Intro to Insulin, Pt. 1

Today I am going to officially introduce you to our friend insulin.  It’s something Phil and I have talked about before on the blog.  Insulin is the chemical that your body makes that helps to lower your blood sugar.  If you are a type 2 diabetic, your body is either not making enough insulin, not recognizing the insulin you are making, or a combination of both.  When diet, exercise, and other medications don’t work we sometimes use insulin, in the form of a shot, to lower blood sugar in type 2 diabetics.

Now I know what you might be thinking: “but Dr. K, I thought type 1 diabetes was the type of diabetes that uses insulin.”  In fact, you are partially right.  Type 1 diabetes (sometimes known as Juvenile Diabetes or insulin-dependent diabetes) is only treated with insulin.  You see, type 1 diabetics have a disease that destroys the cells in their pancreas that produce insulin, so they need to give themselves shots to get the insulin their bodies need.  The main difference between type 1 and type 2 diabetes is that a type 2 diabetic usually produces at least some insulin naturally.  If your diabetes becomes too severe (your blood sugars are too high because your diabetes is not being controlled properly by exercise, eating modifications, and medication) your body can stop producing enough insulin.

So does that mean that we save insulin as a last resort, only to be used when your body stops producing it?  No, it is not quite that simple.  Insulin is one of the most effective medications we have for bringing down that all-important A1c, or blood sugar, to a healthy level.  It is especially useful if you are starting out with very very high blood sugars and metformin or other medications are not bringing your numbers down fast enough.  Remember, we want to get you to a normal blood sugar level as quickly as possible after diagnosis, so that we can avoid other problems down the line with your eyes, kidneys, blood vessels, heart, and nerves.

The problem with insulin is that it is not a medication that you can just swallow and be done with.  Unfortunately, insulin must be injected (using a needle) into your fat cells – common areas include the stomach, inner arm, hip, or thigh.  Most of us don’t like shots to begin with, but turn that into a once daily, or more, shot that you have to give yourself and most people start running for the hills.

I’ll stop here and let you know that injecting insulin is not something that you need to fear.  Putting aside my pharmacist jacket for a moment, let me talk to you friend to friend.  I am not one for needles – I almost pass out when I have to have blood drawn, and get lightheaded for my flu shot every year!  When I was in college, we had to spend one week as a “diabetic.”  We kept a food diary, similar to the one that Phil has provided.  We checked our blood sugars four times daily at various times.  And, twice a day we had to inject a saline into our stomach using an insulin syringe.  You can imagine how much I was dreading this week!

The week came and I came home with my little bag of syringes, my vial of “insulin” (harmless saline solution), and alcohol swabs.  I distinctly remember the first time I injected, standing in the middle of my room, hand shaking.  I knew all of the tricks that we’d been taught in school, but nothing could prepare me for the moment of purposely causing myself “harm.”

I worked up the courage and brought the needle to my skin.  And amazingly, all it took was a little movement of my wrist and the needle went where it needed to go.  In fact, I was so startled by how easily it went in and the fact that I didn’t feel anything that I jumped and brought the needle back out without “injecting” the saline.  Now that I don’t recommend!

My story might sound a bit funny or strange, but my point is that the process of injecting insulin can be almost completely painless, and simple.  There are so many tips to giving yourself an insulin shot, and I will provide all of them to you in my next postings.  These will help you to be successful.  And, a little secret to share with you that should give you some comfort – I found that checking your blood sugar on your fingertip is much more painful than injecting insulin.  So if you can do that already, you are ahead of the game!  Remember, these needles are very, very small compared to the lancet you use to poke your finger or the needle the nurse uses to give you a shot or to draw blood.

Let me just conclude in saying that, although enlightening, my week as a “diabetic” is nothing compared to what each of you with type 2 diabetes face on a daily basis.  At any point in the week I could have “cheated” and eaten what I wanted, skipped a blood sugar test, or skipped an injection.  And at the end of the week, I was free to return to my life without the daily routine that a diabetic goes through.  For each of you with type 2 diabetes, the disease cannot be placed on a shelf and forgotten until later.  Each moment of “cheating” affects you negatively.  And for those of us fortunate enough to not have diabetes, or for those of you with pre-diabetes, we need to remember that good habits like exercise and healthy eating will help to prevent diabetes in the future.

I am truly in awe of and inspired by each and every one of you that are facing and defeating type 2 diabetes on a daily basis.  You are in my thoughts, my prayers, and I know that you can all be successful.