how it works, picturing large needles, bulky equipment and vials that must be constantly refrigerated.

The truth: Advances in insulin delivery have made injections quick and convenient. People who use this medication can travel, eat out and enjoy daily activities, just like anybody else. Insulin can be carried anywhere, at room temperature, in an insulin pen the size of a marker. The amount of insulin to be injected is easily dialed on the pen, which delivers that precise amount. Injections can be done privately almost anywhere, in as little as 20 seconds. 

“ I won’t have the freedom to live my life the way I want.”
“ I’ll have to change my activities if I start using insulin.”

Under the surface: This excuse is about a fear that using insulin will change, disrupt or restrict your life. Many people associate taking insulin with a loss of control.

The truth: Those with type 2 diabetes typically begin by using a basal insulin injection once a day. Diabetes may be successfully managed for years using this type of insulin therapy. Still, despite your best efforts, a time may come when multiple daily injections must be implemented. This includes insulin that needs to be administered with meals.

Insulin types have changed and advanced dramatically over the years. Some insulin medications now very closely match the way that a healthy pancreas releases insulin. This allows a huge amount of freedom in matching insulin use to what is happening in your regular life. You are no longer limited to insulin that requires set meal times and doses at very specific times throughout the day. Many newer insulins allow people to just dose when they decide to eat. If you eat more or occasionally indulge, you can simply take more insulin to accommodate it. Many people find that they can enjoy their usual lifestyle and meal patterns and still get blood glucose control!

“ Insulin can make my sugars go too low.”
“ I don’t want to deal with side effects.”

Under the surface: This reason for this excuse is obvious. Starting a new medication can be scary, especially when you are aware of possible side effects.

The truth: Every medication, including your oral diabetes medication, comes with possible side effects. However, leaving your diabetes uncontrolled is even more risky. It is true that insulin does have the potential to lower your blood glucose too much, which can lead to serious consequences. However, by using proper doses of insulin and effective strategies to prevent and manage hypoglycemia, you can safely reach your blood glucose targets. Your health care provider will provide clear instructions on how this can be achieved. Keep in mind that newer insulins have been shown to have less chance of causing hypoglycemia, compared to others that have been on the market longer. Hypoglycemia should never be taken lightly, but insulin therapy has been and continues to be a vital part of managing diabetes successfully.

“ My diabetes isn’t that serious.”
“ I just have a touch of diabetes or borderline diabetes.”

Under the surface: This excuse is about denial. If you find the idea of having diabetes frightening, it can be easier to pretend that you don’t really have it.

The truth: Lessening or denying the seriousness often creates a false sense of security. It can also affect how aggressive you are in taking charge of your diabetes. The first step in managing diabetes is to acknowledge it. Accept the fact that your diabetes will not go away, so that you can move on to understand how it works and how to control it. Your actions do a great deal to reduce and prevent complications. In the end, you will have more peace of mind knowing that you are in control of your diabetes.

“ I don’t need insulin.”
“ I feel fine.”

Under the surface: This excuse can come from not understanding diabetes.

The truth: Most often, blood glucose problems are something that you cannot feel. Often the body adapts to high blood glucose, so you may feel normal when these levels are indeed dangerous. Perhaps you believe that if you feel fine, then your diabetes must be fine. No matter how you feel, high blood glucose is dangerous. It must be managed to delay and prevent complications associated with diabetes.

“ If I try harder to lose weight, manage my diet and exercise, I can regain control.”
“ I’ll just manage it by taking my diabetes tablets.”

Under the surface: This excuse masks feelings of anger or failure. You may feel that if you go on insulin, it means you have failed. Some people think of using insulin as giving up or losing the fight. Others see it as a punishment for not sticking to diet and lifestyle changes. However, over time, changes to the body mean diabetes must be managed differently. There is a limit to how much diabetes pills can help.

The truth: Using insulin has nothing to do with failing. It is not a punishment for being unsuccessful with other methods. Every three to four years, most people with type 2 diabetes will need a change in dose or medication. Often, this happens despite lifestyle and dietary strategies. Since diabetes is progressive, eventually almost all people with type 2 diabetes will require an insulin supplement. Usually seven to ten years after diabetes is diagnosed, the pancreas becomes sluggish. It cannot keep up an adequate supply of insulin, so adding some becomes necessary. The only reason why insulin is not used right away in most people with type 2 diabetes is because it does not match what is happening in the body at the time. At first, oral tablets often better suit what the body requires to control blood glucose. Once the body cannot keep up with supplying the necessary amount of insulin, no oral tablet can do the job. Insulin is a necessary and expected medication to use once you reach this point.

