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Managing Diabetes Magazine - diabetes

"Insulin? No Thanks"
The most common reasons for putting it off

Refusing insulin may have less to do with the needle itself and is more about associated feelings and emotions. It is important to dig deeper to discover the underlying cause.

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 with type 2 diabetes are not taking advantage of this wonderful medication to help manage their condition. Why? Where does the reluctance come from?

Why do people avoid or delay using insulin, allowing high blood glucose to damage their blood vessels and nerves? Similar excuses are often given for putting off the use of insulin. Common feelings, fears and mistaken ideas underlie these excuses.

Excuse #1

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

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 people who refuse or delay insulin still go for flu shots and travel immunizations, and would not object to B12 or iron injections if necessary. Refusing insulin may have less to do with the needle itself and is more about associated feelings and emotions. It is important to dig deeper to discover the underlying cause. Recognizing this may be the first step in learning to manage diabetes properly.

Excuse #2

“It will hurt.”
“Using insulin is inconvenient.”

Under the surface: Some people are not aware of advances in ways to deliver insulin. Many have mistaken or outdated ideas about how it works – picturing large needles and vials that must be refrigerated.

The truth: Advances in insulin delivery have made injections quick, convenient and painless. Insulin can be carried anywhere at room temperature, in an insulin pen the size of a marker. The amount of insulin needed is dialed or set right on the pen, and the pen delivers that amount. The needles used now are only four millimeters long, slim, and barely visible to the naked eye. Injections can be done privately almost anywhere, in as little as 20 seconds.

Excuse #3

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

Under the surface: This excuse is about denial. It can be easier to pretend you don’t have diabetes if you find the idea too frightening.

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 diabetes. The first step in managing diabetes is to acknowledge it. Accepting the fact that diabetes will not go away will allow you to move on to understand how it works and how to control it. You can do a great deal to reduce and prevent complications. In the end, you will have more peace of mind knowing that you are in charge of your diabetes.
Excuse #4

“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 that it feels normal when it is indeed dangerous. You may have the impression that if you feel fine, then your diabetes must be fine. High blood glucose, regardless of how you are feeling, is dangerous. It must be managed to delay and prevent complications associated with diabetes.

Excuse #5

“If I just 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 is a sign that you have failed to manage the condition. Some people think of it as giving up or losing the fight. Others see it as a punishment for not sticking to diet and lifestyle changes. However, diabetes must be managed differently as the body changes over time. 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 not being successful with other methods. Most people with type 2 diabetes need a change in dose or medication every three to four years. Often, this happens despite lifestyle and dietary changes. Eventually, almost all people with type 2 diabetes require an insulin supplement. Usually seven to 10 years after people are diagnosed, their own insulin supply becomes too low. Adding insulin is 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. Oral tablets often better suit what the body requires to control blood glucose at first. Once the body cannot keep up with supplying the amount of insulin required for blood glucose control, no oral tablet can do the job. Insulin is a necessary and expected medication to use once this point has been reached.

Excuse #6

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

Under the surface: This thinking shows fear. 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 sign that complications of diabetes are getting closer. In fact, starting insulin earlier can play a big role in preventing or delaying potential complications. It is avoiding available medications, like insulin, that allows high blood glucose and puts you at risk.

Excuse #7

“I won’t be able to 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 shows fear that life will be changed, disrupted or restricted. Many people view taking insulin as a loss of control over their lives.

The truth: Insulin types have changed and advanced dramatically over the years. Now, some insulins match the way that a healthy pancreas releases insulin very closely. This allows a huge amount of freedom in matching the insulin to meet 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 they eat more or occasionally indulge, they simply take more insulin to accommodate it. Many find that they can enjoy their usual lifestyle and meal patterns and still get blood glucose control! Often insulin can give people more freedom and flexibility.

Excuse #8

“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: This is a case of physician resistance. Sometimes doctors or other health care providers make a choice to delay insulin. 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 use delaying insulin as a threat, 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 by leaving the blood glucose high. You will have to face the complications of the disease if it is not managed well. That means that you get to say if you are satisfied with the level of control you have over the disease. Today, learning about the disease and treatment options allows you to play a huge role in making decisions. Have an honest conversation with your doctor about all of the options out there 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.

Excuse #9

“Someone in my family went on insulin and had to go on dialysis shortly after.”
“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 a similar outcome.

The truth: Insulin does not make diabetes worse or increase complications. High blood glucose will make diabetes worse over time. Many bad experiences come from high blood glucose. Insulin was likely added after years and years of damage. By then, vessels and nerves had already been significantly affected. In such cases, it is only a coincidence that problems arose after adding insulin. Whether or not insulin was used, the outcome would have been the same. In fact, it might have happened even sooner.

Excuse #10

“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, you need to know that diabetes is not your fault. Unfortunately, you have the genes that made it possible. Most people who carry extra weight and are less active do not get diabetes. Family history, our changing environment and lifestyles are more to blame. However, if you prefer to keep it private, insulin can be carried most anywhere and given privately in seconds.

Excuse #11

“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: People have a hard time starting a treatment that they will have to commit to for the rest of their lives. It is a big decision. However, you can try insulin for a few months to see how it goes. Taking it 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 the insulin is that you will be right back where you started. However, once you see how much better your blood glucose is and how much better you feel, you will likely want to stay on it!

For more information:

Canadian Diabetes Association
American Diabetes Association

Type 2 diabetes is not a condition that you have brought upon yourself. Diet, activity, and oral medications all play a part in managing diabetes. However, in almost all people who have type 2 diabetes, eventually the body’s ability to supply enough insulin fails. When this time comes, insulin is the only option for supplementing your current supply. Do not deny yourself good blood glucose control based on myths, mistaken or outdated ideas, anger, fear or denial. Recognize that insulin therapy simply corrects your body’s shortage of a hormone required for health and 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 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_MDb11]
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