My patients with type 2 diabetes – the most common form (usually adult onset) – usually begin controlling their blood sugar with oral medications, diet changes and exercise. Controlling blood sugar means keeping the measurements within the goal range you set with your health care provider. Managing the disease this way helps you avoid complications that can come from uncontrolled blood sugar. Along with blood pressure and cholesterol control, normal blood sugar levels reduce health problems later.
Sometimes blood sugar levels cannot be managed with diet, exercise and oral medications. When that happens, insulin is often recommended.
I often encounter patients resistant to beginning insulin. It can be difficult accepting that your diabetes is getting worse. You may feel like you have not done a good enough job caring for yourself or be worried that insulin injections will complicate life.
Over time, diabetes does worsen, especially when blood sugar levels are too high. Your insulin producing cells in your pancreas stop working as well after years of having diabetes, especially if your blood sugar levels are high or if you had diabetes for a while before you were diagnosed. Sometimes people do not tolerate the oral medications and so insulin is recommended.
In spite of any concerns, there are good reasons to say “yes” to beginning insulin therapy as part of your plan to bring your blood sugar levels closer to normal.
• Lower your risk of having a stroke (interruption of blood supply to a part of your brain) or a heart attack.
• Feel better, have more energy, sleep better at night and experience improved mood when you have fewer high and fewer low blood sugar levels.
• Lower your risk of developing retinopathy (damage to your retina), which can lead to blindness.
• Prevent or delay permanent nerve damage, which can range from annoying (tingling) to dangerous (numbness, weakness, sores that will not heal or that heal very slowly).
• Reduce your risk of kidney damage.
• Prevent gastroparesis, a slowing of the stomach contractions, which causes heartburn, nausea, vomiting of undigested food, early feeling of fullness when eating, weight loss, abdominal bloating, erratic blood glucose (sugar) levels and lack of appetite.
• Increase fertility and decrease the chances of birth defects.
• Manage your diabetes more easily.
• Help preserve your body’s remaining ability to produce insulin.
There are four broad groups of insulin – rapid-acting, short-acting (also called regular), intermediate acting and long-acting – and within those groups more than 20 types are available in the United States.
You and your health care provider can work together to find an insulin regimen that best suits your health and lifestyle needs. Insulin therapy typically begins with an intermediate or long-acting form taken once or twice a day. If needed, rapid or short-acting insulin is added with meals to keep your blood sugar lower when eating.
Insulin comes in pens that are very convenient and a little less obvious to use when out in public and in bottles that are a little less expensive than pens.
If you have difficulty affording the insulin or any other medications and supplies needed to manage diabetes, you may be able to get assistance. The American Diabetes Association website ( www.diabetes.org/) has an entire page with Web links and phone numbers you can use to see if you qualify for help. Search “prescription assistance” once you get to the website.
Once you begin insulin, you may find yourself saying what I often hear: “That’s it?” or “Why didn’t I do this sooner?” Most people quickly become accustomed to taking insulin and are amazed how much easier it can be to control their blood sugar with prescribed insulin than without it.
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