“ Insulin is for people at the end of the line with their diabetes.”
“ My diabetes is not that bad.”

Under the surface: This is fearful thinking. Some people believe that needing insulin is a sign their disease is getting worse. For them, using insulin means they are getting closer to developing scary complications.

The truth: Starting insulin is not a signal that diabetes complications are getting closer. In fact, starting insulin earlier can play a big role in preventing or delaying complications. However, avoiding available medications like insulin actually allows high blood glucose to persist and puts you at risk.

“ My doctor says I don’t need it and won’t prescribe it even though my blood glucose is high and is not coming down with other medications.”
“ My doctor just keeps telling me to lose weight, follow my diet and exercise, even though these methods do not seem to be working.”

Under the surface: Sometimes doctors or other health care providers choose to delay insulin. This is a case of physician resistance. Perhaps they do not have the time or resources to teach people how to use and dose insulin effectively. Some have misconceptions about insulin. Others want to avoid confrontation, since many people are opposed to taking insulin. Finally, a few may delay insulin to try to motivate you to make lifestyle or dietary changes.

The truth: The fact is that you are the one with diabetes. Your blood vessels are being damaged if your blood glucose remains high. You must live with the complications of the disease if it is not managed well. This reality means that you get to say whether you are satisfied with the level of control you have over the disease. Learning about your disease and available treatments allows you to play a huge role in making decisions. Have an honest conversation with your doctor about all of the options for managing blood glucose, including insulin. Ask about the pros and cons of each choice. If your questions about insulin are not being addressed, persist in asking why. If you are not satisfied, get a second opinion. After all, it is your health on the line.

“ Someone in my family went on insulin and had to go on dialysis shortly afterward.”
“ If I start on insulin I’ll go blind or lose my leg.”

Under the surface: Again, fear is behind this reasoning. A bad experience is chalked up to taking insulin, rather than to diabetes itself. Refusing to take insulin may really mask worry about having something similar happen to you.

The truth: Insulin itself does not make diabetes worse. Rather, high blood glucose will make diabetes worse over time and increase the risk of complications. Sometimes, insulin was added after years of having high blood glucose do damage to blood vessels and nerves.

In these cases, it was only a coincidence that problems arose after adding insulin. Whether insulin was used or not, the outcome would have been the same. In fact, complications might have happened even sooner if the use of insulin was delayed.

“ If I take insulin, people will find out I have diabetes.”

Under the surface: This one is about shame. You may feel as though you are to blame for having diabetes and now having to use insulin. Using insulin may seem like a public sign that you are flawed or have not taken care of yourself.

The truth: If this is how you feel, know that diabetes is not your fault. Unfortunately, you have the genes that made diabetes possible. It is true that poor diet and inactivity play a role in developing diabetes, but many people who carry extra weight and are less active do not develop diabetes. While lifestyle changes can help manage your diabetes, unfortunately you cannot change your genetics. There is no shame in that. However, if you prefer to keep your condition private, insulin can be carried most anywhere and given privately in seconds.

For more information:

Canadian Diabetes Association

American Diabetes Association

“ Once I start insulin, I will be stuck on it. There is no turning back.”

Under the surface: This excuse shows fear of the unknown, and worry about permanently committing to a new and unknown treatment.

The truth: It is hard to begin a treatment that you must commit to for the rest of your life. This is a big decision. However, you can try insulin for a few months to see how it goes. Committing to taking insulin for a few months is a leap that most people can manage. If you do decide to try insulin therapy, usually the only consequence of stopping is that you will be right back where you started. However, once you see how much better you feel and the way your blood glucose levels improve, you will likely want to stay on it!

Type 2 diabetes is not a condition that you have brought upon yourself. Diet, activity, and oral medications do play a part in managing diabetes. However, almost all people who have type 2 diabetes find that the body’s ability to supply enough insulin eventually fails. Once this time comes, insulin is the only way to supplement your limited supply.

Do not let myths, outdated ideas, anger, fear or denial keep you from protecting your health. Recognize that insulin therapy simply corrects your body’s shortage of a hormone required for your well-being - nothing more.

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 2019, Family Health Magazine, a special publication of the Edmonton Journal, a division of Postmedia Network Inc., 10006 - 101 Street, Edmonton, AB T5J 0S1    [DI_MDab15]
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